Untitled

<html>
<head>
<meta charset="UTF-8"/>
<title>XDXDXD</title>
</head>
<body>

<style>
    body {
        font-family: monospace;
    }

    textarea {
        resize: none;
    }

    .td_left {
        text-align: right;
        font-weight: bold;
        vertical-align: text-top;
    }

    @keyframes anim_flash {
        from {
            background-color: #ff00ff;
            color: #00ff00;
        }

        25% {
            background-color: #0cf3d5;
            color: #ff0000;
        }

        66% {
            background-color: #ffff00;
            color: #0000ff;
        }

        to {
            background-color: #ff00ff;
            color: #00ff00;
        }
    }

</style>

<table width="500" style="background-color: #ccddff; border-color: #bbccdd" border="1" cellpadding="2">
<form>

<tr>
<td width="140" class="td_left">Imię(*):</td> <td width="600"><input type="text" name="imie" maxlength="20"></input></td>
</tr>
<tr>
<td class="td_left">Nazwisko:</td> <td><input type="text" name="nazwisko" maxlength="20"></td></input>
</tr>
<tr>
<td class="td_left">Płeć(*):</td> <td><input type="radio" name="plec">M</input><br><input type="radio" name="plec">K</input></td>
</tr>
<tr>
<td class="td_left">Email(*):</td> <td><input type="email" name="email" required="2"></input></td>
</tr>
<tr>
<td class="td_left">Data urodzenia:</td> <td><input type="text" name="birth_date" maxlength="8"><small>(rrrr.mm.dd)</small></input>
</tr>
<tr>
<td class="td_left">ul.: </td> <td><input type="text" name="address"></input>
<small> nr </small>
<input type="text" name="address2" size="4" maxlength="4"></input>
 /
 <input type="text" name="address3" size="4" maxlength="4"></input></td>
</tr>
<tr>
<td class="td_left">Kod pocztowy:</td> <td><input type="text" name="post_code" maxlength="2" size="2"></input> - <input name="post_code2" maxlength="3" size="3"></input></td>
</tr>
<tr>
<td class="td_left">Miasto: </td> <td><input type="text" name="city"></input></td>
</tr>
<tr>
<td class="td_left">Województwo(*):</td>
<td><select>
<option>---------</option>
<option>Warmińsko-Mazurskie</option>
<option>Kujawsko-Pomorskie</option>
<option>Mazowieckie</option>
<option>Pomorskie</option>
<option>Inne</opion>
</select></td>
</tr>
<tr>
<td class="td_left">Uwagi:</td><td><textarea rows="8" cols="40"></textarea>
</tr>
<tr>
<td class="td_left">Zainteresowania:</td><td>
<input type="checkbox">Sport</input><br>
<input type="checkbox">Muzyka</input><br>
<input type="checkbox">Turystyka</input><br>
<input type="checkbox">Literatura</input><br>
</td>
</tr>
<tr>
<td colspan="2"><center><button>Wyślij</button><button>Wyczyść</button></td>
</tr>
</form>
</table>


</body>
</html>