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FORM.html
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36 lines (35 loc) · 6.46 KB
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<!DOCTYPE html>
<html>
<head>
<title>form registration</title>
</head>
<body style="background-color: rgb(212, 226, 229);">
<h1 style="background-color: rgb(1, 30, 38); text-align: center; color: white"> MTIS REGISTER FORM </h1>
<form>
<DIV style="margin-left: 40PX ;padding: 0px 0px 10px 5px; background-color: rgb(193, 223, 232);border-radius: 10px; line-height:30px"><h2 style="background-color: rgb(173, 223, 237);margin-top: 0PX;padding:10px;border-radius: 10px">Personal Information</h2><B>NAME :</B><input type="textbox" name="t1" placeholder="FIRST NAME" style="border-color: red;border-radius: 5px" ><input type="textbox" name="t2"placeholder=" MIDDLE NAME" style="border-color: red;border-radius: 5px"><input type="textbox" name="t3" placeholder=" LAST NAME" style="border-color: red;border-radius: 5px"> <b style="margin-left: 40PX">AGE :</b> <input type="textbox" name="t4" placeholder="ENTER THE AGE" style="border-color: red;border-radius: 5px">
<BR> <b> DATE OF BIRTH: </b><input type="date" name="t5" placeholder=" DD/MM/YYYY" style="border-color: red;border-radius: 5px"> <b style="margin-left: 330PX"> PHONENUMBER: </b> <input type="textbox" name="t6" placeholder=" enter phone number" style="border-color: red;border-radius: 5px"><br>
<b>ADDRESS:</b><br> <textarea rows="4" cols="50" placeholder="enter the address...." name="comment" style="border-color: red;border-radius: 10px" >
</textarea> <br><b> PINCODE: </b><input type="textbox" name="t12" placeholder=" pincode" style="border-color: red;border-radius: 5px"><b style="margin-left: 383PX"> STATE: </b> <input type="textbox" name="t13" placeholder=" enter state" style="border-color: red;border-radius: 5px"><br><b> GENDER: <input type="radio" name="r1">MALE <input type="radio" name="r1">FEMALE</b><B style="margin-left: 410px">SELECT COURSE:</B> <SELECT style="border-color: red;border-radius: 5px" ><OPTION>C, C++</OPTION><OPTION>C#</OPTION><OPTION>ASP.NET</OPTION> <OPTION>VB.NET</OPTION><OPTION>JAVA</OPTION><OPTION>ADVANCE JAVA</OPTION><OPTION>ANDROID PROGRAMMING</OPTION><OPTION>ANGULAR JS</OPTION><OPTION>HADOOP</OPTION><OPTION>TABLEAU</OPTION><OPTION>DATA SCIENCE</OPTION><OPTION>PYTHON</OPTION><OPTION>SQL</OPTION><OPTION>ORACLE</OPTION><OPTION>UI TECHNOLOGIES</OPTION><OPTION>OFFICE TOOLS</OPTION><OPTION>INTERNET SURFING</OPTION></SELECT><br><b>Email: </b><input type="email" name="t7" placeholder=" enter the email address" style="border-color: red;border-radius: 5px">
</DIV><hr width="93%" style="border-top:2px dotted ">
<DIV style="margin-left: 40PX ;padding: 0px 0px 10px 5px; background-color: rgb(193, 223, 232);border-radius: 10px;line-height:30px">
<h2 style="background-color: rgb(173, 223, 237);margin-left: 0PX;padding: 10px;border-radius: 10px">Institute Information</h2>
<B>INSTITUTE NAME: </B><input type="textbox" name="t8" placeholder=" enter the institute name" style="border-color: red;border-radius: 5px;"><b style="margin-left: 325PX">COURSE: </b> <input type="textbox" name="t9" placeholder=" e.g: B.a, B.E...." style="border-color: red;border-radius: 5px;"><BR><B>YEAR: </B><input type="textbox" name="t10" placeholder=" enter the year" style="border-color: red;border-radius: 5px;">
<b style="margin-left: 415PX">SEM: </b><input type="textbox" name="t11" placeholder=" enter the sem" style="border-color: red;border-radius: 5px;"></div>
<hr width="93%" style="border-top:2px dotted ">
<DIV style="margin-left: 40PX ;padding: 0px 0px 10px 5px; background-color: rgb(193, 223, 232);border-radius: 10px;line-height:30px">
<h2 style="background-color: rgb(173, 223, 237);margin-left: 0PX;padding: 10px;border-radius: 10px">Parent/Guardian Information</h2>
<b>Parent/Guardian Name: </b><input type="textbox" name="t14" placeholder="Parent/Guardian Name" style="border-color: red;border-radius: 5px;"><b style="margin-left: 305PX">PHONENUMBER: </b><input type="textbox" name="t14" placeholder=" enter the phonenumber" style="border-color: red;border-radius: 5px;"><br><b>RELATION: </b><input type="textbox" name="t15" placeholder="eg.father,uncle,brother" style="border-color: red;border-radius: 5px;"><br><b>Parent/Guardian Name: </b><input type="textbox" name="t16" placeholder="Parent/Guardian Name" style="border-color: red;border-radius: 5px;"><b style="margin-left: 305PX">PHONENUMBER: </b><input type="textbox" name="t14" placeholder=" enter the phonenumber" style="border-color: red;border-radius: 5px;"><br><b>RELATION: </b><input type="textbox" name="t17" placeholder="eg.father,uncle,brother" style="border-color: red;border-radius: 5px;"><br><b>Emergency contact (not parent): </b><input type="textbox" name="t18" placeholder="Emergency contact Name" style="border-color: red;border-radius: 5px;"> <b style="margin-left: 245PX"> Emergency contact number: </b><input type="textbox" name="t19" placeholder="Emergency contact phonenumber" style="border-color: red;border-radius: 5px;"><br><b>Emergency contact relationship to child:(check anyone) </b> <br><b><input type="checkbox" name="c1">Grandparent<input type="checkbox" name="c1">Anut/Uncle<input type="checkbox" name="c1">Sibling<input type="checkbox" name="c1">Family Friend </b><b>   Others: </b><input type="textbox" name="t20" style="border-color: red;border-radius: 5px;">
</DIV>
<hr width="93%" style="border-top:2px dotted ">
<DIV style="margin-left: 40PX ;padding: 0px 0px 10px 5px; background-color: rgb(193, 223, 232);border-radius: 10px;line-height:30px">
<h2 style="background-color: rgb(173, 223, 237);margin-left: 0PX;padding: 10px;border-radius: 10px">Attachment</h2>
<b>Upload Course Marksheet: </b> <input type="file" name="f1" style="margin-left: 267px"><br><b>Any Disability If any attached the certificate ? </b><br><input type="checkbox" name="c2">Yes <input type="checkbox" name="c2">No<input type="file" name="f1" style="margin-left: 372px"><br><b>Upload Your Recent Photo With Signature(less than 40KB file): </b><input type="file" name="f1" style="margin-left: 20px">
</DIV>
<button type="submit" value="Submit" style="margin-left:450px ;border-radius:10px;background-color: gray " ><h2>Submit</h2></button>
<button type="reset" value="Reset" style="margin-left:110px;border-radius:10px;background-color: gray "><h2>Reset</h2></button>
</form>
<button type="button" onclick="window.location.href = 'mtis3rd.html';" style="margin-left:550px;border-radius:10px;background-color: gray "><h2>Home</h2></button>
<hr width="93%" style="border-top:2px dotted ">
<marquee> contact @www.marckstraining.com or phonenumber:9930067580/902941077 email:marckstraining@gmail.com</marquee>
</body>
</html>