Location: PHPKode > projects > Article Manager > pm30/cgi/data/config/styles/install/register.html
<html>
 
 <head>
 <title>Registration Form </title>
 <style>
 <!--
 a { text-decoration: none }
 a:hover { color: rgb(255,255,255) }
 -->
 </style>
 </head>
 
 <body bgcolor="#FFFFFF">
 <center>
 
 <table border="0" width="80%">
     <tr>
         <td align="center"><table border="0" width="100%">
             <tr>
                 <td valign="top" bgcolor="#F7F9D2">
 	 <table border="0">
 	    <tr><td>
                 <blockquote>
 		<p>
 		<b>
 		<font color="#000080" size="2" face="Arial">
 		Registration:
 		</font>
 		</b>
 		<p>
 
 		<font color="#000080" size="2" face="Arial">
 		Please fill out the form below to create an account:
 		<font color="#000080" size="2" face="Arial">
 
 	<form action=pm.cgi method=post>
 	<input type="hidden" name="action" value="register">
 	<table border="0">
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Login Name:
 	</font></td>
         <td><input type="text" size="15" name="login"></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	First Name:
 	</font></td>
         <td><input type="text" size="25" name="firstname"></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Last Name:
 	</font></td>
         <td><input type="text" size="25" name="lastname"></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	E-mail:
 	</font></td>
         <td><input type="text" size="25" name="email"></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Address:</font></td>
         <td><textarea name="streetaddress" rows="2" cols="20"
         wrap="soft"></textarea>&nbsp; </td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	City:
 	</font></td>
         <td>
 		<input type="text" size="25" name="city">
 	</td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	State:
 	</font></td>
         <td>
 
	<select name=state>
	<option></option>
	<option>Alabama</option>
	<option>Alaska</option>
	<option>Arizona</option>
	<option>Arkansas</option>
	<option>California</option>
	<option>Colorado</option>
	<option>Connecticut</option>
	<option>District of Columbia</option>
	<option>Delaware</option>
	<option>Florida</option>
	<option>Georgia</option>
	<option>Hawaii</option>
	<option>Idaho</option>
	<option>Illinois</option>
	<option>Indiana</option>
	<option>Iowa</option>
	<option>Kansas</option>
	<option>Kentucky</option>
	<option>Louisiana</option>
	<option>Maine</option>
	<option>Maryland</option>
	<option>Massachusetts</option>
	<option>Michigan</option>
	<option>Minnesota</option>
	<option>Mississippi</option>
	<option>Missouri</option>
	<option>Montana</option>
	<option>Nebraska</option>
	<option>Nevada</option>
	<option>New Hampshire</option>
	<option>New Jersey</option>
	<option>New Mexico</option>
	<option>New York</option>
	<option>North Carolina</option>
	<option>North Dakota</option>
	<option>Ohio</option>
	<option>Oklahoma</option>
	<option>Oregon</option>
	<option>Pennsylvania</option>
	<option>Rhode Island</option>
	<option>South Carolina</option>
	<option>South Dakota</option>
	<option>Tennessee</option>
	<option>Texas</option>
	<option>Utah</option>
	<option>Vermont</option>
	<option>Virginia</option>
	<option>Washington</option>
	<option>West Virginia</option>
	<option>Wisconsin</option>
	<option>Wyoming</option>
	<option>Alberta</option>
	<option>British Columbia</option>
	<option>Manitoba</option>
	<option>New Brunswick</option>
	<option>Newfoundland</option>
	<option>Northwest Territories</option>
	<option>Nova Scotia</option>
	<option>Nunavut</option>
	<option>Ontario</option>
	<option>Prince Edward Island</option>
	<option>Quebec</option>
	<option>Saskatchewan</option>
	<option>Yukon</option>
	</select>
 
 	</td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Post Code:
 	</font></td>
         <td>
 		<input type="text" size="6" name="postcode"> 
 	</td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Country:
 	</font></td>
         <td>
	<select name=country>
	<option></option>
	<option>United States of America</option>
	<option>Canada</option>
	<option>Afghanistan</option>
	<option>Albania</option>
	<option>Algeria</option>
	<option>American Samoa</option>
	<option>Andorra</option>
	<option>Angola</option>
	<option>Anguilla</option>
	<option>Antarctica</option>
	<option>Antigua and Barbuda</option>
	<option>Argentina</option>
	<option>Armenia</option>
	<option>Australia</option>
	<option>Austria</option>
	<option>Azerbaijan</option>
	<option>Bahamas</option>
	<option>Bahrain</option>
	<option>Bangladesh</option>
	<option>Barbados</option>
	<option>Belarus</option>
	<option>Belgium</option>
	<option>Belize</option>
	<option>Bermuda</option>
	<option>Bhutan</option>
	<option>Bolivia</option>
	<option>Bosnia and Herzegovina</option>
	<option>Botswana</option>
	<option>Brazil</option>
	<option>Brunei Darussalam</option>
	<option>Bulgaria</option>
	<option>Burkina Faso</option>
	<option>Burundi</option>
	<option>Cambodia</option>
	<option>Cameroon</option>
	<option>Canada</option>
	<option>Central African Republic</option>
	<option>Chad</option>
	<option>Chile</option>
	<option>China</option>
	<option>Colombia</option>
	<option>Congo</option>
	<option>Cook Islands</option>
	<option>Costa Rica</option>
	<option>Croatia (Hrvatska)</option>
	<option>Cuba</option>
	<option>Cyprus</option>
	<option>Czech Republic</option>
	<option>Denmark</option>
	<option>Djibouti</option>
	<option>Dominica</option>
	<option>Dominican Republic</option>
	<option>East Timor</option>
	<option>Ecuador</option>
	<option>Egypt</option>
	<option>El Salvador</option>
	<option>Equatorial Guinea</option>
	<option>Eritrea</option>
	<option>Estonia</option>
	<option>Ethiopia</option>
	<option>Fiji</option>
	<option>Finland</option>
	<option>France</option>
	<option>French Guiana</option>
	<option>French Polynesia</option>
	<option>French Southern Territories</option>
	<option>Gabon</option>
	<option>Gambia</option>
	<option>Georgia</option>
	<option>Germany</option>
	<option>Ghana</option>
	<option>Gibraltar</option>
	<option>Greece</option>
	<option>Greenland</option>
	<option>Grenada</option>
	<option>Guadeloupe</option>
	<option>Guam</option>
	<option>Guatemala</option>
	<option>Guinea</option>
	<option>Guinea-Bissau</option>
	<option>Guyana</option>
	<option>Haiti</option>
	<option>Honduras</option>
	<option>Hong Kong</option>
	<option>Hungary</option>
	<option>Iceland</option>
	<option>India</option>
	<option>Indonesia</option>
	<option>Iran (Islamic Republic of)</option>
	<option>Iraq</option>
	<option>Ireland</option>
	<option>Israel</option>
	<option>Italy</option>
	<option>Jamaica</option>
	<option>Japan</option>
	<option>Jordan</option>
	<option>Kazakhstan</option>
	<option>Kenya</option>
	<option>Korea, Democratic Peoples Republic of</option>
	<option>Korea, Republic of</option>
	<option>Kuwait</option>
	<option>Kyrgyzstan</option>
	<option>Lao Peoples Democratic Republic</option>
	<option>Latvia</option>
	<option>Lebanon</option>
	<option>Lesotho</option>
	<option>Liberia</option>
	<option>Libyan Arab Jamahiriya</option>
	<option>Liechtenstein</option>
	<option>Lithuania</option>
	<option>Luxembourg</option>
	<option>Macau</option>
	<option>Macedonia</option>
	<option>Madagascar</option>
	<option>Malawi</option>
	<option>Malaysia</option>
	<option>Martinique</option>
	<option>Mauritania</option>
	<option>Mauritius</option>
	<option>Mexico</option>
	<option>Micronesia, Federated States Of</option>
	<option>Moldova, Republic of</option>
	<option>Monaco</option>
	<option>Mongolia</option>
	<option>Morocco</option>
	<option>Mozambique</option>
	<option>Namibia</option>
	<option>Nepal</option>
	<option>Netherlands</option>
	<option>Netherlands Antilles</option>
	<option>New Caledonia</option>
	<option>New Zealand</option>
	<option>Nicaragua</option>
	<option>Niger</option>
	<option>Nigeria</option>
	<option>Norway</option>
	<option>Oman</option>
	<option>Pakistan</option>
	<option>Panama</option>
	<option>Papua New Guinea</option>
	<option>Paraguay</option>
	<option>Peru</option>
	<option>Philippines</option>
	<option>Poland</option>
	<option>Portugal</option>
	<option>Puerto Rico</option>
	<option>Romania</option>
	<option>Russian Federation</option>
	<option>Rwanda</option>
	<option>Samoa</option>
	<option>Saudi Arabia</option>
	<option>Senegal</option>
	<option>Seychelles</option>
	<option>Sierra Leone</option>
	<option>Singapore</option>
	<option>Slovakia (Slovak Republic)</option>
	<option>Slovenia</option>
	<option>Somalia</option>
	<option>South Africa</option>
	<option>South Georgia</option>
	<option>Spain</option>
	<option>Sri Lanka</option>
	<option>Sudan</option>
	<option>Suriname</option>
	<option>Swaziland</option>
	<option>Sweden</option>
	<option>Switzerland</option>
	<option>Syrian Arab Republic</option>
	<option>Taiwan</option>
	<option>Tajikistan</option>
	<option>Tanzania, United Republic of</option>
	<option>Thailand</option>
	<option>Togo</option>
	<option>Tonga</option>
	<option>Trinidad and Tobago</option>
	<option>Tunisia</option>
	<option>Turkey</option>
	<option>Turkmenistan</option>
	<option>Uganda</option>
	<option>Ukraine</option>
	<option>United Arab Emirates</option>
	<option>United Kingdom</option>
	<option>United States of America</option>
	<option>Uruguay</option>
	<option>Uzbekistan</option>
	<option>Vatican City State (Holy See)</option>
	<option>Venezuela</option>
	<option>Viet Nam</option>
	<option>Virgin Islands (British)</option>
	<option>Virgin Islands (U.S.)</option>
	<option>Western Sahara</option>
	<option>Yemen</option>
	<option>Yugoslavia</option>
	<option>Zaire</option>
	<option>Zambia</option>
	<option>Zimbabwe</option>
	</select>
 
 	</td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Phone:
 	</font></td>
         <td><input type="text" size="15" name="tel"></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Date of Birth:
 	</font></td>
         <td>
                           <select name="birthday">
                             <option selected></option>
                             <option>01</option>
                             <option>02</option>
                             <option>03</option>
                             <option>04</option>
                             <option>05</option>
                             <option>06</option>
                             <option>07</option>
                             <option>08</option>
                             <option>09</option>
                             <option>10</option>
                             <option>11</option>
                             <option>12</option>
                             <option>13</option>
                             <option>14</option>
                             <option>15</option>
                             <option>16</option>
                             <option>17</option>
                             <option>18</option>
                             <option>19</option>
                             <option>20</option>
                             <option>21</option>
                             <option>22</option>
                             <option>23</option>
                             <option>24</option>
                             <option>25</option>
                             <option>26</option>
                             <option>27</option>
                             <option>28</option>
                             <option>29</option>
                             <option>30</option>
                             <option>31</option>
                           </select>
                            
                           <select name="birthmonth">
                             <option selected></option>
                             <option>January</option>
                             <option>February</option>
                             <option>March</option>
                             <option>April</option>
                             <option>May</option>
                             <option>June</option>
                             <option>July</option>
                             <option>August</option>
                             <option>September</option>
                             <option>October</option>
                             <option>November</option>
                             <option>December</option>
                           </select>
                            
                           <select name="birthyear">
                             <option selected></option>
                             <option>1999</option>
                             <option>1998</option>
                             <option>1997</option>
                             <option>1996</option>
                             <option>1995</option>
                             <option>1994</option>
                             <option>1993</option>
                             <option>1992</option>
                             <option>1991</option>
                             <option>1990</option>
                             <option>1989</option>
                             <option>1988</option>
                             <option>1987</option>
                             <option>1986</option>
                             <option>1985</option>
                             <option>1984</option>
                             <option>1983</option>
                             <option>1982</option>
                             <option>1981</option>
                             <option>1980</option>
                             <option>1979</option>
                             <option>1978</option>
                             <option>1977</option>
                             <option>1976</option>
                             <option>1975</option>
                             <option>1974</option>
                             <option>1973</option>
                             <option>1972</option>
                             <option>1971</option>
                             <option>1970</option>
                             <option>1969</option>
                             <option>1968</option>
                             <option>1967</option>
                             <option>1966</option>
                             <option>1965</option>
                             <option>1964</option>
                             <option>1963</option>
                             <option>1962</option>
                             <option>1961</option>
                             <option>1960</option>
                             <option>1959</option>
                             <option>1958</option>
                             <option>1957</option>
                             <option>1956</option>
                             <option>1955</option>
                             <option>1954</option>
                             <option>1953</option>
                             <option>1952</option>
                             <option>1951</option>
                             <option>1950</option>
                             <option>1949</option>
                             <option>1948</option>
                             <option>1947</option>
                             <option>1946</option>
                             <option>1945</option>
                             <option>1944</option>
                             <option>1943</option>
                             <option>1942</option>
                             <option>1941</option>
                             <option>1940</option>
                             <option>1939</option>
                             <option>1938</option>
                             <option>1937</option>
                             <option>1936</option>
                             <option>1935</option>
                             <option>1934</option>
                             <option>1933</option>
                             <option>1932</option>
                           </select>
 
 	</td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>Gender:</td>
         <td><select name="gender" size="1">
 	    <option value="  "> 
             <option value="Male"> Male </option>
             <option value="Female"> Female </option>
         </select></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>Marital Status:</td>
         <td><select name="status" size="1">
 	    <option value="  "> 
             <option value="single"> Single </option>
             <option value="married"> Married </option>
         </select></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Occupation:
 	</font></td>
         <td><input type="text" size="25" name="occupation"></td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Favorite Quote:</font></td>
         <td><textarea name="quote" rows="3" cols="30"
         wrap="soft"></textarea>&nbsp; </td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Hobbies:</font></td>
         <td><textarea name="hobbies" rows="3" cols="30"
         wrap="soft"></textarea>&nbsp; </td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	News:</font></td>
         <td><textarea name="news" rows="3" cols="30"
         wrap="soft"></textarea>&nbsp; </td>
     </tr>
     <tr>
         <td><font color="navy" face=Arial size=2>
 	Homepage:
 	</font></td>
         <td><input type="text" size="35" name="homepage"></td>
     </tr>
     <tr>
 	<td>
 		<font size=2 face=arial color=navy>
 		Receive Newsletters
 		</font>
 	</td>
 	<td>
 		<input type=checkbox name=mailing value=yes> 
 	</td>
    </tr> 
     <tr>
         <td><font color="navy" face=Arial size=2>
 <INPUT type="submit" name="submit" value="Register"> 
 </form></td>    </tr>
 </table>
                 </blockquote>
                 </td>
             </tr>
         </table>
         </td>
     </tr>
 </table>
 </table>
 </body>
 </html>
 
 
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