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Home > Kmita Mail PHP form to email > Demo > Registration Form

Kmita Mail v.3 : Registration Form Demo

Kmita Mail can be easily used for collecting information for registration for some event or registration of Internet Username and Password. The data submitted in the form can be stored in an MySQL database (PHP only) which can be integrated with various other application like Member login .

Personal Details
First Name
Last Name
Gender		M F
Contact Details
Email Address
Address
Zip Code
Telephone
Mobile
Alternate Email
Registration Details
Preferred Username
Password
Re-type Password

		Enter the characters shown in the above image [0-9, A-F]:

Registration Form HTML

<form action="http://alldemos.kmitascripts.com/kmitam/submit.php" method="post" > <div align="justify"><span class="text">Kmita Mail can be easily used for collecting information for registration for some event or registration of Internet Username and Password. The data submitted in the form can be stored in an MySQL database (PHP only) which can be integrated with various other application like Member login . </span><br /> <br /> </div> <table width="100%" height="507" border="0" align="center" cellpadding="1" cellspacing="3"> <tr> <td height="25" colspan="3" bgcolor="#F1F1F1" class="text_justify_no_side_border"> <input type="hidden" name="formname" value="userreg0.php" /> <strong>Personal Details </strong></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">First Name</div></td> <td width="12" height="25" class="text_justify_no_side_border"> </td> <td width="400" height="25" class="text_justify_no_side_border"><input name="rn_Name" type="text" id="rn_Name" /></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Last Name</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="ne_Last_Name" type="text" id="ne_Last_Name" /></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Gender</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="km_Gender" type="radio" value="M" checked="checked" /> M <input name="km_Gender" type="radio" value="F" /> F</td> </tr> <tr> <td height="25" colspan="3" bgcolor="#F1F1F1" class="text_justify_no_side_border"><div align="right"></div> <strong>Contact Details </strong></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Email Address </div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="re_Email" type="text" id="re_Email" /></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Address</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><textarea name="ne_Address" id="ne_Address"></textarea></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Zip Code </div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="nn_Zip_code" type="text" id="nn_Zip_code" /></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Telephone</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="nn_Telephone" type="text" id="nn_Telephone" /></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Mobile</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="km_Mobile" type="text" id="km_Mobile" /></td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right">Alternate Email</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="re_Alternate_Email" type="text" id="re_Alternate_Email" /></td> </tr> <tr bgcolor="#F1F1F1"> <td height="25" colspan="3" class="text_justify_no_side_border"><strong>Registration Details </strong> </td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Preferred Username</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="rn_Username" type="text" id="rn_Username" maxlength="10" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Password</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="rn_Password" type="password" id="rn_Password" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Re-type Password </div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="rn_Confirm_password" type="password" id="rn_Confirm_password" onblur="checkpassword();"/> <script>  </script> </td> </tr> <tr> <td width="145" height="25" class="text_justify_no_side_border"><div align="right"></div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right"><img src="http://alldemos.kmitascripts.com/kmitam/image.php" width="150" height="80" /> </div></td> <td height="25" valign="top" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><div align="left">Enter the characters shown in the above image [0-9, A-F]: <input name="secnum" type="text" id="secnum" /> </div></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input type="submit" value="Proceed >>" /></td> </tr> </table> <p><span class="style2"> <input name="_multipage" type="hidden" id="_multipage" value="http://www.kmitascripts.com/kmitamhome/demoregistration_preview.html" /> </span> </p> </form>

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