<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="userreg" /> <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">&nbsp;</td> <td width="400" height="25" class="text_justify_no_side_border"><input name="Name" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Last_Name" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Gender" type="radio" value="M" checked="checked" /> M <input name="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">&nbsp;</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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><textarea name="Address" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Zip_code" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Telephone" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Mobile" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Alternate_Email" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Username" type="text" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Password" type="password" id="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">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input name="Confirm_password" type="password" id="Confirm_password" onblur="checkpassword();"/> <script> <!-- function checkpassword() { if(document.getElementById('rn_Password').value!=document.getElementById('rn_Confirm_password').value) { alert("Your Passwords do not match"); } document.getElementById('rn_Confirm_password').focus; } //--> </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">&nbsp;</td> <td height="25" class="text_justify_no_side_border">&nbsp;</td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right"><img src="http://alldemos.kmitascripts.com/kmitaadmin/kmitam/image.php" width="150" height="80" /> </div></td> <td height="25" valign="top" class="text_justify_no_side_border">&nbsp;</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">&nbsp;</td> <td height="25" class="text_justify_no_side_border">&nbsp;</td> <td height="25" class="text_justify_no_side_border"><input type="submit" value="Proceed &gt;&gt;" /></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>