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html-registration-form-15.html
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<!DOCTYPE html>
<html>
<head>
<title>Registration Form</title>
</head>
<body bgcolor="#A3E4D7" text="black">
<h1><font color="#117A65">STEP1</font></h1>
<table cellspacing="20" cellspacing="6" >
<tr>
<td colspan="8" >
<table width="100%" bgcolor="white" >
<tr><td>PERSONAL INFORMATION</td><td align="right">All fields are manidatory</td></tr>
</table>
</td>
</tr>
<tr>
<td>
<label>First Name:</label>
</td>
<td colspan="3">
<input type="text" name="firstname" id="firstname" size="30">
</td>
<td>
<label>Second Name:</label>
</td>
<td colspan="3">
<input type="text" name="secondname" id="secondname" size="30">
</td>
</tr>
<tr>
<td>
<label>Email:</label>
</td>
<td colspan="3">
<input type="text" name="email" id="email" size="30">
</td>
<td>
<label>Tel No:</label>
</td>
<td colspan="3">
<input type="text" name="telno" id="telno" size="30">
</td>
</tr>
<tr>
<td>
<label>Mobile No:</label>
</td>
<td colspan="3">
<input type="text" name="mobile" id="mobile" size="30">
</td>
<td>
<label>City:</label>
</td>
<td colspan="3">
<input type="text" name="city" id="city" size="30">
</td>
</tr>
<tr>
<td>
<label>State:</label>
</td>
<td colspan="3">
<input type="text" name="state" id="state" size="30">
</td>
<td>
<label>Gender:</label>
</td>
<td>
<input type="radio" name="gender" id="gender" size="5" value="male">male
</td>
<td colspan="2">
<input type="radio" name="gender" id="gender" size="5" value="female">female
</td>
</tr>
<tr>
<td>
<label>Date Of Birth:</label>
</td>
<td>
<select name="day">
<option value="day" disabled selected>Day
<option value="1">01
<option value="2">02
<option value="3">03
<option value="4">04
<option value="5">05
<option value="6">06
<option value="7">07
<option value="8">08
<option value="9">09
<option value="10">10
<option value="11">11
<option value="12">12
<option value="13">13
<option value="14">14
<option value="15">15
<option value="16">16
<option value="17">17
<option value="18">18
<option value="19">19
<option value="20">20
<option value="21">21
<option value="22">22
<option value="23">23
<option value="24">24
<option value="25">25
<option value="26">26
<option value="27">27
<option value="28">28
<option value="29">29
<option value="30">30
<option value="31">31
</select>
</td>
<td>
<select name="months">
<option value="months" disabled selected>Month
<option value="Jan">Jan
<option value="Feb">Feb
<option value="Mar">Mar
<option value="Apr">Apr
<option value="May">May
<option value="Jun">Jun
<option value="Jul">Jul
<option value="Aug">Aug
<option value="Sep">Sep
<option value="Oct">Oct
<option value="Nov">Nov
<option value="Dec">Dec
</select>
</td>
<td>
<select name="year">
<option value="Year" disabled selected>Year
<option value="1980">1980
<option value="1981">1981
<option value="1982">1982
<option value="1983">1983
<option value="1984">1984
<option value="1985">1985
<option value="1986">1986
<option value="1987">1987
<option value="1988">1988
</select>
</td>
<td>
<label >Emer Ct No:</label>
</td>
<td colspan="3">
<input type="text" name="Emergency" id="Emergency" size="30">
</td>
</tr>
<tr>
<td>
<label>Name:</label>
</td>
<td colspan="3">
<input type="text" name="name" id="name" size="30">
</td>
<td>
<label>Relationship:</label>
</td>
<td colspan="3">
<input type="text" name="rel" id="rel" size="30">
</td>
</tr>
<tr>
<td>
<label>Mobile No:</label>
</td>
<td colspan="3">
<input type="text" name="mob" id="mob" size="30">
</td>
</tr>
</table>
<h1><font color="#117A65">STEP2</font></h1>
<table cellspacing="20" cellspacing="0">
<tr>
<td colspan="6" >
<table width="100%" bgcolor="white" >
<tr><td>OTHER DETAILS</td><td align="right">All fields are manidatory</td></tr>
</table>
</td>
</tr>
<tr>
<td>
<label>Employment Details:</label>
</td>
<td>
<input type="radio" name="ed" id="ed" value="Public Sector">Public Sector
</td>
<td>
<input type="radio" name="ed" id="ed" value="Student">Student
</td>
<td>
<input type="radio" name="ed" id="ed" value="Self Employed">Self Employed
</td>
<td colspan="2">
<input type="radio" name="ed" id="ed" value="None">None
</td>
</tr>
<tr>
<td>
<label>Annual <br> Family Income:</label>
</td>
<td>
<input type="radio" name="ed" id="ed" value="50,000"><font size="-8"> 50,000</font>
</td>
<td>
<input type="radio" name="ed" id="ed" size="0" value="50,000-1,00,000"><font size="-8">50,000-1,00,000</font>
</td>
<td>
<input type="radio" name="ed" id="ed" value="1 Lakh-5 Lakh"><font size="-8"> 1 Lakh-5 Lakh</font>
</td>
<td>
<input type="radio" name="ed" id="ed" value="5 Lakh-10 Lakh"><font size="-8"> 5 Lakh-10 Lakh </font>
</td>
<td>
<input type="radio" name="ed" id="ed" value="10 Lakh and above"><font size="-8"> 10 Lakh and above</font>
</td>
</tr>
<tr>
<td>
<label>Education:</label>
</td>
<td>
<input type="radio" name="ed" id="ed" value="High School">High School
</td>
<td>
<input type="radio" name="ed" id="ed" value="Graduate">Graduate
</td>
<td>
<input type="radio" name="ed" id="ed" value=" Post Graduate">Post Graduate
</td>
<td>
<input type="radio" name="ed" id="ed" value="Professional">Professional
</td>
<td>
<input type="radio" name="ed" id="ed" value="Other">Other
</td>
</tr>
<tr>
<td>
<label>I own the <br> following:</label>
</td>
<td>
<input type="checkbox" name="own" id="own" value="Car">Car
</td>
<td>
<input type="checkbox" name="own" id="own" value="Credit Card">Credit <br> Card
</td>
<td>
<input type="checkbox" name="own" id="own" value="Mobile Phone">Mobile <br> Phone
</td>
<td>
<input type="checkbox" name="own" id="own" value="Club Membership">Club <br> Membership
</td>
<td>
<input type="checkbox" name="own" id="own" value="Insurance policy">Insurance <br> policy
</td>
<tr>
<td>
<label>Cycling Experience:</label>
</td>
<td colspan="2">
<input type="checkbox" name="own" id="own" value="I am regular Cyclist">I am regular Cyclist
</td>
<td colspan="2">
<input type="checkbox" name="own" id="own" value="I am a part of Cycling Club">I am a part of Cycling Club
</td>
</tr>
<tr>
<td colspan="2">
<label>Name of the <br> Cycling Club:</label>
</td>
<td colspan="2">
<input type="text" name="cycling-club" size="30" >
</td>
</tr>
</table>
</body>
</html>