<html>
<head></head>
<body bgcolor="pink">
<br><br><br>
<table width="600" border="0" align="center" cellpadding="3" cellspacing="0">
<tr>
<td><strong><font face="arial"color="gray">Pinkbox Registration</font></strong></td>
</tr>
</table>
</table>
<table width="600" border="0" align="center" cellpadding="3" cellspacing="0">
<tr>
<td align=left><strong>
<a href="club_members.php"><font face=arial narrow size=1>VIEW PINKBOX CLUB</font></a> | <a href="welcomeadmin.php"><font face=arial narrow size=1>ADMIN</font></a>
|
<a href="logout.php"><font face=arial narrow size=1>LOG OUT</font></a>
</strong></td>
</tr>
</table>
<table width="600" border="1" align="center" cellpadding="0" cellspacing="1" bgcolor="#CCCCCC">
<tr>
<form id="form1" name="form1" method="post" action="addclub_members.php">
<td>
<table width="600" border="0" cellpadding="3" cellspacing="1" bgcolor="#FFFFFF">
<tr>
<td align=right><font face="arial">Branch Code</font></td>
<td width="14">:</td>
<td width="400"><input name="bcode" type="text" id="bcode" size="40" maxlength="4"/></td>
</tr>
<tr>
<td align=right><font face="arial">ID Number</font></td>
<td>:</td>
<td><input name="idno" type="text" id="idno" size="40" maxlength="13" /></td>
</tr>
<tr>
<td align=right><font face="arial">Name</font></td>
<td valign="top">:</td>
<td><input name="name" type="text" id="name" size="40" /></td>
</tr>
<tr>
<td align=right><font face="arial">Address</font></td>
<td valign="center">:</td>
<td><textarea name="address" cols="50" rows="3" id="address"></textarea></td>
</tr>
<tr>
<td align=right><font face="arial">Date of Birth</font></td>
<td valign="top">:</td>
<td><select name="m_dbirth">
<option value="">Month</option>
<option value="01">Jan</option>
<option value="02">Feb</option>
<option value="03">Mar</option>
<option value="04">Apr</option>
<option value="05">May</option>
<option value="06">Jun</option>
<option value="07">Jul</option>
<option value="08">Aug</option>
<option value="09">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select>
<select name="d_dbirth">
<option value="">Day</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<select name="y_dbirth">
<option value="">Year</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
</select></td>
</tr>
<tr>
<td align=right><font face="arial">Branch</font></td>
<td valign="top">:</td>
<td><input name="branch" type="text" id="branch" size="40" maxlength="20" /></td>
</tr>
<tr>
<td align=right><font face="arial">Registration Date</font></td>
<td valign="top">:</td>
<td><select name="m_reg_date">
<option value="">Month</option>
<option value="01">Jan</option>
<option value="02">Feb</option>
<option value="03">Mar</option>
<option value="04">Apr</option>
<option value="05">May</option>
<option value="06">Jun</option>
<option value="07">Jul</option>
<option value="08">Aug</option>
<option value="09">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select>
<select name="d_reg_date">
<option value="">Day</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<select name="y_reg_date">
<option value="">Year</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
</select></td>
</tr>
<tr>
<td align=right><font face="arial">School</font></td>
<td valign="top">:</td>
<td><input name="school" type="text" id="school" size="40" /></td>
</tr>
<tr>
<td align=right><font face="arial">Contact Number</font></td>
<td valign="top">:</td>
<td><input name="contact_num" type="text" id="contact_num" size="40" /></td>
</tr>
<tr>
<td align=right><font face="arial">Email</font></td>
<td valign="top">:</td>
<td><input name="email" type="text" id="email" size="40" maxlength="30" /></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td><input type="submit" name="Submit" value="Submit" /> <input type="reset" name="Submit2" value="Reset" /></td>
</tr>
</table>
</td>
</form>
</tr>
</body>
</html>
*mod edit - added code tags. please use them next time, liek this
3 Jan, 2008 - 07:45 PM
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