]>
Commit | Line | Data |
---|---|---|
1 | <form action="/action/register" method="POST" class="jsform"> | |
2 | <div class="main"> | |
3 | <table> | |
4 | <tr> <td>Username <td><input type="text" name="username" required> | |
5 | <tr> <td>Password <td><input type="password" name="password" required> | |
6 | <tr> <td>Confirm password <td><input type="password" name="confirm_password" required> | |
7 | ||
8 | <tr> <td>Full name <td><input type="text" name="name" required> | |
9 | <tr> <td>Email <td><input type="email" name="email" required> | |
10 | <tr> <td>Phone <td><input type="tel" name="phone" required> | |
11 | <tr> <td>Town <td><input type="text" name="town" required> | |
12 | <tr> <td>University <td><input type="text" name="university" required> | |
13 | <tr> <td>Level <td><select name="level"> <option>Highschool</option> <option>Undergraduate</option> <option>Master</option> <option>Doctorate</option> <option>Other</option> </select> | |
14 | ||
15 | <tr> <td colspan="2"><input type="submit" value="Register" class="submit"> | |
16 | </table> | |
17 | <div class="logos"> | |
18 | <a href="http://www.societatea-hermes.ro"><div class="hermes"></div></a> | |
19 | <a href="https://www.facebook.com/mindcodingcluj"><div class="fb"></div></a> | |
20 | </div> | |
21 | </div> | |
22 | </form> |