ledena.github.io/RegistrationForm.html at master · ledena/ledena.github.io · GitHub

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<!DOCTYPE html>
<html>
<head>
	<title>Workshop Registration</title>
	<style type="text/css">
		.asteriks{color: red;}
        .bottom{width:200px;
                margin: auto;}
        .form1{padding:10px;}
	</style>

</head>
<body>

	<form action="#"   method="GET" class="form1">
       <div class="head" style="background:#80ff00 ; color: white">
       	 <h3>Workshop Registration</h3>
       </div>


       <div class="main">
       	<table>
       	    <tr>
       		<td>
       			 <div class="column1">

       	 	<h4>Register now while seats are available!</h4>
       	 	<table>
       	 	 <tr><td><label>First Name:</label><label class="asteriks">*</label></label></td><td><input type="text" id="fname" name="fname"  required></td></tr>
       	 	 <tr><td><label>Last Name:</label><label class="asteriks">*</label></td><td><input type="text" id="lname" name="lname" required></td></tr>
       	 	 <tr><td><label>Company/Institution:</label><label class="asteriks">*</label></td><td><input type="text" id="compnay" name="company" required></td></tr>
       	 	 <tr><td><label>Address:</label><label class="asteriks">*</label></td><td><textarea id="address" name="address" rows="4" cols="40" required></textarea></td></tr>
       	 	 <tr><td><label>City:</label></td><td><input type="text" id="city" name="city" value=" "></td></tr>
       	 	 <tr><td><label>State/Provience/Region:</label></td><td><select name="state" id="state">
                                                                      <option value="iowa">Select</option>
                                                                      <option value="iowa">Iowa</option>
                                                                      <option value="ohio">Ohio</option>
                                                                      <option value="california">California</option>
                                                                      <option value="atlanta">Atlanta</option>
                                                                   </select></td></tr>
            <tr><td><label>Country:</label></td><td><select name="country" id="state">
                                                                      <option value="select">Select</option>
                                                                      <option value="ethiopia">Ethiopia</option>
                                                                      <option value="usa">USA</option>
                                                                      <option value="canada">Canada</option>
                                                                      <option value="mexico">Mexico</option>
                                                                   </select></td></tr>
            <tr><td><label>Email:</label><label class="asteriks">*</label></td><td><input type="email" id="email" name="email" required></td></tr>
            <tr><td><label>Phone:</label><label class="asteriks">*</label></td><td><input type="tel" id="phone" name="phone"  required></td></tr>
            </table>
       	 </div>
       		</td>
       		<td>
 <div class="column2">
       	 	<h4>Lunch</h4>
       	 	<table>
       	 	  <tr><td><label>Meal Preference:</label></td><td><select name="meal" id="meal">
                                                                      <option value="vegiterian">Verigetrian</option>
                                                                      <option value="vegan">Vegan</option>
                                                                      <option value=" "></option>
                                                                   </select></td></tr>
              <tr><td><label>Payment Details</label></td><td><label>                 </label></td></tr>
              <tr><td><label>Payment Mode</label></td><td> <input type="radio" name="payment" />Cash<br>
                                                            <input type="radio" name="payment" />Cheque<br>
                                                            <input type="radio" name="payment" />Demand Draft<br>
                                                            <td></tr>
              <tr><td><label>DD/Cheque No.</label></td><td><input type="text" id="chequeno" name="chequeno" value=" "></td></tr>
              <tr><td><label>Drawn On(Bank Name):</label></td><td><input type="text" id="bankname" name="bankname" value=" "></td></tr>
              <tr><td><label>Payable at</label></td><td><input type="text" id="payableat" name="payableat" value=" "></td></tr>
       	 	</table>

       	 </div></td>
         	</tr>
       </table>

       </div>
       <div class="footer"  style="background:#80ff00 ; color: white">
       	  <div class="bottom">
       	  	<input type="submit"  style="background:#80ff00 ; color: white">
       		<input type="reset" value="Reset" style="background:#80ff00 ; color: white">
       	  </div>


       </div>
	</form>

</body>
</html>