Posted By

r00tk3y on 10/09/12

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craig

jQUery Mobile

/ Published in: HTML

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<form name='registration-form' class='form-template fullheight' method='post' action='/register/submit/'>
				<h3>Personal Information</h3>
				<ul class='well'>
					<input type='hidden' name='action'/>
					<li>
						<span class='span2'>First Name:</span>
						<input class='fullheight' name='first_name' type='text'class='span7' placeholder='First Name' onkeyup='validateFields()'/>
					</li>
					<li>
						<div id="fnamealert">
						</div>
					</li>
					<li>
						<span class='span2'>Last Name:</span>
						<input  class='fullheight' name='last_name' type='text'class='span7' placeholder='Last Name' onkeyup='validateFields()'/>
					</li>
					<li>
						<div id="lnamealert">
						</div>
					</li>
					<li>
						<span class='span2'>Address:</span>
						<input  class='fullheight' name='address' type='text' class='span7' placeholder='Address ' onkeyup='validateFields()'/>
					</li>
					<li>
						<div id="addralert">
						</div>
					</li>
					<li><span class='span2'>Gender:</span>
						<select name='gender' class='span4'>
							<option value="M">Male</option>
							<option value="F">Female</option>
						</select>
					</li>
					
				</ul>
				<h3>Contact Information</h3>
				<ul class='well'>
					<li>
						<span class='span2'>Contact Number:</span>
						<input class='fullheight'  type='text' name='contact_number' class='span7' placeholder='Cellphone, Fax, Telephone, etc.' onkeyup='validateFields()'/>
					</li>
					<li>
						<span class='span2'>Email:</span>
						<input class='fullheight'  type='text' name='email' class='span7' placeholder='Email' onkeyup='validateFields()'/>
					</li>
					<li>
						<span class='span2'>Facebook:</span>
						<input class='fullheight'  type='text' name='facebook' class='span7' placeholder='Facebook User Name' onkeyup='validateFields()'/>
					</li>
					<li>
						<span class='span2'>Yahoo! Messenger:</span>
						<input class='fullheight'  type='text' name='yahoo' class='span7' placeholder='YM User Name' onkeyup='validateFields()'/>
					</li>
					<li>
						<div id="contalert">
						</div>
					</li>
				</ul>
				<h3>Account Information</h3>
				<ul class='well'>
					<li>
						<span class='span2'>Username:</span>
						<input class='fullheight'  type='text' name='username' class='span7' placeholder='Username' onkeyup='validateFields()'/>
					</li>
					<li>
						<div id="unamealert">
						</div>
					</li>
					<li>
						<span class='span2'>Password:</span>
						<input class='fullheight'  id='pword' type='password' name='first_password' class='span7' placeholder='Password' onkeyup='validateFields()'></li>
					<li>
						<span class='span2'>Confirm Password:</span>
						<input class='fullheight'  id='cpword' type='password' name='confirm_password' class='span7' placeholder='Confirm Password' onkeyup='validateFields()' />
					</li>
					<li>
						<div id="pwordalert">
						<div class='alert alert-block alert-error fade in'><a type='button' class='close' data-dismiss='alert'>X</a><h4 class='alert-heading'>Passwords doesn't match or is empty!</h4><p>Please check the fields for password and confirm password</p></div>
						</div>
					</li>
				</ul>
				<ul>
					<ul>
						<li><input id='submit_btn' name='submit-btn' onsubmit='validate_field()' type='submit' class='span2 btn btn-small'></input></li>
					</ul>
					<input id='submit_btn' type="submit" data-theme="a" data-icon="check" data-iconpos="left" data-role='button' value="Submit" class='btn btn-large'>
					<a  href='#' data-rel='back' data-role='button'  data-theme='e' data-icon="delete"
					data-iconpos="left">
						Cancel
					</a>
				</ul>
			</form>

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