Posted By

MDEMRS on 04/13/18


Tagged

form register


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Register form


 / Published in: HTML
 

simple register form with name, email, dob

  1. <h1>Register</h1>
  2. <form action="/ici/page.html" method="post">
  3. <div>
  4. <label for="first-name">First Name:</label><input id="first-name" type="text" placeholder="John" required>
  5. <label for="last-name">Last Name:</label><input id="last-name" type="text" placeholder="Smith" required>
  6. </div>
  7. <div>
  8. <label for="gender_1">
  9. <input type="radio" id="gender_1" name="gender" value="Male" >
  10. Male
  11. </label>
  12. <label for="gender_2">
  13. <input type="radio" id="gender_2" name="gender" value="Female" >
  14. Female
  15. </label>
  16. <label for="gender_3">
  17. <input type="radio" id="gender_3" name="gender" value="Other" >
  18. Other
  19. </label>
  20. </div>
  21. <div>
  22. <label>Email:<input type="email" placeholder="your email" required></label>
  23. <label>Password:<input type="password" placeholder="your password" pattern=".{5,10}" required title="5 to 10 characters"></label>
  24. </div>
  25. <div>
  26. <label for="birthday">Birthday</label>
  27. <select id="day" name="day">
  28. <option value='00'>Day</option>
  29. <option value='01'>01</option>
  30. <option value='02'>02</option>
  31. <option value='03'>03</option>
  32. <option value='04'>04</option>
  33. <option value='05'>05</option>
  34. <option value='06'>06</option>
  35. <option value='07'>07</option>
  36. <option value='08'>08</option>
  37. <option value='09'>09</option>
  38. <option value='10'>10</option>
  39. <option value='11'>11</option>
  40. <option value='12'>12</option>
  41. <option value='13'>13</option>
  42. <option value='14'>14</option>
  43. <option value='15'>15</option>
  44. <option value='16'>16</option>
  45. <option value='17'>17</option>
  46. <option value='18'>18</option>
  47. <option value='19'>19</option>
  48. <option value='20'>20</option>
  49. <option value='21'>21</option>
  50. <option value='22'>22</option>
  51. <option value='23'>23</option>
  52. <option value='24'>24</option>
  53. <option value='25'>25</option>
  54. <option value='26'>26</option>
  55. <option value='27'>27</option>
  56. <option value='28'>28</option>
  57. <option value='29'>29</option>
  58. <option value='30'>30</option>
  59. <option value='31'>31</option>
  60. <select id="month" name="month">
  61. <option value="0">Month</option>
  62. <option value="1">January</option>
  63. <option value="2">February</option>
  64. <option value="3">March</option>
  65. <option value="4">April</option>
  66. <option value="5">May</option>
  67. <option value="6">June</option>
  68. <option value="7">July</option>
  69. <option value="8">August</option>
  70. <option value="9">September</option>
  71. <option value="10">October</option>
  72. <option value="11">November</option>
  73. <option value="12">December</option>
  74. <select id="birthyear" name="birthyear">
  75. <option value="1910">2018</option>
  76. <option value="1909">2017</option>
  77. <option value="1908">2016</option>
  78. <option value="1907">2015</option>
  79. <option value="1906">2014</option>
  80. <option value="1905">2013</option>
  81. <option value="1904">2012</option>
  82. <option value="1903">2011</option>
  83. <option value="1902">2010</option>
  84. <option value="1901">2009</option>
  85. <option value="1900">2008</option>
  86. <option value="2007">2007</option>
  87. <option value="2006">2006</option>
  88. <option value="2005">2005</option>
  89. <option value="2004">2004</option>
  90. <option value="2003">2003</option>
  91. <option value="2002">2002</option>
  92. <option value="2001">2001</option>
  93. <option value="2000">2000</option>
  94. <option value="1999">1999</option>
  95. <option value="1998">1998</option>
  96. <option value="1997">1997</option>
  97. <option value="1996">1996</option>
  98. <option value="1995">1995</option>
  99. <option value="1994">1994</option>
  100. <option value="1993">1993</option>
  101. <option value="1992">1992</option>
  102. <option value="1991">1991</option>
  103. <option value="1990">1990</option>
  104. <option value="1989">1989</option>
  105. <option value="1988">1988</option>
  106. <option value="1987">1987</option>
  107. <option value="1986">1986</option>
  108. <option value="1985">1985</option>
  109. <option value="1984">1984</option>
  110. <option value="1983">1983</option>
  111. <option value="1982">1982</option>
  112. <option value="1981">1981</option>
  113. <option value="1980">1980</option>
  114. <option value="1979">1979</option>
  115. <option value="1978">1978</option>
  116. <option value="1977">1977</option>
  117. <option value="1976">1976</option>
  118. <option value="1975">1975</option>
  119. <option value="1974">1974</option>
  120. <option value="1973">1973</option>
  121. <option value="1972">1972</option>
  122. <option value="1971">1971</option>
  123. <option value="1970">1970</option>
  124. <option value="1969">1969</option>
  125. <option value="1968">1968</option>
  126. <option value="1967">1967</option>
  127. <option value="1966">1966</option>
  128. <option value="1965">1965</option>
  129. <option value="1964">1964</option>
  130. <option value="1963">1963</option>
  131. <option value="1962">1962</option>
  132. <option value="1961">1961</option>
  133. <option value="1960">1960</option>
  134. <option value="1959">1959</option>
  135. <option value="1958">1958</option>
  136. <option value="1957">1957</option>
  137. <option value="1956">1956</option>
  138. <option value="1955">1955</option>
  139. <option value="1954">1954</option>
  140. <option value="1953">1953</option>
  141. <option value="1952">1952</option>
  142. <option value="1951">1951</option>
  143. <option value="1950">1950</option>
  144. <option value="1949">1949</option>
  145. <option value="1948">1948</option>
  146. <option value="1947">1947</option>
  147. <option value="1946">1946</option>
  148. <option value="1945">1945</option>
  149. <option value="1944">1944</option>
  150. <option value="1943">1943</option>
  151. <option value="1942">1942</option>
  152. <option value="1941">1941</option>
  153. <option value="1940">1940</option>
  154. <option value="1939">1939</option>
  155. <option value="1938">1938</option>
  156. <option value="1937">1937</option>
  157. <option value="1936">1936</option>
  158. <option value="1935">1935</option>
  159. <option value="1934">1934</option>
  160. <option value="1933">1933</option>
  161. <option value="1932">1932</option>
  162. <option value="1931">1931</option>
  163. <option value="1930">1930</option>
  164. <option value="1929">1929</option>
  165. <option value="1928">1928</option>
  166. <option value="1927">1927</option>
  167. <option value="1926">1926</option>
  168. <option value="1925">1925</option>
  169. <option value="1924">1924</option>
  170. <option value="1923">1923</option>
  171. <option value="1922">1922</option>
  172. <option value="1921">1921</option>
  173. <option value="1920">1920</option>
  174. <option value="1919">1919</option>
  175. </select>
  176. </div>
  177. <div>
  178. I agree to the terms and conditions <input type="checkbox" id="ok">
  179. </div>
  180. <input type="reset" value="Reset">
  181. <input type="submit" value="Submit">
  182.  
  183. </form>

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