<html>
<head>
<title>APPLICATION FORM</TITLE>
<script type="text/javascript">
function valid(field,alerttxt)
{
with(field)
{
if (value==null ||value=="")
{
alert(alerttxt);
return false
}
else
{
return true
}
}
}
function valid_form(thisform)
{
with(thisform)
{
if(valid(fname,"please enter your name first")==false){fname.focus();return false
}
}
}
</script>
</head>
<body bgcolor="white" >
<form name="submitpage.htm" method="post" onsubmit="return valid_form">
<center><table border="2"></center>
<caption align="top"><h1><font color="red"><center>Please fill up your information<BR>for Registering to Web Site </center>
</font>
</h1>
<h1><font color="blue">Registration Form</font></h1></caption>
<tr><td>FIRST NAME</td>
<td><input type="text" NAME="fname" Size="36" maxlength="36" ></td></tr>
<TR><td>LAST NAME</td>
<td> <input type="text" name="lname" size="36">
<tr><td>FATHER NAME</td>
<td><input type="text" NAME="faname" Size="36" maxlength="36" value="">
</td></BR>
</tr>
<tr><td>GENDER</Td>
<td>
<input type="RADIO" NAME="GENDER"
VALUE="MALE" CHECKED>MALE&nbsp&nbsp&nbsp
<input type="RADIO" NAME="GENDER"
value="FEMALE">FEMALE
</td>
</tr>
<TR>
<TD>CREATE A PASSWORD</TD>
<TD>
<INPUT TYPE="PASSWORD" NAME="CREATE A PASSWORD" SIZE="36" MAXLENGTH="36">
</TD>
</TR>
<TR>
<TD>CONFIRM PASSWORD</TD>
<TD>
<INPUT TYPE="PASSWORD" NAME="CREATE A PASSWORD" SIZE="36" MAXLENGTH="36">
</TD>
</TR>
<TR>
<TD>CITY</TD><TD>
<SELECT NAME="LIST CITY">
<OPTION>DELHI
<OPTION>GREATER NOIDA
<OPTION>LUCKNOW
<OPTION>MUMBAI
</SELECT>
</TD></TR>
<TR><TD>STATE</TD><TD><input type="state" name="STATE" size="36"></TD></TR><BR>
<TR><td>PIN CODE</TD><TD><input type="pin code" name="PIN CODE" size="36"></td></tr>
</table>
<TR>
<TD><center>
<INPUT TYPE="submit" VALUE="SUBMIT">
<INPUT TYPE="RESET" VALUE="RESET">
<BR></center>
</TD></TR>
</form>




</body>
</html>