-
Notifications
You must be signed in to change notification settings - Fork 0
/
Donorregistration.html
28 lines (26 loc) · 1.94 KB
/
Donorregistration.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
<html>
<head>
<title>Donor Registration</title>
<link rel="stylesheet" type="text/css" href="static/registration.css">
</head>
<body>
<form action="donorregistration.php" method="POST">
<div class="container">
<h1>Donor Registration</h1>
Enter Username: <input type="text" name="Username" required="required" placeholder="Enter Username" /> <br/><br/>
Enter First Name: <input type="text" name="FirstName" required="required" placeholder="Enter First name" /> <br/><br/>
Enter Last Name: <input type="text" name="LastName" required="required" placeholder="Enter Last name" /> <br/><br/>
Enter Password: <input type="Password" name="Password" required="required" placeholder="Enter Password" /> <br/><br/>
Enter Address: <input type="text" name="Address" required="required" placeholder="Enter Address" /> <br/><br/>
Enter DOB: <input type="date" name="DOB" required="required" placeholder="Enter Date of Birth" /> <br/><br/>
Enter Weight: <input type="text" name="Weight" required="required" placeholder="Enter Weight" /> <br/><br/>
Enter Height: <input type="text" name="Height" required="required" placeholder="Enter Height" /> <br/><br/>
Enter Contact: <input type="text" name="Contact" required="required" placeholder="Enter Contact (10 digit number)" /> <br/><br/>
Enter Email: <input type="text" name="Email" required="required" placeholder="Enter valid email-ID " /> <br/><br/>
Enter Gender: <input type="text" name="Gender" required="required" placeholder="Enter Gender (M/F)" /> <br/><br/>
Enter Blood Group: <input type="text" name="BloodGroup" required="required" placeholder="Enter Blood group(A+/A-/B+/B-/O+/O-/AB+/AB-)" /> <br/><br/>
<button type="submit" value="Register"/>Register</button>
</div>
</form>
</body>
</html>