Scribd Logo
Upload

Welcome to Scribd!

  • Pagina 1

    Uploaded by

    Luis Gomez
    8 views6 pages

    Original Title

    pagina1

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    8 views6 pages

    Pagina 1

    Uploaded by

    Luis Gomez

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 6

    <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.

    0 Transitional//EN"
    "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
    <html xmlns="http://www.w3.org/1999/xhtml">
    <head>
    <meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
    <title>Pagina1</title>

    <style type="text/css">
    <!--
    body {font-family: Verdana}
    -->
    </style>

    </head>

    <body>

    <form id="evaluando" name="evaluando" method="post" action="pagina2.php">

    <table align="center" border="0" cellpadding="3" cellspacing="3">
    <tr>
    <td><div align="center">* Cedula de Identidad</div></td>
    <td><div align="center">* Nombre</div></td>
    <td><div align="center">* Apellido</div></td>
    </tr>
    <tr>
    <td><div align="center">
    <input name="cedula" type="text" id="cedula" maxlength="8" />
    </div></td>
    <td><div align="center">
    <input name="nombre" type="text" id="nombre" maxlength="50" />
    </div></td>
    <td><div align="center">
    <input name="apellido" type="text" id="apellido" maxlength="50" />
    </div></td>
    </tr>
    <tr>
    <td><div align="center">* Login</div></td>
    <td><div align="center">* Password</div></td>
    <td><div align="center">* E-mail</div></td>
    </tr>
    <tr>
    <td><div align="center">
    <input name="login" type="text" id="login" onkeypress="return validarn(event)"
    maxlength="8" />
    </div></td>
    <td><div align="center">
    <input name="password" type="password" id="password" onkeypress="return
    validarc(event)" maxlength="50" />
    </div></td>
    <td><div align="center">
    <input name="mail" type="text" id="mail" onkeypress="return validarc(event)"
    maxlength="50" />
    </div></td>
    </tr>
    <tr>
    <td colspan="2"><div align="center">* Sexo</div></td>
    <td><div align="center"></div></td>
    </tr>
    <tr>
    <td><div align="center">Masculino
    <input type="radio" name="sexo" id="sexo" value="Masculino" />
    </div>
    <label></label></td>
    <td><div align="center">Femenino
    <label>
    <input type="radio" name="sexo" id="sexo2" value="Femenino" />
    </label>
    </div></td>
    <td>&nbsp;</td>
    </tr>
    <tr>
    <td colspan="3"><div align="center">* Direccin de Habitacin</div></td>
    </tr>
    <tr>
    <td colspan="3"><label></label>
    <div align="center">
    <textarea name="direccion" id="direccion" cols="75" rows="5"></textarea>
    </div></td>
    </tr>
    <tr>
    <td colspan="2"><div align="center">Telefono de Habitacin</div></td>
    <td>&nbsp;</td>
    </tr>
    <tr>
    <td><div align="right">
    <select name="codArea" class="TxtForm" title="Seleccione el codigo de rea"
    id="codArea">
    <option value="248">248</option>
    <option value="281">281</option>
    <option value="247">247</option>
    <option value="243">243</option>
    <option value="273">273</option>
    <option value="285">285</option>
    <option value="241">241</option>
    <option value="258">258</option>
    <option value="287">287</option>
    <option selected="selected" value="212">212</option>
    <option value="268">268</option>
    <option value="246">246</option>
    <option value="251">251</option>
    <option value="275">275</option>
    <option value="234">234</option>
    <option value="291">291</option>
    <option value="295">295</option>
    <option value="257">257</option>
    <option value="293">293</option>
    <option value="276">276</option>
    <option value="272">272</option>
    <option value="237">237</option>
    <option value="254">254</option>
    <option value="261">261</option>
    </select>
    - </div></td>
    <td><input name="tlfHab" type="text" id="tlfHab" onKeyPress="return validarn(event)"
    maxlength="7" /></td>
    <td>&nbsp;</td>
    </tr>
    <tr>
    <td colspan="2"><div align="center">Telefono de Celular</div></td>
    <td>&nbsp;</td>
    </tr>
    <tr>
    <td><div align="right">
    <select name="codMovil" class="TxtForm" title="Seleccione el codigo de rea"
    id="codMovil">
    <option value="412" selected="selected">412</option>
    <option value="414">414</option>
    <option value="416">416</option>
    <option value="424">424</option>
    <option value="426">426</option>
    </select>
    - </div></td>
    <td><input name="tlfMovil" type="text" id="tlfMovil" onkeypress="return validarn(event)"
    maxlength="7" /></td>
    <td>&nbsp;</td>
    </tr>
    <tr>
    <td colspan="3"><div align="center">Entretenimientos</div></td>
    </tr>
    <tr>
    <td><div align="center"><span class="Estilo1">Cine</span>
    <label>
    <input name="entretenimiento" type="checkbox" id="entretenimiento" value="Cine" />
    </label>
    </div></td>
    <td><div align="center"><span class="Estilo1">Playa</span>
    <label>
    <input name="entretenimiento" type="checkbox" id="entretenimiento" value="Playa" />
    </label>
    </div></td>
    <td><div align="center"><span class="Estilo1">Montaa</span>
    <label>
    <input name="entretenimiento" type="checkbox" id="entretenimiento" value="Montaa"
    />
    </label>
    </div></td>
    </tr>
    </table>

    <br />
    <div align="center">
    <input type="submit" value="Registrar" />
    <input type="reset"value="Limpiar" /></div>

    </form>
    </body>
    </html>

    You might also like