You are on page 1of 2

<html><body bgcolor="blue"><form>

<h1>Create a Internet Mail Account</h1>


<p>First Name <input type="text" name="T1" size="30"></p>
<p>Last Name <input type="text" name="T2" size="30"></p>
<p>Desired Login Name <input type="text" name="T3" size="20">
@mail.com</p>
<p>Password <input type="password" name="T4" size="20"></p>
<input type="radio" checked="checked" name="sex" value="male"/> Male</br>
<input type="radio" name="sex" value="female" /> Female
<p>Birthday <input type="text" name"T6" size"05">
<select size="1" name="D1">
<option>-Select One-</option>
<option>01</option>
<option>02</option>
<option>03</option>
<option>04</option>
<option>05</option>
<option>06</option>
<option>07</option>
<option>08</option>
<option>09</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option></select>
<select size="1" name="D2">
<option>-Select One-</option>
<option>January</option>
<option>February</option>
<option>March</option>
<option>April</option>
<option>May</option>
<option>June</option>
<option>July</option>
<option>August</option>
<option>September</option>
<option>October</option>
<option>November</option>
<option>December</option></select>
<select size="1" name="D3">
<option>2000</option>
<option>1999</option>
<option>1998</option>
<option>1997</option>
<option>1996</option>
<option>1995</option>
<option>1994</option>
<option>1993</option>
<option>1992</option>
<option>1991</option>
<option>1990</option></select>
<input type="text" name="T7" size="10"></p>
TypeYourself<textarea rows="4" name="S1" cols="20"></textarea>
<br><input type="submit" value="Accept" name="B1"> <input type="reset"
value="cancel" name="B2"></br> </form></bgcolor="blue"></body></html>