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<html><head><title>Romina Bordanea 12°B</title><style type="text/css">.barra{ scrollbar-3dlight-color:E06986; scrollbar-arrow-color:40A8E4; scrollbar-base-color:B2FD1B; scrollbar-darkshadow-colorF60206; scrollbar-highlight-color-; scrollbar-shadow-color:</style></head><body bgcolor="pink" class="barra"><center><table border="3" width="50%"bgcolor="blueocean"><form action="mailto:bordanearomina@outlook.com" method="post" enctype="text/plain"><tr><td><center><img src="http://www.dazzlejunction.com/generators/glitter-text/donez/dj558b51792000d.gif"><hr><img src="http://3.bp.blogspot.com/_2FiaCkhD_qI/THRhnNlMwKI/AAAAAAAAAAM/Q89QHw0fPQ4/S1600-R/bienvenidos.gif"><p><br><b><u><i>Intrduzca su clave</i></u></b><br><input type="password" name="clave" size="15" maxlenght="5" style="background-color=Light Salmon;color="Indian Red"><p><br><b> Introduzca su nombre</b><input type="text" name="nombre" size="23" maxlength="25"><p><br><b> Introduzca su e-mail</b><input type="text" name="correo" size="25" maxlength="50" value= "@"><p><br><b> Ocupacion</b><input type="text" name="profesion" value="Vendedor"><p><br><u><b> Fecha de Nacimiento</b></u><p><br><select name="mes" size="1"><option selected>Enero</option><option>Febrero</option><option>Marzo</option><option>Abril</option><option>Mayo</option><option>Junio</option><option>Julio</option><option>Agosto</option><option>Septiembre</option><option>Octubre</option><option>Noviembre</option><option>Diciembre</option></select><select name="dia" size="1"><option selected>1</option><option>2</option><option>3</option><option>4</option><option>5</option><option>6</option><option>7</option><option>8</option><option>9</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><input type="text" name="año" size="5" maxlength="25"><p><br><u><b>Seleccione su salario aproximado que desea ganar:</b></u><br><input type="radio" name="salario" value="1" Checked>300$-600$<br><input type="radio" name="salario" value"2">610$-1000$<br><input type="radio" name="salario" value="3">1100$-1500$<p><br><b>Estado Civil</b><br><input type="checkbox" name="Estc" Checked>Casado<input type="checkbox" name="Estc">Casada<p><br><input type="checkbox" name="Estc">Soltero<input type="checkbox" name="Estc">Soltera<p><br><textarea name="comentario" rows="5" cols="50">Comentarios Aquí...</textarea><p><br><b> Desea rehacer nuevamente el formulario?</b><br><input type="reset" value="Borrar"><p><br><input type="Submit" value="Enviar"></center></td></tr></form></table></body></html>