<HTML>
<HEAD>
<TITLE>My first Web Page with Forms</TITLE>
</HEAD>
<BODY>
<H2>Mailing List Registration</H2>
<FORM METHOD="POST" ACTION="mailto:[email protected]">
Name: <INPUT TYPE="TEXT" NAME="name" SIZE="20" MAXLENGTH="20">
e-mail: <INPUT TYPE="TEXT" NAME="mail" SIZE="30" MAXLENGTH="30"><BR><BR>
Select your favorite pastimes from the following options:<BR>
<INPUT TYPE="CHECKBOX" NAME="choice_1"> Music
<INPUT TYPE="CHECKBOX" NAME="choice_2"> Sports
<INPUT TYPE="CHECKBOX" NAME="choice_3"> Reading
<INPUT TYPE="CHECKBOX" NAME="choice_4"> Computer Games
<INPUT TYPE="CHECKBOX" NAME="choice_5"> Surfing the Web
<INPUT TYPE="CHECKBOX" NAME="choice_6"> Sleeping<BR><BR>
Enter your comment below:<BR>
<TEXTAREA NAME="comment" ROWS="5" COLS="50" WRAP="VIRTUAL">
</TEXTAREA><BR><BR>
How would you like to receive my news letter:<BR>
<INPUT TYPE="RADIO" NAME="receive" VALUE="1" CHECKED> Weekly<BR>
<INPUT TYPE="RADIO" NAME="receive" VALUE="2"> Monthly<BR>
<INPUT TYPE="RADIO" NAME="receive" VALUE="3"> Quarterly<BR><BR>
Which news letter would you like to receive:
<SELECT NAME="letter">
<OPTION SELECTED VALUE="J"> Jokes
<OPTION VALUE="B"> Business
<OPTION VALUE="A"> Academic
<OPTION VALUE="M"> Medical
</SELECT><BR><BR>
<INPUT TYPE="RESET" VALUE="Reset the Form">
</FORM>
</BODY>
</HTML>
Hosted by www.Geocities.ws

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