62 lines
2.3 KiB
HTML
62 lines
2.3 KiB
HTML
<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="UTF-8">
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<title>Registration</title>
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<link rel="stylesheet" href="register.css">
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</head>
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<body>
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<main>
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<h1>Register for an Account</h1>
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<form action="confirm.html" method="post">
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<label for="email_address">E-Mail:</label>
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<input type="email" name="email_address" id="email_address"
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placeholder="name@domain.com" autocomplete="off"
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autofocus required>
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<span>*</span><br>
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<label for="dob">DOB:</label>
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<input type="date" name="dob" id="dob"
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title="You must be at least 13 years old." required>
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<span>*</span><br>
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<label for="phone">Mobile Phone:</label>
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<input type="tel" name="phone" id="phone"
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placeholder="nnn-nnn-nnnn" autocomplete="off"
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pattern="\d{3}[\-]\d{3}[\-]\d{4}"
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title="Must be nnn-nnn-nnnn format." required>
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<span>*</span><br>
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<label for="country">Country:</label>
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<select name="country" id="country"
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title="Please select a country." required>
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<option value="">Select a country</option>
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<option>USA</option>
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<option>Canada</option>
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<option>Mexico</option>
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</select>
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<span>*</span><br>
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<label>Contact me by:</label>
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<input type="radio" name="contact" id="text"
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value="text" checked>Text
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<input type="radio" name="contact" id="email"
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value="email">Email
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<input type="radio" name="contact" id="none"
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value="none">Don't contact me<br>
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<label>Terms of Service:</label>
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<input type="checkbox" name="terms" id="terms" required
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title="Please accept the terms of service.">I accept
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<span>*</span><br>
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<label> </label>
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<input type="submit" id="register" value="Register">
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<input type="reset" id="reset_form" value="Reset">
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</form>
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</main>
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<script src="register.js"></script>
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</body>
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</html> |