<?php session_start (); if (isset($_SESSION['post'])){ $post=$_SESSION['post']; }else{ $post=array(); } if (isset($_SESSION['error'])){ $error=$_SESSION['error']; }else{ $error=array(); } ?> <!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>REGISTERATION</title> <style type="text/css"> body { background-image: url(img/bg_tile.jpg); } </style> </head> <body> <title>กรอกข้อมูลสำหรับการติดต่อ</title> <SCRIPT language=JavaScript> <!-- function validate(_form1) { // // Build the form data // _fd += "PassportNo: " + _form1.PassportNo.value + _n; _fd += "First Name: " + _form1.FirstName.value + _n; _fd += "Family Name: " + _form1.FamilyName.value + _n; _fd += "Country: " + _form1.country.value + _n; _fd += "Position: " + _form1.position.value + _n; _fd += "Affiliation: " + _form1.affiliation.value + _n; _fd += "Work address: " + _form1.workaddress.value + _n; _fd += "Phone: " + _form1.phone.value + _n; _fd += "E-mail: " + _form1.email.value + _n; for(var i=0;i<_form1.gender.length;i++) if(_form1.intro[i].checked) _fd += "Gender: " + _form1.gender[i].value + _n; // // Show the data to the user // return confirm(_f+_n+_n+_fd+_n+_l); } //--> </SCRIPT> <style type="text/css"> .style1 {color: #FF0000} .style10 {color: #0065d5} .style11 {font-size: 24px} .style12 {color: #FF6666; font-weight: bold; } .style14 {color: #0065d5; font-size: 20px; } .style16 {font-size: 20px} </style><br /> <br /> <div align="center"> <table width="900" border=""> <tr> <td align="center" bgcolor="#FFFFFF"> <br /> <p><strong><span class="style14">The 6th WHO-FIC Asia-Pacific Network Bangkok, Thailand</span></strong></p> <br /> <form id="form1" name="form1" method="post" action=insert.php onsubmit="return validate(document.form1)"> <table width="824" border="0" align="center" bgcolor="#cde5ff"> <tr> <td align="right"><span class="style14"><strong>Registration</strong></span></td> <td> </td> </tr> <tr> <td width="255"><div align="right"><span class="style14">(Personal Information)</span></div></td> <td width="559"> </td> </tr> <tr> <td><span><div align="right">Passport No:</div></span></td> <td><input type="text" name="PassportNo" id="PassportNo" value="<?php echo isset ($post['PassportNo'])? $post['PassportNo'] : '';?>" maxlength="15" /> <span class="style1">*<?php echo isset ($error['PassportNo'])? $error['PassportNo'] : '';?></span></td> </tr> <tr> <td ><span><div align="right">First Name :</div></span></td> <td ><input type="text" name="FirstName" id="FirstName" value="<?php echo isset ($post['FirstName'])? $post['FirstName'] : '';?>" /> <span class="style1">*<?php echo isset ($error['FirstName'])? $error['FirstName'] : '';?></span></td> </tr> <tr> <td><span><div align="right">Family Name :</div></span></td> <td><input type="text" name="FamilyName" id="FamilyName" value="<?php echo isset ($post['FamilyName'])? $post['FamilyName'] : '';?>" /> <span class="style1">*<?php echo isset ($error['FamilyName'])? $error['FamilyName'] : '';?></span></td> </tr> <tr> <td><span><div align="right">Gender :</div></span></td> <td><input name="gender" type="radio" id="radio3" value="M" checked="checked" <?php isset($post['gender'])? "checked" :''; ?> /> Male <input type="radio" name="gender" id="radio4" value="F" <?php isset($post['gender'])? "checked" :''; ?> /> Female</td> </tr> <tr> <td><span><div align="right">Country :</div></span></td> <td><input type="text" name="country" id="country" value="<?php echo isset ($post['country'])? $post['country'] : '';?>"/> <span class="style1">*<?php echo isset ($error['country'])? $error['country'] : '';?></span></td> </tr> <tr> <td> </td> <td> </td> </tr> <tr> <td colspan="2" bgcolor="#FFFFFF"> </td> </tr> <tr> <td><div align="right"><span class="style14">(Other Information)</span></div></td> <td> </td> </tr> <tr> <td><span><div align="right">Position:</div></span></td> <td><input type="text" name="position" id="position" value="<?php echo isset ($post['position'])? $post['position'] : '';?>" /> <span class="style1">*<?php echo isset ($error['position'])? $error['position'] : '';?></span></td> </tr> <tr> <td><span><div align="right">Affiliation :</div></span></td> <td><input type="text" name="affiliation" id="affiliation" value="<?php echo isset ($post['affiliation'])? $post['affiliation'] : '';?>" /> <span class="style1">*<?php echo isset ($error['affiliation'])? $error['affiliation'] : '';?></span></td> </tr> <tr> <td><span> <div align="right">Work address :</div></span></td> <td><textarea name="workaddress" id="workaddress" cols="45" rows="5"><?php echo isset ($post['workaddress'])? $post['workaddress'] : '';?></textarea> <span class="style1">*<?php echo isset ($error['workaddress'])? $error['workaddress'] : '';?></span></td> </tr> <tr> <td><span><div align="right">Phone :</div></span></td> <td><input type="text" name="phone" id="phone" value="<?php echo isset ($post['phone'])? $post['phone'] : '';?>" maxlength="15" /> <span class="style1">*<?php echo isset ($error['phone'])? $error['phone'] : '';?></span></td> </tr> <tr> <td><span><div align="right">E-mail :</div></span></td> <td><input type="text" name="email" id="email" value="<?php echo isset ($post['email'])? $post['email'] : '';?>" /> <span class="style1"> *<?php echo isset ($error['email'])? $error['email'] : '';?></span></td> </tr> <tr> <td class="style12"> </td> <td> </td> </tr> <tr> <td colspan="2"> </td> </tr> </table> <br /> <input type="submit" name="button" id="button" value="REGISTER" /> <input type="reset" name="button2" id="button2" value="CANCEL" /> <br /> <br /> </form> </td> </tr> </table> </div> </body> </html>
เพื่อความปลอดภัยของเว็บบอร์ด ไม่อนุญาติให้แทรก แท็ก [img]....[/img] โดยการอัพโหลดไฟล์รูปจากที่อื่น เช่นเว็บไซต์ ฟรีอัพโหลดต่าง ๆ อัพโหลดแทรกรูปภาพ ให้ใช้บริการอัพโหลดไฟล์ของไทยครีเอท และตัดรูปภาพให้พอดีกับสกรีน เพื่อความโหลดเร็วและไฟล์ไม่ถูกลบทิ้ง
Load balance : Server 03
Load balance : Server 03
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