<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<title>Course registration page</title>
<meta http-equiv='content-type' content='text/html; charset=iso-8859-7'>
<link rel="stylesheet" href="css/design.css" type="text/css">
</head>
<body>
<div id="wrapper">
<div id="page">
<h1>Course registration form</h1>
<form action="servlet/RegisterCustomer" method="post" name="registrationform">
<fieldset>
<legend>Contact information</legend>
<table>
<tr>
<th>Name:</th>
<td><input name="name" type="text" size="30" > <span class="asterisc">*</span></td>
</tr>
<tr>
<th>Surname:</th>
<td><input name="surname" type="text" size="30" > <span class="asterisc">*</span></td>
</tr>
<tr>
<th>Email:</th>
<td><input name="mail" type="text" size="30" > <span class="asterisc">*</span></td>
</tr>
<tr>
<th>Address:</th>
<td><input name="address" type="text" size="30" > <span class="asterisc">*</span></td>
</tr>
<tr>
<th>Phone:</th>
<td><input name="phone" type="text" size="30" > <span class="asterisc">*</span></td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>Personal information</legend>
<table>
<tr>
<th>Gender:</th>
<td><input type="radio" value="Male" name="gender"> male <input type="radio" value="Female" name="gender"> female <span class="asterisc">*</span></td>
</tr>
<tr>
<th>Date of birth:</th>
<td>
<input type="text" maxlength="2" size="2" name="dd" id="dd"> <span class="small">(DD)</span> /
<input type="text" maxlength="2" size="2" name="mm" id="mm"> <span class="small">(MM)</span> /
<input type="text" maxlength="4" size="4" name="yyyy" id="yyyy"> <span class="small">(YYYY)</span>
<span class="asterisc">*</span>
</td>
</tr>
<tr>
<th>Native language:</th>
<td>
<input name="language" type="text" size="30" > <span class="asterisc">*</span>
</td>
</tr>
<tr>
<th>Level of Greek:</th>
<td>
<select name="gr_level" >
<option value="0"> </option>
<option value="none">none</option>
<option value="weak">weak</option>
<option value="intermediate">intermediate</option>
<option value="good">good</option>
<option value="very good">very good</option>
</select>
<span class="asterisc">*</span>
</td>
</tr>
<tr>
<th>Occupation:</th>
<td>
<input name="occupation" type="text" size="30" id="occupation" > <span class="asterisc">*</span>
</td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>Course enrollment</legend>
<p>
<span class="question">Please select which course you are applying for:</span> <span class="asterisc">*</span>
<br>
<input type="checkbox" value="Art and Design" name="course1"> Art and Design
<br>
<input type="checkbox" value="Business" name="course2"> Business
<br>
<input type="checkbox" value="Engineering" name="course3"> Engineering
<br>
<input type="checkbox" value="Computing" name="course4"> Computing
<br>
<input type="checkbox" value="Travel and Tourism" name="course5"> Travel and Tourism
</p>
<p>
<span class="question">Please let us know any comments or questions that you might have.</span>
<br>
<textarea name="commentsfield" cols="55" rows="3"></textarea>
</p>
</fieldset>
<p class="buttons">
<input type="submit" value="Submit" name="submit">
<input type="reset" value="Reset" name="reset"> Required fields <span class="asterisc">*</span>
</p>
</form>
<div id="w3cvalidator">
<a href="http://validator.w3.org/check?uri=referer"><img
src="http://www.w3.org/Icons/valid-html401" alt="Valid HTML 4.01 Transitional" height="31" width="88"></a>
</div> <!-- end of w3cvalidator link and icon-->
</div> <!-- end of page -->
</div> <!-- end of wrapper -->
</body>
</html>
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