30 lines
1.2 KiB
PHP
30 lines
1.2 KiB
PHP
<?php $form = '<form action="info.php" target="_blank" method="post">
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Фамилия: <br>
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<input type = "text" name = "surname" required size="50" autofocus placeholder="Фамилия"> <br> <br>
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Имя: <br>
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<input type = "text" name = "name" required size="50" placeholder="Имя"> <br> <br>
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Отчество (если есть): <br>
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<input type = "text" name = "patronymic" size="50" placeholder="Отчество"> <br> <br>
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Дата Рождения: <br>
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<input type="date" name="dateOfBirth" required> <br> <br>
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Ваш пол: <br>
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<input type="radio" name="gender" value="Мужчина" checked> Мужчина
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<input type="radio" name="gender" value="Женжина"> Женжина<br> <br>
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Номер телефона (Например 1234567890): <br>
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<select name="countryCode">
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<option value="+7" >Russia +7</option>
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<option value="+38">Ukraine +38</option>
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</select>
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<input type="tel" name="phoneNumber" pattern="[0-9]{10}" maxlength="10" required placeholder="1234567890"> <br> <br>
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Email адрес: <br>
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<input type="Email" name="email" required> <br><br>
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<input type = "submit" value="Подтвердить">
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<input type="reset">
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</form>';
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echo $form;
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