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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Login</title>
<link rel="stylesheet" href="style.css">
<style>
body
{
background-image: url(images/bglogin.jpg);
background-repeat: no-repeat;
background-size: 100%;
}
</style>
</head>
<body>
<form>
<table align="center" class="box">
<tr>
<th colspan="2" align="center" style="color: #0084ff; font-size: 24px;">Enter Your Details</th>
</tr>
<tr>
<td colspan="2" style="width: 100%;"><hr style="margin-top: 0; margin-bottom: 10px;"></td>
</tr>
<tr>
<td align="right"><label>Name: </label></td>
<td align="left"><input type="text" class="inp" required="" placeholder="Name"></td>
</tr>
<tr>
<td align="right"><label>Password:</label></td>
<td align="left"><input type="password" class="inp" required="" placeholder="Password"></td>
</tr>
<tr>
<td align="right"><label>E-mail: </label></td>
<td align="left"><input type="text" class="inp" required="" placeholder="user@sample.com"></td>
</tr>
<tr>
<td align="right"><label>Phone Number: </label></td>
<td align="left"><input type="text" class="inp" required="" placeholder="XXXXXXXXXX"></td>
</tr>
<tr>
<td align="right"><label>Gender: </label></td>
<td align="left" style="color: rgb(255, 225, 0); font-size: 15px;">
<input type="radio" name="gender" value="Male">Male
<input type="radio" name="gender" value="Female" style="margin-left: 30px;">Female
</td>
</tr>
<tr>
<td align="right"><label>Date of Birth: </label></td>
<td align="left">
<select name="dobd">
<option>01</option><option>02</option><option>03</option><option>04</option><option>05</option><option>06</option><option>07</option><option>08</option><option>09</option><option>10</option><option>11</option><option>12</option><option>13</option><option>14</option><option>15</option><option>16</option><option>17</option><option>18</option><option>19</option><option>20</option><option>21</option><option>22</option><option>23</option><option>24</option><option>25</option><option>26</option><option>27</option><option>28</option><option>29</option><option>30</option><option>31</option>
</select>
<select>
<option>Jan</option><option>Feb</option><option>Mar</option><option>Apr</option><option>May</option><option>Jun</option><option>Jul</option><option>Aug</option><option>Sep</option><option>Oct</option><option>Nov</option><option>Dec</option>
</select>
<select>
<option>2000</option><option>2001</option><option>2002</option><option>2003</option><option>2004</option><option>2005</option><option>2006</option><option>2007</option><option>2008</option><option>2009</option><option>2010</option>
</select>
</td>
</tr>
<tr>
<td align="right"><label>Address:</label></td>
<td align="left"><textarea class="inp" style="height: 55px;" placeholder="Full Address"></textarea></td>
</tr>
<tr>
<td align="right"><label>Languages Known: </label></td>
<td align="left" style="color: rgb(255, 225, 0); font-size: 15px;">
<input type="checkbox">English
<input type="checkbox" value="Female" style="margin-left: 30px;">Hindi</td></tr><tr><td></td><td style="color: rgb(255, 225, 0); font-size: 15px;">
<input type="checkbox">Telegu
<input type="checkbox" value="Female" style="margin-left: 30px;">Tamil
</td>
</tr>
<tr>
<td colspan="2" align="center">
<button type="submit" class="lgbtn">Submit</button>
<button type="reset" class="lgbtn" style="background-color: #ff1231;">Reset</button>
</td>
</tr>
</table>
</form>
</body>
</html>