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recipient_registration.html
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recipient_registration.html
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<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<style>
button {
color: white;
height:40px;
width:118px;
background-color: #87CEEB;
font-family: verdana;
font-weight:bold;
font-size: 100%;
border: 0;
}
body {
background-image:url("http://media.istockphoto.com/photos/blood-donation-picture-id519792164?k=6&m=519792164&s=170667a&w=0&h=iPmuLBKlgKJ8ucw9W6UNTnFNu5_fTpbCocnuRPBLr-k=");
background-attachment:fixed;
background-repeat:no-repeat;
background-position:right;
background-color:#BA0015;
background-size:40% 100%;
font-family: 'Open Sans', sans-serif;
}
form {
width:450;
background-color:white;
opacity:0.8;
}
h11
{
color:rgb(0, 0, 102);
font-size: 250%;
}
h12
{
color:rgb(255, 102, 102);
font-size: 250%;
}
h13
{
color:rgb(51, 51, 204);
font-size: 250%;
}
a {
text-decoration:none;
font-family: 'Open Sans', sans-serif;
font-size: 16px;
}
a:link {
color: white;
}
a:visited {
color: white;
}
ul {
list-style-type: none;
margin: 0;
padding: 0;
overflow: hidden;
background-color: #333;
}
li {
float: left;
}
li a {
display: block;
color: white;
text-align: center;
padding: 12px 16px;
text-decoration: none;
}
li a:hover:not(.active) {
background-color: #111;
}
.active {
background-color: #4CAF50;
}
</style>
</head>
<body class="">
<div>
<div>
<center>
<center><h11>ONLINE</h11><h12> BLOOD </h12><h13>BANK</h13></center>
<br>
<ul>
<li><a href='index.html'>Home</a></li>
<li><a href='donor_registration.html'>Donor Registration</a></li>
<li><a class="active" href="#home">Recipient Registration</a></li>
<li><a href='bank_registration.html'>Blood Bank Registration</a></li>
<li><a href='result.php'>Registered Donors</a></li>
<li><a href='eligibility.html'>Eligibility</a></li>
<li><a href='login.html'>Login</a></li>
<li><a href='contactus.html'>About Us</a></li>
</ul>
<br>
<u><h1>Enter your details</h1></u>
<form target="_blank" method="POST" action="process_rec.php" >
<table border="0">
<tbody><tr>
<td style="FONT-SIZE:18px;LINE-HEIGHT:40px; font-family:verdana;"><label><center><b>Name:</b></center></label></td>
</tr>
<tr>
<td style="LINE-HEIGHT:40px"><center><input style="font-size:15px" type="text" name="name"></center></td>
</tr>
<tr>
<td style="FONT-SIZE:18px;LINE-HEIGHT:40px; font-family:verdana;"><label><center><b>Emp ID:</b></center></label></td>
</tr>
<tr>
<td><center><input style="font-size:15px; font-family:verdana;" type="value" name="empid"></center></td>
</tr>
<tr>
<td style="FONT-SIZE:18px;LINE-HEIGHT:40px; font-family:verdana;"><label><center><b>Hospital ID:</b></center></label></td>
</tr>
<tr>
<td><center><input style="font-size:15px; font-family:verdana;" type="value" name="hospid"></center></td>
</tr>
<tr>
<td style="FONT-SIZE:18px;LINE-HEIGHT:40px; font-family:verdana;"><label><center><b>Address:</b></center></label></td>
</tr>
<tr>
<td><textarea style="font-size:18px; font-family:verdana;" rows="5" cols="30" name="addr"></textarea></td>
</tr>
<tr>
<td style="FONT-SIZE:18px;LINE-HEIGHT:40px; font-family:verdana;"><center><label><b>Phone No:</b></center></label></td>
</tr>
<tr>
<td><center><input style="font-size:18px; font-family:verdana;" type="tel" name="phone"></center></td>
</tr>
<tr>
<td style="FONT-SIZE:18px;LINE-HEIGHT:40px; font-family:verdana;"><label><center><b>Blood Group:</b></center></label></td>
</tr>
<tr>
<td><center>
<select name="bgroup">
<option value="A">A</option>
<option value="B">B</option>
<option value="AB">AB</option>
<option value="O">O</option>
</select>
<input style="font-size:15px; font-family:verdana;" type="radio" name="rh" id="rh" value='+'>+ve
<input style="font-size:15px; font-family:verdana;" type="radio" name="rh" id="rh" value='-'>-ve
</td>
</tr>
<tr>
<td>
<br>
<center><button type="submit" value="submit" name="submit">Submit</button></center>
</td>
</tr>
<tr><td>
<br>
<font color="red"><center>All fields are mandatory</center></font>
<br>
</td></tr>
</tbody>
</center>
</form>
</div>
<div id="wpsn-container" class="wpsn-container" style="position: absolute; top: 0px; left: 0px;"><span class="wpsn-preloadfont" style="visibility:hidden">a</span></div><div id="wpsn-popup-container" class="wpsn-popup-container" style="position: fixed; top: 0px; left: 0px; display: none;"></div>
</body>
</html>