Created
April 10, 2012 01:51
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| <?xml version="1.0" encoding="UTF-8"?> | |
| <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" | |
| "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> | |
| <html xmlns="http://www.w3.org/1999/xhtml"> | |
| <script type="text/javascript"> | |
| function button_actions() { | |
| var errors = 0; | |
| if (document.getElementById('fname').value == ""){ | |
| alert('You need to enter your first name.'); | |
| document.getElementById('fname').focus(); | |
| errors = errors + 1; | |
| } | |
| //lname | |
| if (document.getElementById('lname').value == ""){ | |
| alert('You need to enter your last name.'); | |
| document.getElementById('lname').focus(); | |
| errors = errors + 1; | |
| } | |
| if (document.getElementById('Gym').checked == false && document.getElementById('Group Fitness').checked == false && document.getElementById('Boxing').checked == false && document.getElementById('Taekwondo').checked == false) | |
| { | |
| alert('You need to chose a membership type'); | |
| document.getElementById('Gym').focus(); | |
| errors = errors + 1; | |
| } | |
| if(errors == 0) { | |
| document.getElementById('f1').action = "http://tl28serv.uws.edu.au/twainfo/form.asp"; document.my_form.submit(); } | |
| else{ | |
| event.preventDefault(); | |
| document.getElementById('myspan').innerHTML = "Warning, you did not input all the information. "; | |
| } | |
| } | |
| </script> | |
| <body> | |
| <form method="post" name='myform' id="f1" > | |
| <fieldset> | |
| Get Fit Quick Gynasium MEMBERSHIP APPLICATION FORM | |
| <span id='myspan'></span> <!-- <--- This is the thing! --> | |
| <br/> | |
| <input type="radio" name="membership" value="new" /> New Membership<br /> | |
| <input type="radio" name="membership" value="renew" /> Renew Membership | |
| </fieldset> | |
| <fieldset> | |
| <p> 1. Membership Details </p> | |
| <p> Title : </p> | |
| <select name="title" size="1"> | |
| <option value="Dr">Dr</option> | |
| <option value="Mr">Mr</option> | |
| <option value="Mrs">Mrs</option> | |
| <option value="Ms">Ms</option> | |
| <option value="Miss">Miss</option> | |
| </select></label> | |
| <p> | |
| First Name: | |
| <input type="text" id="fname" name="fname" maxlength="35" size="35"/> <br /> | |
| Last Name: | |
| <input type="text" id="lname" name="lname" maxlength="35" size="35"/> | |
| </p> | |
| <p> Membership Type : <br/> | |
| <input type="checkbox" id="Gym" name="type" value="Gym" /> Gym <br/> | |
| <input type="checkbox" id="Group Fitness" name="type" value="Group Fitness" /> Group Fitness <br/> | |
| <input type="checkbox" id="Boxing" name="type" value="Boxing " /> Boxing <br/> | |
| <input type="checkbox" id="Taekwondo" name="type" value="Taekwondo" /> Taekwondo</p> | |
| <p> Membership Category: | |
| <select name="MemCategory" size="1"> | |
| <option value="UWSStudent">UWS Student</option> | |
| <option value="UWSStaff">Staff</option> | |
| <option value="Senior">Senior</option> | |
| <option value="Student">Student Other</option> | |
| <option value="Public">General Public</option> | |
| </select></p> | |
| <p> | |
| Stduent No: <input type="text" name="studentNo" /> | |
| </p> | |
| <p>Membership Term : <br /> | |
| <input type="radio" name="membership" value="1month" /> 1 Month <br /> | |
| <input type="radio" name="membership" value="3month" /> 3 Months <br /> | |
| <input type="radio" name="membership" value="6month" /> 6 Months <br /> | |
| <input type="radio" name="membership" value="12months" /> 12 Months | |
| </p> | |
| </fieldset> | |
| <fieldset> | |
| <p> 2. Members Details </p> | |
| Sex: | |
| <select name="sex" size="1"> | |
| <option value="Male"> Male </option> | |
| <option value="Female"> Female </option> | |
| </select> <br /> | |
| D.O.B : <input type="date" name="DOB" /> <br /> | |
| Age : <input type="text" name="age" size="3" /> Years <br /> | |
| Postal Address: <input type="text" name="postal" /> <br /> | |
| Suburb : <input type="text" name="suburb" /> <br /> | |
| Postcode: <input type="text" name="postcode" /> <br /> | |
| <label> Email : | |
| <input type="email" required> | |
| </label> | |
| </fieldset> | |
| <fieldset> | |
| <p> 3.Members Declartation & Payment Details </p> | |
| Before signing this document, i have read, understood and hereby agree to the terms and conditions of | |
| membership as defined on the back of this membership form and know that it effects my legal rights. | |
| </fieldset> | |
| <button onClick="javascript:button_actions();">Submit</button> | |
| </form> | |
| </body> | |
| </html> |
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