formularz

by Sylwek on December 6th, 2009
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
 
<head>
    <meta http-equiv="Content-Language" content="pl" />
    <meta http-equiv="Content-type" content="text/html; charset=windows-1250" />
    <link rel="Stylesheet" href="Style.css" type="text/css" />
 
    <title>Sylwester Siminski</title>
 
 
  <script language="JavaScript" src="formularz.js" type="text/javascript"></script>
 
 
</head>
<body>
 
<div id="errorSummary" class="Alarm"></div>
 
 <h1>Formularz</h1>
<form action="http://www.iem.pw.edu.pl/~siminsks/strona/prog.php" method="post" name="Form" onsubmit="return walidacja(this)" enctype="multipart/form-data">
 
<table class="table">
 
<tr>
	<td>
        <b>imię*</b>
	</td>
	<td>
	    <input type="text" maxlength="50" name="Imie" onkeypress="return blockNumbers(event);" onblur="validImie(this)"/>
	</td>
	<td class="Alert"><div id="Imie_error"></div>
	</td>
</tr>
 
<tr>
	<td>
        <b>nazwisko*</b>
	</td>
	<td>
	    <input type="text" maxlength="50" name="Nazwisko" onkeypress="return blockNumbers(event);" onblur="validNazwisko(this)"/>
	</td>
	<td class="Alert"><div id="Nazwisko_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>login*</b>
	</td>
	<td>
	    <input type="text" maxlength="50" name="Login" onkeypress="return blockNumbers(event);"/>
	</td>
	<td class="Alert"><div id="Login_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>hasło*</b>
	</td>
	<td>
        <input type="password" name="Haslo" onblur="isEmpty(this)"/>
	</td>
	<td class="Alert"><div id="Haslo_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>potwierdź hasło*</b>
	</td>
	<td>
        <input type="password" name="Haslo2" onblur="isEmpty(this)"/>
	</td>
	<td class="Alert"><div id="Haslo2_error"></div>
	</td>
</tr>
 
<tr>
	<td>
        <b>płeć:*</b>
	</td>
	<td>
        <label for="Kobieta">Kobieta</label><input type="radio" name="Plec" value="Kobieta" id="Kobieta" checked="checked"/>
        <label for="Mezczyzna">Mężczyzna</label><input type="radio" name="Plec" value="Mezczyzna" id="Mezczyzna"/>
	</td>
	<td class="Alert"><div id="Plec_error"></div>
	</td>
</tr>
 
<tr>
	<td>
        <b>PESEL*</b>
	</td>
	<td>
        <input type="text" name="Pesel" maxlength="11" onkeypress="return blockText(event, this);" onblur="vallidPesel(this)"/>
	</td>
 
	<td class="Alert"><div id="Pesel_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>e-mail*</b>
	</td>
	<td>
        <input type="text" name="Email" onblur="validEmail(this)" id="Text1"/>
	</td>
	<td class="Alert"><div id="Email_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>Ulica*</b>
	</td>
	<td>
        <input name="Ulica" onblur="validUlica(this)" onkeypress="return blockNumbers(event);"/>
	</td>
	<td class="Alert"><div id="Ulica_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>Numer domu*</b>
	</td>
	<td>
        <input name="Numerdomu" onblur="validNrdomu(this)"/>
	</td>
	<td class="Alert"><div id="Numerdomu_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>Numer mieszkania</b>
	</td>
	<td>
        <input name="Numermieszkania" onblur="validNrmieszkania(this)"/>
	</td>
	<td class="Alert"><div id="Numermieszkania_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>Telefon kom.*</b>
	</td>
	<td>
        <input name="Telefon" maxlength="16" onblur="NrTel(this)" onkeypress="return uzupelnijTelefon(event)" />
	</td>
	<td class="Alert"><div id="Telefon_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>Kod pocztowy*</b>
	</td>
	<td>
        <input name="Kodpocztowy" maxlength="6" onblur="validKod(this)" onkeypress="return KodPocztowy(event)"/>
	</td>
	<td class="Alert"><div id="Kodpocztowy_error"></div>
	</td>
</tr>
<tr>
	<td>
        <b>Województwo*</b>
	</td>
	<td>
        <select name="Wojewodztwo">
          <option value="0" selected="selected">Wybierz z listy</option>
          <option value="1">Dolnośląskie</option>
          <option value="2">Kujawsko-Pomorskie</option>
          <option value="3">Lubelskie</option>
          <option value="4">Lubuskie</option>
          <option value="5">Łódzkie</option>
          <option value="6">Małopolskie</option>
          <option value="7">Mazowieckie</option>
          <option value="8">Opolskie</option>
          <option value="9">Podkarpackie</option>
          <option value="10">Podlaskie</option>
          <option value="11">Pomorskie</option>
          <option value="12">Śląskie</option>
          <option value="13">Świętokrzyskie</option>
          <option value="14">Warmińsko-mazurskie</option>
          <option value="15">Wielkopolskie</option>
          <option value="16">Zachodnio-pomorskie</option>
        </select>
	</td>
	<td class="Alert"><div id="Wojewodztwo_error"></div>
	</td>
</tr>
 
<tr>
	<td>
        <b>Umiejętności:</b>
	</td>
	<td>
        <textarea name="Umiejetnosci" cols="30" rows="5" onchange="MaxLength(this);" onkeyup="javascript:MaxRozmiar(500)" onkeypress="javascript:MaxRozmiar(500)" ></textarea>
	</td>
	<td class="Alert"><div id="Umiejetnosci_error"></div>
	</td>
</tr>
 
<tr>
	<td>
	</td>
	<td>Pozostało znaków:
	</td>
	<td>
	    <input type="text" readonly="readonly" style="width: 30px" name="PozostaloZnakow" value="500"/>
	</td>
</tr>
 
 
<tr>
	<td>
        <b>Zainteresowania (co najmniej jedno)*</b>
	</td>
	<td>
        <!--<fieldset name="Okienko"><legend>Wybierz odpowied·(i)</legend><br>-->
        <input type="checkbox" name="Z0" value="0" id="int0" />Informatyka<br />
        <input type="checkbox" name="Z1" value="1" id="int1" />Internet<br />
        <input type="checkbox" name="Z2" value="2" id="int2" />Komputery<br />
        <input type="checkbox" name="Z3" value="3" id="int3" />Kryptografia
        <!--</fieldset>-->
	</td>
	<td class="Alert"><div id="Zainteresowania_error"></div>
	</td>
</tr>
 
<tr>
	<td>
        <b>Informacje dodatkowe</b>
	</td>
	<td>
        <textarea name="InformacjeDodatkowe" cols="50" rows="10" onchange="MaxLength2(this);"></textarea>
	</td>
	<td class="Alert"><div id="InformacjeDodatkowe_error"></div>
	</td>
</tr>
 
<tr>
	<td>Zgadzam się na przetwarzanie danych osobowych*
	</td>
	<td>
<input type="checkbox" name="Przetwarzanie"/>
	</td>
	<td class="Alert"><div id="Przetwarzanie_error"></div>
	</td>
</tr>
 
 
 
<tr>
	<td colspan="3">Dane oznaczone '*' są obowiązkowe!
 
 
	</td>
</tr>
 
<tr>
	<td>
        <input type="submit" value="Wyślij formularz"/>
        <input type="reset" value="Wyczyść dane"/>
	</td>
	<td>
	</td>
	<td class="Alert">
	</td>
</tr>
 
 
 </table>
</form>
 
<p>
    <a href="http://validator.w3.org/check?uri=referer"><img
        src="http://www.w3.org/Icons/valid-xhtml10"
        alt="Valid XHTML 1.0 Transitional" height="31" width="88" /></a>
  </p>
 
 
</body>
 
 
</html>
 

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