Comments and Feedback
From Faculty of Medicine Online Museum and Archive
(Difference between revisions)
(Removing all content from page) |
|||
| Line 1: | Line 1: | ||
| + | <div><form name="alumnifeedback" method="post" action="alumniupdate_dbform.php"> | ||
| + | <input type="hidden" name ="db_enqtype" value ="feedback"><input type="hidden" name = "db_timestamp" value = "1235014292"> | ||
| + | <table><tr> | ||
| + | <td valign="top"><div align="right">First name</div></td> | ||
| + | <td><input type="text" name="db_firstname" value="" tabindex="1" ></td> | ||
| + | </tr> | ||
| + | <tr> | ||
| + | <td valign="top"><div align="right">Surname</div></td> | ||
| + | <td><input type="text" name="db_surname" value="" tabindex="2"></td> | ||
| + | </tr> | ||
| + | <tr> | ||
| + | <td valign="top"><div align="right">Email </div></td> | ||
| + | <td><input type="text" name="db_email" tabindex="3"></td> | ||
| + | </tr> | ||
| + | |||
| + | <tr> | ||
| + | <td valign="top"><div align="right">Phone</div></td> | ||
| + | <td><input type="text" name="db_phone" tabindex="6"></td> | ||
| + | </tr> | ||
| + | <tr> | ||
| + | <td valign="top"><div align="right">Comment</div></td> | ||
| + | <td><textarea name="db_comment" cols="40" rows="5" tabindex="10"></textarea></td> | ||
| + | |||
| + | </tr> | ||
| + | <tr> | ||
| + | <td valign="top"></td> | ||
| + | <td><input type="submit" name="Submit" value="Submit" tabindex="100"></td> | ||
| + | </tr> | ||
| + | </table> | ||
| + | </form></div> | ||
Revision as of 03:41, 19 February 2009
<form name="alumnifeedback" method="post" action="alumniupdate_dbform.php">
</form>
<input type="hidden" name ="db_enqtype" value ="feedback"><input type="hidden" name = "db_timestamp" value = "1235014292">
First name |
<input type="text" name="db_firstname" value="" tabindex="1" > |
Surname |
<input type="text" name="db_surname" value="" tabindex="2"> |
Email |
<input type="text" name="db_email" tabindex="3"> |
Phone |
<input type="text" name="db_phone" tabindex="6"> |
Comment |
<textarea name="db_comment" cols="40" rows="5" tabindex="10"></textarea> |
| <input type="submit" name="Submit" value="Submit" tabindex="100"> |