Comments and Feedback

From Faculty of Medicine Online Museum and Archive

Revision as of 03:41, 19 February 2009 by Kbond (Talk | contribs)
Jump to: navigation, search
<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">

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">
</form>