Code: Select all
<form action="form.do" method="post">
<input type="hidden" name="agnCI" value="1" />
<input type="hidden" name="agnFN" value="optincompletebg" />
<input type="hidden" name="agnUID" value="$agnUID" />
<input type="hidden" name="agnSUBSCRIBE1" value="1" />
<input type="hidden" name="agnMAILINGLIST1" value="1" />
<input type="hidden" name="field1_day_date" value="10" />
<input type="hidden" name="field1_month_date" value="08" />
<input type="hidden" name="field1_year_date" value="2007" />
<input type="hidden" name="field2_day_date" value="15" />
<input type="hidden" name="field2_month_date" value="08" />
<input type="hidden" name="field2_year_date" value="2007" />
<input type="hidden" name="field3_day_date" value="20" />
<input type="hidden" name="field3_month_date" value="08" />
<input type="hidden" name="field3_year_date" value="2007" />
<table width="50%" cellpadding="3">
<tr>
<td><label for="gender">Gender:</label></td>
<td><select name="gender">
<option value="2" selected="selected" >no specification</option>
<option value="0" >Male</option>
<option value="1" >Female</option>
</select></td>
</tr>
<tr>
<td><label for="firstname">First Name:</label></td>
<td><input name="firstname" type="text" id="firstname" size="25" maxlength="20" /></td>
</tr>
<tr>
<td><label for="lastname">Last Name:</label></td>
<td><input name="lastname" type="text" id="lastname" size="25" maxlength="20" /></td>
</tr>
<tr>
<td><label for="email">E-Mail Address:</label></td>
<td><input name="email" type="text" id="email" size="50" maxlength="100" /></td>
</tr>
<tr>
<td><label for="mailtype">E-Mail Format:</label></td>
<td>
<label><input type="radio" name="mailtype" value="0" />Text</label>
<label><input name="mailtype" type="radio" value="1" checked="checked" />HTML</label>
</td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="2"><input name="subscribe" type="submit" id="subscribe" value="Subscribe" /><input name="cancel" type="reset" id="cancel" value="Cancel" /></td>
</tr>
</table>
</form>