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Text File  |  2010-08-24  |  3KB  |  72 lines
  1. ∩╗┐<%@ Page Language="VB" MasterPageFile="~/HealthCard.master" AutoEventWireup="false"
  2.     CodeFile="register.aspx.vb" Inherits="register" %>
  3.  
  4.  
  5. <asp:Content ID="Content1" ContentPlaceHolderID="cntPageTitle" runat="Server">
  6.     <h1>REGISTER</h1>
  7.                     
  8. </asp:Content>
  9. <asp:Content ID="Content2" ContentPlaceHolderID="cntBody" runat="Server">
  10.     <form id="form1" runat="server">
  11.     <div class="login_right">
  12.                                         
  13.                                           <div class="fieldgrp"><strong>
  14.                                               <asp:Label ID="lblRegHeader" runat="server" Text="Please fill out the form below to register"></asp:Label>
  15.                                           </strong></div>
  16.                                         
  17.                                         <div class="fieldgrp">
  18.                                           <label>ID Number <span class="style3">*</span></label>
  19.                                           <div class="field">
  20.                                               <asp:TextBox ID="txtIDNumber" class="input1" runat="server"></asp:TextBox>
  21.                                           </div>
  22.                                             </div>
  23.                                             
  24.                                             <div class="fieldgrp">
  25.                                               <label><span class="style2"><strong>health</strong></em></span><span class="style1">CARD</span> Number <span class="style3">*</span></label>
  26.                                               <div class="field"><asp:TextBox ID="txtHealthCard" class="input1" runat="server"></asp:TextBox></div>
  27.                                             </div>
  28.                                             
  29.                                     <div class="fieldgrp">
  30.                                               <label>Surname <span class="style3">*</span></label>
  31.                                       <div class="field"><asp:TextBox ID="txtSurname" class="input1" runat="server"></asp:TextBox></div>
  32.                                             </div>
  33.                                             
  34.                                     <div class="fieldgrp">
  35.                                               <label>Password <span class="style3">*</span></label>
  36.                                       <div class="field"><asp:TextBox ID="txtPassword" class="input1" runat="server"></asp:TextBox></div>
  37.                                             </div>
  38.                                             
  39.                                   <div class="fieldgrp">
  40.                                                 <label>Confirm Password <span class="style3">*</span></label>
  41.                           <div class="field"><asp:TextBox ID="txtPassword2" class="input1" runat="server"></asp:TextBox>
  42.                                                 </div>
  43.                                             </div>
  44.                                             
  45.                                   <div class="fieldgrp">
  46.                                                 <label>E-mail Address <span class="style3">*</span></label>
  47.                                     <div class="field"><asp:TextBox ID="txtEmail" class="input1" runat="server"></asp:TextBox></div>
  48.                                             </div>
  49.                                             
  50.                                   <div class="fieldgrp">
  51.                                                 <label>Mobile Number <span class="style3">*</span></label>
  52.                                     <div class="field"><asp:TextBox ID="txtCell" class="input1" runat="server"></asp:TextBox></div>
  53.                                             </div>
  54.                                             
  55.                                         <div class="fieldgrp"><strong>Receive notification by email? <span class="style3">*</span></strong></div>
  56.                                              
  57.                                   <div class="fieldgrp">
  58.                                                 <label>E-mail Address</label>
  59.                                                 <div class="field">
  60.                                                     <asp:CheckBox ID="chkEmail" runat="server" /></div>
  61.                                                 
  62.                                             </div>
  63.                                             
  64.                                             <div class="fieldgrp">
  65.                                                 <asp:ImageButton ID="imgSubmit" ImageUrl="images/new_submit.jpg" runat="server" />
  66.                                                 <asp:ImageButton ID="ImageButton1" ImageUrl="images/new_reset.jpg" runat="server" />
  67.                                             </div>
  68.                                         
  69.                                         </div>
  70.     </form>
  71. </asp:Content>
  72.