<!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-Type" content="text/html; charset=iso-8859-">
<title>Untitled Document</title>
<style type="text/css">
<!--
.style1 {
font-family: Arial, Helvetica, sans-serif;
font-weight: bold;
}
.style2 {color: #FF0000}
-->
</style>
</head>
<body>
<form id="form1" name="form1" method="post" action="">
<table width="776" border="0" cellpadding="2" cellspacing="5">
<tr>
<td colspan="2"><img src="images/uyeolust.png" width="776" height="70" /></td>
</tr>
<tr>
<td width="240" bgcolor="#FFFFCC"><span class="style1">*Kullanıcı Adı:*</span></td>
<td width="532"><label>
<input type="text" name="adsoy" id="adsoy" />
</label></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><span class="style1">*Şifre:*</span></td>
<td><label>
<input type="text" name="sifre" id="sifre" />
</label></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><p class="style1">*E-Posta Adresiniz:</p> </td>
<td><label>
<input type="text" name="email" id="email" />
</label></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><span class="style1">*Adınız Soyadınız:</span></td>
<td><input type="text" name="adsoy2" id="adsoy2" /></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><span class="style1">Doğum Tarihiniz:</span></td>
<td><select name="gun" id="gun">
<? for($g = 01 ; $g < 32 ; $g++) {?>
<option value=" <?=$g ?>">
<?=$g ?>
</option>
<? } ?>
</select>
<select name="ay" id="ay">
<? for($a = 01 ; $a < 13 ; $a++) {?>
<option value="<?=$a ?>">
<?=$a ?>
</option>
<? } ?>
</select>
<select name="yil" id="yil">
<? for($y = 1980 ; $y < 2011 ; $y++) {?>
<option value="<?=$y ?>">
<?=$y ?>
</option>
<? } ?>
</select></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><span class="style1">Cinsiyetiniz:</span></td>
<td><select name="cins" id="cins">
<option value="ERKEK" selected="selected">Erkek</option>
<option value="BAYAN">Bayan</option>
</select></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><span class="style1">*Cep Telefonu:</span></td>
<td><label>
<input type="text" name="ceptel" id="ceptel" />
</label></td>
</tr>
<tr>
<td bgcolor="#FFFFCC"><span class="style1">*Adresiniz:</span></td>
<td><label>
<textarea name="adres" cols="45" rows="10" id="adres"></textarea>
<br />
<span class="style2">Not:</span> Havale işleminden sonra ürününüz burdaki adrese gönderilecektir.<br />
Lütfen açık ve net adres yazınız.</label></td>
</tr>
<tr>
<td> </td>
<td align="left"><label>
<input type="submit" name="kayit" id="kayit" value="Kayıt Ol" />
<input type="reset" name="temiz" id="temiz" value="Temizle" />
</label></td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
</table>
</form>
</body>
</html>