<!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=utf-8" />
<title>Application Form</title>
<style type="text/css">
body {
	background-color: #D9E8B1;
	margin-top: 0px;
	margin-left: 0px;
	margin-right: 0px;
}
.appl {
	font-family: Verdana, Geneva, sans-serif;
	font-size: 16px;
	font-weight: bolder;
	color: #00A859;
}
</style>
</head>

<body>
<form id="form1" name="form1" method="post" action="formtoemail.php">
  <table width="800" border="0" align="center" cellpadding="5" cellspacing="5">
    <tr>
      <td colspan="5" scope="col"><img src="images/logo1.jpg" alt="" width="150" height="97" /></td>
    </tr>
    <tr>
      <td width="234">&nbsp;</td>
      <td colspan="4" class="appl">REGISTRATION FORM</td>
    </tr>
    <tr>
      <td>Title</td>
      <td colspan="4"><label for="Title"></label>
      <input type="text" name="Title" id="Title" /></td>
    </tr>
    <tr>
      <td>Surname</td>
      <td colspan="4"><label for="Surname"></label>
      <input type="text" name="Surname" id="Surname" /></td>
    </tr>
    <tr>
      <td>Given Names</td>
      <td colspan="4"><label for="Given_names"></label>
      <input type="text" name="Given_names" id="Given_names" /></td>
    </tr>
    <tr>
      <td>Sex</td>
      <td colspan="4"><p>
        <label>
          <input type="radio" name="Sex" value="Male" id="Sex_0" />
          Male</label>
        <br />
        <label>
          <input type="radio" name="Sex" value="Female" id="Sex_1" />
          Female</label>
        <br />
      </p></td>
    </tr>
    <tr>
      <td>Occupation</td>
      <td colspan="4"><label for="Occupation"></label>
      <input type="text" name="Occupation" id="Occupation" /></td>
    </tr>
    <tr>
      <td>Nationality</td>
      <td colspan="4"><label for="Nationality"></label>
      <input type="text" name="Nationality" id="Nationality" /></td>
    </tr>
    <tr>
      <td>Email Address</td>
      <td colspan="4"><label for="Email"></label>
      <input type="text" name="Email" id="Email" /></td>
    </tr>
    <tr>
      <td>Phone Numbers</td>
      <td colspan="4"><label for="Phone"></label>
      <input type="text" name="Phone" id="Phone" />
      seperate with commas.</td>
    </tr>
    <tr>
      <td>Home Address</td>
      <td colspan="4"><label for="Home_Address"></label>
      <textarea name="Home_Address" id="Home_Address" cols="28" rows="5"></textarea></td>
    </tr>
    <tr>
      <td>Office Address</td>
      <td colspan="4"><textarea name="Office_Address" id="Office_Address" cols="28" rows="5"></textarea></td>
    </tr>
    <tr>
      <td>Spouse Name</td>
      <td colspan="4"><label for="Spouse_Name"></label>
      <input type="text" name="Spouse_Name" id="Spouse_Name" /></td>
    </tr>
    <tr>
      <td>Spouse Phone Number</td>
      <td colspan="4"><label for="spouse_phone_nos"></label>
      <input type="text" name="spouse_phone_nos" id="spouse_phone_nos" /></td>
    </tr>
    <tr>
      <td>Spouse Email</td>
      <td colspan="4"><label for="spouse_email"></label>
      <input type="text" name="spouse_email" id="spouse_email" /></td>
    </tr>
    <tr>
      <td>Emergency Phone Number</td>
      <td colspan="4"><label for="Emergency_Phone_Number"></label>
      <input type="text" name="Emergency_Phone_Number" id="Emergency_Phone_Number" /></td>
    </tr>
    <tr>
      <td>Emergency Contact Details</td>
      <td colspan="4"><textarea name="emergency_contact_details" id="emergency_contact_details" cols="28" rows="5"></textarea></td>
    </tr>
    <tr>
      <td>Children's Details</td>
      <td width="116">SURNAME</td>
      <td width="143">GIVEN NANE</td>
      <td width="140">DATE OF BIRTH</td>
      <td width="87">GENDER</td>
    </tr>
    <tr>
      <td>Child 1</td>
      <td><label for="child_surname"></label>
      <input type="text" name="child_surname" id="child_surname" /></td>
      <td><input type="text" name="child_name" id="child_name" /></td>
      <td><label for="child_dob"></label>
      <input type="text" name="child_dob" id="child_dob" /></td>
      <td><label for="child_gender"></label>
        <select name="child_gender" id="child_gender">
          <option value="Male">Male</option>
          <option value="Female">Female</option>
      </select></td>
    </tr>
    <tr>
      <td>Child 2</td>
      <td><input type="text" name="child_surname2" id="child_surname2" /></td>
      <td><input type="text" name="child_name2" id="child_name2" /></td>
      <td><input type="text" name="child_dob2" id="child_dob2" /></td>
      <td><select name="child_gender2" id="child_gender2">
        <option value="Male">Male</option>
        <option value="Female">Female</option>
      </select></td>
    </tr>
    <tr>
      <td>Child 3</td>
      <td><input type="text" name="child_surname3" id="child_surname3" /></td>
      <td><input type="text" name="child_name3" id="child_name3" /></td>
      <td><input type="text" name="child_dob3" id="child_dob3" /></td>
      <td><select name="child_gender3" id="child_gender3">
        <option value="Male">Male</option>
        <option value="Female">Female</option>
      </select></td>
    </tr>
    <tr>
      <td>Child 4</td>
      <td><input type="text" name="child_surname4" id="child_surname4" /></td>
      <td><input type="text" name="child_name4" id="child_name4" /></td>
      <td><input type="text" name="child_dob4" id="child_dob4" /></td>
      <td><select name="child_gender4" id="child_gender4">
        <option value="Male">Male</option>
        <option value="Female">Female</option>
      </select></td>
    </tr>
    <tr>
      <td>Child 5</td>
      <td><input type="text" name="child_surname5" id="child_surname5" /></td>
      <td><input type="text" name="child_name5" id="child_name5" /></td>
      <td><input type="text" name="child_dob5" id="child_dob5" /></td>
      <td><select name="child_gender5" id="child_gender5">
        <option value="Male">Male</option>
        <option value="Female">Female</option>
      </select></td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td><input type="submit" name="button" id="button" value="Submit" /></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
  </table>
</form>
</body>
</html>
