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<td>
<font size="5" face="tahoma">Hemen, Ücretsiz Üye Ol!</font>
</td>
<td></td>
<tr>
<td><font size="3" face="tahoma"
color="blue">Adınız:</font></td>
<td><input type="text" name="adiniz"></td>
</tr>

<tr>
color="blue">Soyadınız:</font></td>
<td><input type="text" name="Soyadiniz"></td>
</tr>
<tr>
<td><font size="3" face="tahoma" color="blue">E-Posta

• <tr>
<td><font size="3" face="tahoma" color="blue">E-Posta
Adresiniz(Tekrar):</font></td>
<td><input type="text" name="E-Posta1"></td>
</tr>
<tr>
<td><font size="3" face="tahoma" color="blue">ġifreniz:</font></td>
<td><input type="password" name="Sifreniz"></td>
</tr>
<tr>
color="blue">Cinsiyetiniz:</font></td>
<td><select name="Cinsiyet">
<option>ERKEK</option>
<option>KADIN</option>
</select>
</td>
</tr>
<tr>
<td><font size="3" face="tahoma" color="blue">Doğum
Tarihiniz:</font></td>

•

<td><select name="Gun">
<option>Gün</option>
<option>P.TESĠ</option>
<option>SALI</option>
<option>ÇARġAMBA</option>
<option>PERġEMBE</option>
<option>CUMA</option>
<option>C.TESĠ</option>
<option>PAZAR</option>
</select>
<select name="Ay">
<option>Ay</option>
<option>OCAK</option>
<option>ġUBAT</option>
<option>MART</option>
<option>NĠSAN</option>
<option>MAYIS</option>
<option>HAZĠRAN</option>
<option>TEMMUZ</option>
<option>AĞUSTOS</option>
<option>EYLÜL</option>
<option>EKĠM</option>
<option>KASIM</option>
<option>ARALIK</option>
</select>
<select name="Yil">
<option>Yıl</option>
<option>2000</option>
</select>
</td>
</tr>

•
<tr>
<td><font size="3" face="tahoma" color="blue">YaĢadığınız ġehir:</font></td>
<td><select name="Sehir">
<option>ġehir</option>
<option>istanbul</option>
<option>izmir</option>
<option>tekirdağ</option>
<option>rize</option>
<option>gars</option>
<option>erzurum</option>
</select>
</td>
</tr>
<tr>
<td><font size="3" face="tahoma" color="blue">Güvenlik Kodu:</font></td>
<td><input type="password"</td>
</tr>
<tr>
<td></td>
<td><input type="checkbox" checked="on">üniaktivite haftalık bültenini e-posta adresini gönder.<a href="#">(Nedir?)</a></td>
</tr>
<tr>
<td></td>
<td><input type="checkbox" checked="on">üniaktivite duyuru ve kampanyalarını e-posta adresime gönder.<a href="#">(Nedir?)</a></td>
</tr>
<tr>
<td></td>
<td><input type="checkbox"><a href="#">Kullanım Ģartlarını</a>okudum,Ģartları kabul ediyorum.</td>
</tr>
<tr>
<td></td>
<td><input type="submit" value="Hesabımı OluĢtur"></td>
</tr>
<tr>
<td></td>
<td><font size="3" face="tahoma" color="blue">Mesajınız:</font></td>
</tr>
<tr>
<td></td>
<td><textarea name="mesaj" rows="10" cols="50"></textarea></td>
</tr>
<tr>
<td></td>
<td><input type="submit" value="GÖNDER"></td>
</tr>
</form>
</table>
</fieldset>
</body>
</html>

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