<html>
<head>
<title>Abakada HTML Demo: HTML Samples</title>
<meta name="description" content="Abakada WorkShop: HyperText Markup Language Samples">
<meta name="keywords" content="HTML, CSS, DHTML, JavaScript, XML, workshop, samples, demos">
<meta name="author" content="Reynald Nu�ez">
<link rel="stylesheet" href="/shared/netdemos.css">
<style type="text/css">
<!--
fieldset, td { color: navy }
fieldset { margin: 10 }
-->
</style>
</head>
<body>
<!-- #include virtual="~/shared/top.inc" -->
<div class="header"><h2>Abakada HTML Demo: FIELDSET Element Sample</h2></div>
<hr size=1 width=92%>
<div class="back" style="background: beige; width: "90%">
<form action="..." method="post">
<fieldset><legend>Personal Information</legend>
<table width="75%" align="center">
<tr>
<td align="right">Last Name: </td>
<td><input name="personal_lastname" type="text" tabindex="1"></td></tr>
<tr>
<td align="right"> First Name: </td>
<td><input name="personal_address" type="text" tabindex="3"></td></tr>
<tr>
<td align="right">Address: </td>
<td><input name="personal_firstname" type="text" tabindex="2"></td></tr>
</table>
</fieldset>
<fieldset><legend>Medical History</legend>
<input name="hist_illness" type="checkbox" value="Smallpox" tabindex="4"> Smallpox
<input name="hist_illness" type="checkbox" value="Mumps" tabindex="5"> Mumps
<input name="hist_illness" type="checkbox" value="Dizziness" tabindex="6"> Dizziness
<input name="hist_illness" type="checkbox" value="Sneezing" tabindex="7"> Sneezing<br>
...more medical history...
</fieldset>
<fieldset><legend>Current Medication</legend>
Are you currently taking any medication?<br>
<input name="med_now" type="radio" value="Yes" tabindex="8">Yes
<input name="med_now" type="radio" value="No" tabindex="9">No<br>
If you are currently taking medication, please indicate
it in the space below: <p></p>
<textarea name="current_medication" rows="5" cols="40" tabindex="10"></textarea><p></p>
</fieldset>
</form></div>
<hr size=1 width=92%>
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</body>
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