01.<br><br>
02.<div class="container">
03.<div class="row">
04. <div class= "col-xs-12 col-sm-5 col-md-5 col-md-offset-3 ">
05. <div class="panel panel-primary">
06. <div class="panel-heading"><center><center><h3>สมัครสมาชิก</h3> </center></div>
07. <div class="panel-body"><form name="form" action="checregis.php" method="POST">
08. <div class="table-responsive">
09. <table class="table">
10. <tr>
11. <td colspan="2"><label for="ex3">ชื่อ/นามสกุล</label>
12. <input name="username" type="text" class="form-control" id="username" size="5" required></td>
13. </tr>
14. <tr>
15. <td height="46" colspan="2"><label for="ex3">ที่อยู่</label>
16. <textarea name="address" class="form-control" id="address" size="5" type="text" required></textarea></td>
17. </tr>
18.
19. <tr>
20. <td><label for="ex3">จังหวัด</label>
21. <div>
22. <select id="province" name="province" >
23. <option value="province" >- กรุณาเลือกจังหวัด -</option>
24. </select>
25.</div></td>
26.
27. <td><label for="ex3">อำเภอ/เขต</label>
28. <div>
29. <select id="amphur" name="amphur">
30. <option value="amphur">- กรุณาเลือกอำเภอ -</option>
31. </select>
32.
33.</div></td>
34. <tr>
35. <td> <label for="ex3">ตำบล/แขวง</label>
36. <div>
37. <select id="district" name="district">
38. <option value="district">- กรุณาเลือกตำบล -</option>
39. </select>
40.</div></td>
41.
42. <td><label for="ex3">รหัสไปรษณีย์</label>
43. <input type="text" id="postcode" name="postcode" class="form-control" maxlength="5" size="10" required /></td>
44. </tr>
45. <tr>
46. <td><label for="ex3">Email</label>
47. <input name="email" type="email" class="form-control" id="email" size="10" required ></td>
48.
49. <td><label for="ex3">Password</label>
50. <input name="password" type="Password" class="form-control" id="password" maxlength="10" size="10" required ></td>
51. </tr>
52. <tr>
53. <td><label for="ex3">เบอร์โทรศัพท์</label>
54. <input class="form-control" name="phone" id="phone" size="10" maxlength="10" type="text" required></td>
55. <td> </td>
56. </tr>
57.</table></div>
58.<br>
59.
60.<input name="Register" type="submit" class="btn btn-success" id="Register" value="สมัครสมาชิก"/>
61.<input name="reset" type="reset" class="btn btn-danger" id="reset" value="แก้ไข"/>
62.
63.
64.</form></div>
65. </div>
66.
67.</div></div></div></div><br><br>
69.<script type="text/javascript" src="AutoProvince.js"></script>
70.<script>
71. $('body').AutoProvince({
72. PROVINCE: '#province',
73. AMPHUR: '#amphur',
74. DISTRICT: '#district',
75. POSTCODE: '#postcode',
76. arrangeByName: false
77. });
78.</script>
