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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <meta http-equiv="Content-Type" content="text/html; charset=windows-874"> <html> <head> <link href="https://fonts.googleapis.com/css2?family=Trirong:wght@500&display=swap" rel="stylesheet"> <meta http-equiv="X-UA-Compatible" content="IE=edge"> <meta name="viewport" content="width=device-width, initial-scale=1"> <title>��û����Թ�����ͺ����ҹ�آ�Ҿ��оĵԡ����آ�Ҿ�����ѡ����§�</title> <meta name="description" content=""> <meta name="author" content="templatemo"> <!-- Visual Admin Template https://templatemo.com/tm-455-visual-admin --> <link href="css/font-awesome.min.css" rel="stylesheet"> <link href="css/bootstrap.min.css" rel="stylesheet"> <link href="css/templatemo-style.css" rel="stylesheet"> <!-- HTML5 shim and Respond.js for IE8 support of HTML5 elements and media queries --> <!-- WARNING: Respond.js doesn't work if you view the page via file:// --> <!--[if lt IE 9]> <script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script> <script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script> <![endif] background-color: #d2f3f9; background-image: url("images\bg.png") --> <style> body { background-color: #ff99ff; } #customers { border-collapse: collapse; width: 100%; } #customers td, #customers th { border: 1px solid #ddd; padding: 8px; text-align: center; } #customers tr:nth-child(even){background-color: #99ff00;} #customers tr:hover {background-color: #ddd;} #customers th { padding-top: 12px; padding-bottom: 12px; text-align: center; background-color: #00cccc; color: white; font-size: 18px; } </style> </head> <body> <div class="templatemo-content-container"> <div class="templatemo-content-widget w1-bg"><img src="images/Srinakharinwirot_Logo_TH_Color.png" width="100" height="100" border="0" alt=""><img src="images/logo_NRCT.jpg" height="100" border="0" alt=""> <h3 class="margin-bottom-10">��û����Թ "��ѧ" �����������Ԩ����</h3> <h2 class="margin-bottom-10">�����ͺ����ҹ�آ�Ҿ��оĵԡ����آ�Ҿ�����ѡ����§</h2> <h3 class="margin-bottom-10">�� ʶҺѹ�Ԩ�¾ĵԡ�����ʵ�� ����Է�������չ��Թ�����ò </h3> <p>(���ͺ���� ������¼���˭����� 20-65 �� ���� �ѡ�֡�� ���ӧҹ�ͧ����Ҥ�Ѱ/�͡����л�ЪҪ�㹪����)</p> <h4 class="margin-bottom-10">�Ӫ��ᨧ</h4> <p>����֡�Ҥ��駹������ǹ˹�觢ͧ <strong>�����Ԩ����оѲ������ͧ��ͻ����Թ�����ͺ����ҹ�آ�Ҿ��оĵԡ����آ�Ҿ�����ѡ����§���µ��ͧ�ҧ�ԨԷ����С������ѡ�ٵ�������������ͺ����ҹ�آ�Ҿ����Ŵ�ä���Դ���������ѧ (NCDs) 㹡��������§��·ӧҹ�</strong> �����ѵ�ػ��ʧ�����ͻ����Թ�дѺ�����ͺ����ҹ�آ�Ҿ��оĵԡ����آ�Ҿ�����ѡ����§��ҹ�к��ԨԷ�������ӡѺ�Դ��� �š������ѡ�ٵá��������������ͺ����ҹ�آ�Ҿ���������§�ä NCDs �� ����ҹ �����ѹ���Ե�٧ ��ѹ�٧ ���������ʹ���ʹ �ä��ǹ �ä� ����� �繵� <p>Ẻ�ͺ���������� 3 � ��� 67 ��� ��� <p><strong>���� 1 �ͺ��������ŷ����</strong>�ӹǹ 9 ��� <p><strong>���� 2 �ͺ��� �����ͺ����ҹ�آ�Ҿ</strong> �ӹǹ 28 ��� <p><strong>���� 3 �ͺ����ĵԡ����آ�Ҿ�����ѡ����§</strong>�ӹǹ 30 ��� <p>�ͤ�����سҷ�ҹ��ҹ�Ӷ�����Т�����Ѵਹ������ͺ���ú�ء��ء��� ��Т��Ѻ�ͧ��ҡ�õͺ�ͧ��ҹ���繤����Ѻ ������ա���кص�ǵ��ͧ��ҹ�ҡ��õͺ �繡����§ҹ����Ҿ�����ҹ�� �ҡ�բ��ʧ��� �Դ��� ungsinun@gmail.com ���� �ҡ ��ҹ���ѭ�ҷҧ��ҹ�Ԥ㹡�á�͡Ẻ�ͺ��� �Դ������� 0866071458 (��ʹ�)</p> <div class="panel-heading border-radius-10"> <h2 class="margin-bottom-10">���� 1 �����ŷ����</h2> </div> <form action="add.asp" class="templatemo-login-form" method="post"> <div class="row form-group"> <div class="col-lg-12 form-group"> <label for="name">����-ʡ�� (����ͧ�кؤӹ�˹�� <strike>��� �ҧ �ҧ��� </strike>���)</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="text" class="form-control" id="name" placeholder="" name="name" required> </div> </div> </div> </div> <div class="col-lg-12 form-group"> <label for="team">������....</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team1" value="1" required> <label for="team1" class="font-weight-400"><span></span>��� 1 �ͧ�آ�֡�� ���ʹѺʹع��ԡ���آ�Ҿ</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team2" value="2" required> <label for="team2" class="font-weight-400"><span></span>��� 2 ��С���Ҿ�ӺѴ ���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team3" value="3" required> <label for="team3" class="font-weight-400"><span></span>��� 3 �ç��Һ�ŷ�ǧ͡</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team4" value="4" required> <label for="team4" class="font-weight-400"><span></span>��� 4 ��о�Һ����ʵ�����͡��س�� �.���Թ���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team5" value="5" required> <label for="team5" class="font-weight-400"><span></span>��� 5 ʶҺѹ�Ѳ���آ����ࢵ���ͧ �������</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team6" value="6" required> <label for="team6" class="font-weight-400"><span></span>��� 6 �Է������Ҹ�ó�آ���Թ�� �ź���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team7" value="7" required> <label for="team7" class="font-weight-400"><span></span>��� 7 þʵ. �.�ù��� �.�������</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team8" value="8" required> <label for="team8" class="font-weight-400"><span></span>��� 8 �Ҹ�ó�آ�ѧ��Ѵ�ԧ�����</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team9" value="9" required> <label for="team9" class="font-weight-400"><span></span>��� 9 ʶҹ��Һ��/��� �.��ù�¡</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="team" id="team10" value="10" required> <label for="team10" class="font-weight-400"><span></span>��� 10 þʵ. ˹ͧ�ǧ �.������</label> </div> </div> </div> </div> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="weight">���˹ѡ</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <input type="number" class="form-control" id="weight" placeholder="" name="weight" required><label for="weight" class="font-weight-400"><span></span>���š���</label> </div> </div> </div> </div> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="height">��ǹ�٧</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <input type="number" class="form-control" id="height" placeholder="" name="height" required><label for="height" class="font-weight-400"><span></span>ૹ������</label> </div> </div> </div> </div> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="bloodt">�дѺ�����ѹ���Ե��Ǻ�</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <input type="number" class="form-control" id="bloodt" placeholder="" name="bloodt" required>�����ѹ���Ե������ ��Ǻ� 110-120 ��������û�ͷ </div> </div> </div> </div> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="bloodb">�дѺ�����ѹ���Ե�����ҧ</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <input type="number" class="form-control" id="bloodb" placeholder="" name="bloodb" required>�����ѹ���Ե������ �����ҧ 70-80 ��������û�ͷ </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <!--<h3>��<strong><u>�óշ���ҹ��ͧ�������С�Ѻ���Դ�����ū��</u></strong>㹼š�õͺẺ�ͺ������駹��ͧ��ҹ �����Ũж١��价��������ͧ��ҹ �ô�к� ����� <input type="test" name="emaill" id="email" maxlength="50">--><h3> </div> <div class="col-lg-12 form-group"> <label for="sex">1. ��</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="sex" id="sex4" value="1" required> <label for="sex4" class="font-weight-400"><span></span>���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="sex" id="sex5" value="2" required> <label for="sex5" class="font-weight-400"><span></span>˭ԧ</label> </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <label for="status">2. ʶҹ�Ҿ</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="status" id="status1" value="1" required> <label for="status1" class="font-weight-400"><span></span>�ʴ</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="status" id="status2" value="2" required> <label for="status2" class="font-weight-400"><span></span>����</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="status" id="status3" value="3" required> <label for="status3" class="font-weight-400"><span></span>�����/����/�¡</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="status" id="status4" value="4" required> <label for="status4" class="font-weight-400"><span></span>��� � �к�...</label> <input type="text" class="form-control" id="status_o" placeholder="" name="status_o"> </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <label for="iage">3. ���آͧ�ѹ����㹪�ǧ</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="age" id="age1" value="1" required> <label for="age1" class="font-weight-400"><span></span>20 - 30 ��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="age" id="age2" value="2" required> <label for="age2" class="font-weight-400"><span></span>31 - 40 ��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="age" id="age3" value="3" required> <label for="age3" class="font-weight-400"><span></span>41 - 50 ��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="age" id="age4" value="4" required> <label for="age4" class="font-weight-400"><span></span>51 - 59 ��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="age" id="age5" value="5"> <label for="age5" class="font-weight-400"><span></span>60 - 65 ��</label> </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="edu">4. �дѺ����֡���٧�ش ���͡��ѧ�֡���дѺ����</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="edu" id="edu1" value="1" required> <label for="edu1" class="font-weight-400"><span></span>��ж��֡�� </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="edu" id="edu2" value="2" required> <label for="edu2" class="font-weight-400"><span></span>�Ѹ���֡��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="edu" id="edu3" value="3" required> <label for="edu3" class="font-weight-400"><span></span>ػ�ԭ��/�Ǫ./���.</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="edu" id="edu4" value="4" required> <label for="edu4" class="font-weight-400"><span></span>��ԭ�ҵ�բ���</label> </div> </div> </div> </div> </div> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="duty">5. �ѡɳЧҹ��ѡ��������㹪��Ե��Ш��ѹ��Ẻ�</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="duty" id="duty1" value="1" required> <label for="duty1" class="font-weight-400"><span></span>�ѡ���¹/���Ե/�ѡ�֡��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="duty" id="duty2" value="2" required> <label for="duty2" class="font-weight-400"><span></span>�ӧҹ�˹��§ҹ�Ҥ�Ѱ</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="duty" id="duty3" value="3" required> <label for="duty3" class="font-weight-400"><span></span>�ӧҹ�˹��§ҹ�Ҥ�͡��/�Ӹ�áԨ��ǹ���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="duty" id="duty4" value="4" required> <label for="duty4" class="font-weight-400"><span></span>�ɵá� �� �����/��/�ǹ/����� �繵�</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="duty" id="duty5" value="5" required> <label for="duty5" class="font-weight-400"><span></span>������Ҫվ��Ш�/������ҹ/�Ѻ��ҧ�����</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="duty" id="duty6" value="6" required> <label for="duty6" class="font-weight-400"><span></span>��� � �к�...</label> <input type="text" class="form-control" id="duty_o" placeholder="" name="duty_o"> </div> </div> </div> </div> </div> <div class="col-lg-6 col-md-6 form-group"> <label for="income">6. �����/����Թ������ͧ�ѹ㹻Ѩ�غѹ </label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="income" id="income1" value="1" required> <label for="income1" class="font-weight-400"><span></span>��§��/������� </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="income" id="income2" value="2" required> <label for="income2" class="font-weight-400"><span></span>��§��/������������ </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="income" id="income3" value="3" required> <label for="income3" class="font-weight-400"><span></span>�����§��/�����˹�� </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="income" id="income4" value="4" required> <label for="income4" class="font-weight-400"><span></span>�����§��/��˹�� </label> </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="province">7. �Ѩ�غѹ�ѹ���������㹨ѧ��Ѵ�����ѡ</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov1" value="1" required> <label for="prov1" class="font-weight-400"><span></span>��ا��ҹ��</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov2" value="2" required> <label for="prov2" class="font-weight-400"><span></span>�ԧ�����</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov3" value="3" required> <label for="prov3" class="font-weight-400"><span></span>������</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov4" value="4" required> <label for="prov4" class="font-weight-400"><span></span>��ù�¡</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov5" value="5" required> <label for="prov5" class="font-weight-400"><span></span>�ź���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov6" value="6" required> <label for="prov6" class="font-weight-400"><span></span>�������</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="province" id="prov7" value="7" required> <label for="prov7" class="font-weight-400"><span></span>��� � �к�...</label> <input type="text" class="form-control" id="prov_o" placeholder="" name="prov_o"> </div> </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="commu">8. �ѡɳС�����������㹪�����ͧ��ҹ</label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="commu" id="commu1" value="1" required> <label for="commu1" class="font-weight-400"><span></span>���ͧ</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="commu" id="commu2" value="2" required> <label for="commu2" class="font-weight-400"><span></span>������ͧ��觪���</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="commu" id="commu3" value="3" required> <label for="commu3" class="font-weight-400"><span></span>��� � �к�...</label> <input type="text" class="form-control" id="commu_o" placeholder="" name="commu_o"> </div> </div> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <label for="ncd">9. �ѹ����������§����ä���Դ���������ѧ (NCDs) �� �ä����ҹ �ä���� �ä��ʹ���ʹ��ͧ �ä����� �ä�����ѹ���Ե�٧ �繵� (����ö�ͺ���ҡ���� 1 ���) </label> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd2" id="n2" value="1" > <label for="n2" class="font-weight-400"><span></span>���� ���� ��ǹ ���� ��ǹŧ�ا </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd3" id="n3" value="1"> <label for="n3" class="font-weight-400"><span></span>���Ф����ѹ���Ե�٧</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd4" id="n4" value="1"> <label for="n4" class="font-weight-400"><span></span>�չ�ӵ������ʹ�٧</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd5" id="n5" value="1"> <label for="n5" class="font-weight-400"><span></span>����ѹ����ʹ�٧</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd6" id="n6" value="1"> <label for="n6" class="font-weight-400"><span></span>����ѹ��еѺ</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd7" id="n7" value="1"> <label for="n7" class="font-weight-400"><span></span>�Թ���������ҹ ���� �ѹ ���� ����Ѵ </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd8" id="n8" value="1"> <label for="n8" class="font-weight-400"><span></span>����������¹�ŧ����</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd9" id="n9" value="1"> <label for="n9" class="font-weight-400"><span></span>����͡ ���� ᷺����͡���ѧ��� </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd10" id="n10" value="1"> <label for="n10" class="font-weight-400"><span></span>�ٺ�������繻�Ш�</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd11" id="n11" value="1"> <label for="n11" class="font-weight-400"><span></span>��������ͧ�����������š������繻�Ш� </label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd12" id="n12" value="1"> <label for="n12" class="font-weight-400"><span></span>�վ�����/������/����� �������͵�´����ä���Դ���������ѧ</label> </div> <div class="templatemo-block margin-bottom-5"> <label for="n13" class="font-weight-400"><span></span>��� � (�����) �к�</label> <input type="text" class="form-control" id="n13" placeholder="" name="ncd_o"> </div> <!--<div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="ncd1" id="n1" value="1"> <label for="n1" class="font-weight-400"><span></span>�������������§����ä���Դ���������ѧ</label> </div>--> </div> </div> </div> </div> </div> <% author=request("round") 'round ������ͺ��� 0 pre 2 post 3 follow ��˹�������ͺ � � 'Response.write "<tr><td colspan=2>vvv"&author&"<td><tr>" %> <input type="hidden" name="author" value=<%=author%>> <!-- <div class="row form-group"> <div class="col-lg-6 col-md-6 form-group"> <label for="inputCurrentPassword">Current Password</label> <input type="password" class="form-control highlight" id="inputCurrentPassword" placeholder="*********************"> </div> </div> <div class="row form-group"> <div class="col-lg-6 col-md-6 form-group"> <label for="inputNewPassword">New Password</label> <input type="password" class="form-control" id="inputNewPassword"> </div> <div class="col-lg-6 col-md-6 form-group"> <label for="inputConfirmNewPassword">Confirm New Password</label> <input type="password" class="form-control" id="inputConfirmNewPassword"> </div> </div> <div class="row form-group"> <div class="col-lg-12 has-success form-group"> <label class="control-label" for="inputWithSuccess">Input with success</label> <input type="text" class="form-control" id="inputWithSuccess"> </div> </div> <div class="row form-group"> <div class="col-lg-12 has-warning form-group"> <label class="control-label" for="inputWithWarning">Input with warning</label> <input type="text" class="form-control" id="inputWithWarning"> </div> </div> <div class="row form-group"> <div class="col-lg-12 has-error form-group"> <label class="control-label" for="inputWithError">Input with error</label> <input type="text" class="form-control" id="inputWithError"> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <label class="control-label" for="inputNote">Note</label> <textarea class="form-control" id="inputNote" rows="3"></textarea> </div> </div> <div class="row form-group"> <div class="col-lg-6 col-md-6 form-group"> <label class="control-label templatemo-block">Single Selection Control</label> <select class="form-control"> <option value="html">HTML</option> <option value="plain">Plain Text</option> </select> </div> <div class="col-lg-6 col-md-6 form-group"> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="emailOptions" id="c1" value="new" checked> <label for="c1" class="font-weight-400"><span></span>Email me when new member sign up.</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="checkbox" name="emailOptions" id="c2" value="weekly"> <label for="c2" class="font-weight-400"><span></span>Weekly summary email</label> </div> </div> </div> <div class="row form-group"> <div class="col-lg-6 col-md-6 form-group"> <label class="control-label templatemo-block">Multiple Selection Control</label> <select multiple class="templatemo-multi-select form-control" style="overflow-y: scroll;"> <option value="">Charts</option> <option value="">Graphs</option> <option value="">Icons</option> <option value="">Repsonsive</option> <option value="">HTML5</option> <option value="">CSS3</option> <option value="">jQuery</option> </select> </div> <div class="col-lg-6 col-md-6 form-group"> <div> <label class="control-label templatemo-block">Email Option</label> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="emailOptions" id="r1" value="html" checked> <label for="r1" class="font-weight-400"><span></span>HTML Format</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="emailOptions" id="r2" value="plain"> <label for="r2" class="font-weight-400"><span></span>Plain Text</label> </div> <div class="templatemo-block margin-bottom-5"> <input type="radio" name="emailOptions" id="r3" value="rich"> <label for="r3" class="font-weight-400"><span></span>Rich Text</label> </div> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <input type="checkbox" name="server" id="c3" value="" checked> <label for="c3" class="font-weight-400"><span></span>Server Status</label> </div> <div class="margin-right-15 templatemo-inline-block"> <input type="checkbox" name="member" id="c4" value=""> <label for="c4" class="font-weight-400"><span></span>Member Status</label> </div> <div class="margin-right-15 templatemo-inline-block"> <input type="checkbox" name="expired" id="c5" value=""> <label for="c5" class="font-weight-400"><span></span>Expired Members</label> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12 form-group"> <div class="margin-right-15 templatemo-inline-block"> <input type="radio" name="radio" id="r4" value=""> <label for="r4" class="font-weight-400"><span></span>Bootstrap</label> </div> <div class="margin-right-15 templatemo-inline-block"> <input type="radio" name="radio" id="r5" value="" checked> <label for="r5" class="font-weight-400"><span></span>Foundation</label> </div> <div class="margin-right-15 templatemo-inline-block"> <input type="radio" name="radio" id="r6" value=""> <label for="r6" class="font-weight-400"><span></span>Skeleton</label> </div> </div> </div> <div class="row form-group"> <div class="col-lg-12"> <label class="control-label templatemo-block">File Input</label> --> <!-- <input type="file" name="fileToUpload" id="fileToUpload" class="margin-bottom-10"> <input type="file" name="fileToUpload" id="fileToUpload" class="filestyle" data-buttonName="btn-primary" data-buttonBefore="true" data-icon="false"> <p>Maximum upload size is 5 MB.</p> </div> </div> --> <div class="form-group text-right"> <button type="submit" class="templatemo-blue-button">��͡��������ǹ�Ѵ� (��سҡ�͡���ú�ء���)</button> <!--<button type="reset" class="templatemo-white-button">Reset</button>--> </div> </form> </div> <!--<footer class="text-right"> <p>Copyright © 2084 Company Name | Design: Template Mo</p> </footer>--> </div> </div> </div> <!-- JS --> <script type="text/javascript" src="js/jquery-1.11.2.min.js"></script> <!-- jQuery --> <script type="text/javascript" src="js/bootstrap-filestyle.min.js"></script> <!-- http://markusslima.github.io/bootstrap-filestyle/ --> <script type="text/javascript" src="js/templatemo-script.js"></script> <!-- Templatemo Script --> </body> </html>