205 lines
6.0 KiB
HTML
205 lines
6.0 KiB
HTML
<html>
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<head>
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<title>WebCT регистрация</title>
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<style>
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*{margin:0;padding:0;}
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div {width:679; height:600px; margin:0 auto;}
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</style>
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</head>
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<body>
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<div>
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<table height="600" width="674" border="0" cellspacing="0" sellpadding="0">
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<tr>
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<td width="120" rowspan="22"></td>
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<td colspan="2">
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<font size="2"><br><br>The information requested below will help us tailor our communications to meet your needs. Thank you for you interest in WebCT`s software and services.<br><br>All fields are required</font>
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</td>
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<td width="120" rowspan="22"></td>
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</tr>
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<tr>
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<td bgcolor="skyblue">
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<font size="2">Contact information</font>
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</td>
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<td></td>
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</tr>
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<tr>
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<td colspan="2">
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<hr color="skyblue">
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</td>
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</tr>
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<tr>
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<td>
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<font size="2">First Name:</font>
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</td>
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<td><input type="text" size="24"></td>
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</tr>
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<tr>
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<td>
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<font size="2">Last Name</font>
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</td>
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<td><input type="text" size="24"></td>
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</tr>
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<tr>
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<td>
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<font size="2">E-mail</font>
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</td>
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<td><input type="text" size="24" value="e-mail address"></td>
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</tr>
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<tr>
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<td>
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<font size="2">Confirm E-Mail</font>
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</td>
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<td><input type="text" size="24" value="e-mail address"></td>
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</tr>
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<tr>
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<td>
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<font size="2">Preferred Email Format:</font>
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</td>
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<td>
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<select>
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<option>Choose one</option>
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</select>
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</td>
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</tr>
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<tr>
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<td>
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<font size="2">City</font>
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</td>
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<td><input type="text" size="24"></td>
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</tr>
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<tr>
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<td>
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<font size="2">State or Province:</font>
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</td>
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<td>
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<select>
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<option>Choose State or Province</option>
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</select>
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</td>
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</tr>
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<tr>
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<td>
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<font size="2">Country</font>
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</td>
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<td>
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<select>
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<option>- Select a Country -------------------------------</option>
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</select>
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</td>
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</tr>
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<tr>
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<td bgcolor="skyblue">
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<font size="2">Institution Information</font>
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</td>
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<td></td>
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</tr>
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<tr>
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<td colspan="2">
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<hr color="skyblue">
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</td>
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</tr>
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<tr>
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<td>
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<font size="2">Job Title:</font>
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</td>
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<td><input type="text" size="24"></td>
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</tr>
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<tr>
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<td>
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<font size="2">Role:</font>
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</td>
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<td>
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<select>
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<option>Select Primary Role</option>
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</select>
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</td>
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</tr>
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<tr>
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<td>
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<font size="2">Name of Institution</font>
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</td>
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<td><input type="text" size="24"></td>
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</tr>
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<tr>
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<td>
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<font size="2">Type of Institution</font>
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</td>
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<td>
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<select>
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<option>
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<font size="2">Select Institution Type</font>
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</option>
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</select>
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</td>
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</tr>
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<tr>
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<td>
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<font size="2">Does your institution currently license WebCT?</font>
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</td>
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<td>
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<select>
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<option>Choose one</option>
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</select>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<hr color="grey">
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<input type="checkbox">
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<font size="2">I would like to receive the mounthly WebCT Newsletter</font><br>
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<input type="checkbox">
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<font size="2">I am interested in receiving periodic information about WebCT events, promotions and products</font>
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</td>
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</tr>
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<tr>
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<td align="center" colspan="2"><input type="submit" value="Submit"></td>
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</tr>
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<tr>
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<td colspan="2">
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<font size="2">To ensure that messages from WebCT are delivered to your invox, please add email@webct.rsc02.com to your address book, or ask your IT department to add us to your "approved sender" list.<br><br>
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WebCT is commited to privacy. For information, read our </font><a href="#">
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<font size="2">Privacy Policy</font>
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</a>
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</td>
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</tr>
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<tr>
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<td align="center" colspan="4" bgcolor="navy">
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<font color="white" size="2">Contact Us | Tems of Service | Privacy Policy | Employment | Accessibillity | Site Map</font>
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</td>
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</tr>
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</table>
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</div>
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</body>
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</html>
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