Welcome to our sample survey!

Personal Information

What is your first name: 

What is your last name: 

About that dinner

What are your favourite choices for dinner? (you can select more than one)
    Lasagna
    Spaghetti
    Hamburger

How would you rate your dining experience here?
    Awesome!
    Just ok
    Not that great
    Fire the chef!

Where do you live?  

Comments:

Would you us like to:

 

 <form id="myform" method="post" action="http://hal.cs.camosun.bc.ca/~langs/cgi-bin/formhandler.php">

<h2>Welcome to our sample survey!</h2>

<fieldset><legend align="left">Personal Information</legend>

<p>What is your <u>f</u>irst name:&nbsp;<input type="text" name="txtFirstName" size="20" accesskey="f" /></p>

<p>What is your <u>l</u>ast name:&nbsp;<input type="text" name="txtLastName" size="20" accesskey="l" /></p>

</fieldset>
<fieldset><legend align="right">About that dinner</legend>

<p>What are your favourite choices for dinner? (you can select more than one)<br>

&nbsp;&nbsp;&nbsp; <input type="checkbox" name="chkLasagna" value="ON" accesskey="s" /> La<u>s</u>agna<br>

&nbsp;&nbsp;&nbsp; <input type="checkbox" name="chkSpaghetti" value="ON" accesskey="p" /> S<u>p</u>aghetti<br>

&nbsp;&nbsp;&nbsp; <input type="checkbox" name="chkHamburger" value="ON" accesskey="h" /> <u>H</u>amburger</p>

<p>How would you rate your dining experience here?<br>

&nbsp;&nbsp;&nbsp; <input type="radio" value="10" checked name="rdRating" accesskey="a"> <u>A</u>wesome! <br>

&nbsp;&nbsp;&nbsp; <input type="radio" name="rdRating" value="8" accesskey="j" /> <u>J</u>ust ok<br>

&nbsp;&nbsp;&nbsp; <input type="radio" name="rdRating" value="5" accesskey="n" /> <u>N</u>ot that great<br>

&nbsp;&nbsp;&nbsp; <input type="radio" name="rdRating" value="2" accesskey="i"/> F<u>i</u>re the chef!</p>

</fieldset>

<p>Where do you li<u>v</u>e? &nbsp;

<select size="3" name="pdLocation" accesskey="v">

   <optgroup label="Canada">
   <option>BC</option>
   <option>Alberta</option>
   <option>Saskatchewan</option>
   <option>Manitoba</option>
   <option>Ontario</option>
   <option>Quebec</option>
   <option>New Brunswick</option>
   <option>PEI</option>
   <option>Nova Scotia</option>
   <option>Newfoundland and Labrador</option>
   <option>Yukon</option>
   <option>Nunavit</option>
   <option>NWT</option>
   </optgroup>

   <optgroup label="United States">
   <option>Washington</option>
   <option>California</option>
   <option>Rhode Island</option>
</opgroup>
</select>

</p>

<p><u>C</u>omments: <textarea rows="3" name="frmComments" cols="50" accesskey="c">Enter your comments here</textarea></p>

<p><u>W</u>ould you us like to: <select size="2" name="pdOption" multiple="multiple" accesskey="w">

<option>Call you</option>
<option>Don't call you</option>
<option>Email you</option>
<option>Fax you</option>
<option>Text message you</option>

</select></p>

<p><input type="submit" value="Submit Form" name="theSubmit" accesskey="b" />

<input type="reset" value="Reset" name="theReset" accesskey="r" />

</p>

</form>