UMPAN BALIK

<HTML>

  <HEAD>

    <TITLE>Feedback Form</TITLE>

  </HEAD>

  <BODY>

    <H1>Feedback Form</H1>

    <FORM action="mailto:simon.long@cit.ie" method="post" enctype="text/plain">

      First Name : <INPUT type="text" name="firstname" placeholder="Enter name here">

      Second Name : <INPUT type="text" name="secondname"  placeholder="Enter surname here">

      <BR>

      <BR>

      <!--It's important that both of these radio button have the same name so they behave as one component (i.e. Only one can be selected at a time)-->  

      <INPUT type="radio" name="gender" value="male">Male<BR>

      <INPUT type="radio" name="gender" value="female">Female  

      <BR>

      <BR>

      <!--This uses the new HTML "email" INPUT type which will automatically validates the email address when the SUBMIT button is clicked-->

      email: <INPUT type="email" name="mail" placeholder="e-mail address">

      <BR>

      <BR>

        Comment :<BR>        

        <TEXTAREA rows="6" cols="50" name="commentfield"></TEXTAREA>

        <BR>

        <SELECT name="countychooser">

          <OPTION value="cork">Cork</OPTION>

          <OPTION value="dublin">Dublin</OPTION>

          <OPTION value="galway">Galway</OPTION>

          <OPTION value="kerry">Kerry</OPTION>

        </SELECT>

        <BR>

        <BR>

        <INPUT TYPE="submit" value="Send Feedback">

        <INPUT TYPE="reset" value="Reset">

    </FORM>

    

  </BODY>  

</HTML>