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<html>

<head>
<?php
//form validation
// define variables and set to empty values
$fname = $lname = $email = $address = $gender = @$memtype = "";
@$uname = @$passn = "";
if ($_SERVER["REQUEST_METHOD"] == "POST")
{
$fname = test_input($_POST["fname"]);
$lname = test_input($_POST["lname"]);
$email = test_input($_POST["email"]);
@$address = test_input($_POST["add"]);
@$gender = test_input($_POST["gen"]);
@$uname = test_input($_POST["username"]);
@$passn = test_input($_POST["pass"]);
@$memtype = test_input($_POST["mtype"]);
}
function test_input($data)
{
$data = trim($data);
$data = stripslashes($data);
$data = htmlspecialchars($data);
return $data;
}
?>
<?php
// define variables and initialize with empty values
$fnameErr = $lnameErr = $emailErr = $addressErr= $ageErr= $unameErr = $passnErr= $genderErr = $memtypeErr = "";
$fname1 = $age1 = $lname1 = $email1 = $address1 = $gender1 = $passn1 = $uname1 = $memtype1 = "";
if ($_SERVER["REQUEST_METHOD"] == "POST") {
$valid = true;
if(empty($_POST["fname"])) {
$fnameErr = "Missing Firstname";

$valid =false;
}
else {
$fname1 = test_input($_POST["fname"]);
// check if name only contains letters and whitespace
if (!preg_match("/^[a-zA-Z ]*$/",$fname))
{
$fnameErr = "Only letters and white space allowed";
$valid=false;
}
}
if (empty($_POST["lname"])) {
$lnameErr = "Missing Lastname";
$valid=false;
}
else {
$lname1 = test_input($_POST["lname"]);
// check if name only contains letters and whitespace
if (!preg_match("/^[a-zA-Z ]*$/",$lname))
{
$lnameErr = "Only letters and white space allowed";
$valid=false;
}
}
if (empty($_POST["email"])) {
$emailErr = "Missing email address";
$valid=false;
}
else {
$email1 = test_input($_POST["email"]);
// check if e-mail address syntax is valid
if (!preg_match("/([\w\-]+\@[\w\-]+\.[\w\-]+)/",$email))
{
$emailErr = "Invalid email format";

$valid=false;
}
}
if (empty($_POST["add"])) {
$addressErr = "specify Address ";
$valid=false;
}
else {
$address1 = test_input($_POST["add"]);
}
if (!isset($_POST["gen"])) {
$genderErr = "specify your gender";
$valid=false;
}
else {
$gender1 = test_input($_POST["gen"]);
}
if (!isset($_POST["mtype"])) {
$memtypeErr = "specify your membership type";
$valid=false;
}
else {
$memtype1 = test_input($_POST["mtype"]);
}
if (empty($_POST["age"])) {
}
else {
$age = test_input($_POST["age"]);
if (preg_match("/^[a-zA-Z ]*$/",$age))
{
$ageErr = "Invalid age";
$valid=false;
}
}

if (empty($_POST["username"])) {
$unameErr = "specify your username";
$valid=false;
}
else {
$uname1 = test_input($_POST["username"]);
}
if (empty($_POST["pass"])) {
$passnErr = "specify your password";
$valid=false;
}
else {
$passn1 = test_input($_POST["pass"]);
}
}
// here form validation ends
?>
<?Php
/*
--- Database: `user_signup`
--- ---------------------------------------------------------- Table structure for table `user`
-CREATE TABLE IF NOT EXISTS `user` (
`FirstName` char(30) NOT NULL,
`LastName` char(30) NOT NULL,
`Email` char(30) DEFAULT NULL,
`CPhone` mediumtext,
`Address` varchar(70) DEFAULT NULL,
`Age` int(11) DEFAULT NULL,
`Gender` char(10) DEFAULT NULL,

`UserName` varchar(20) NOT NULL,


`Password` varchar(20) NOT NULL,
`MType` char(10) NOT NULL,
`UId` int(11) NOT NULL AUTO_INCREMENT,
PRIMARY KEY (`UId`)
) ENGINE=InnoDB DEFAULT CHARSET=latin1 AUTO_INCREMENT=1 ;
*/
?>
<?php
//mysql database connectivity
//inserting form data into the database
if(@$valid==true)
{
$con= mysql_connect("localhost","username","password");

//change the username and password

mysql_select_db("user_signup", $con);
@$a=$_POST['fname'];
@$b=$_POST['lname'];
@$c=$_POST['email'];
@$d=$_POST['cell'];
@$e=$_POST['add'];
@$f=$_POST['age'];
@$g=$_POST['gen'];
@$i=$_POST['username'];
@$j=$_POST['pass'];
@$h=$_POST['mtype'];
mysql_query("insert into user (FirstName,LastName,Email,CPhone,Address,Age,Gender,Username,Password,MType)
values('$a','$b','$c','$d','$e','$f','$g','$i','$j','$h')");
header("Location:form1.php");
mysql_close($con);
}
?>
</head>
<style>
div.ex
{

width:600px;
padding:30px;
border:7px solid red;
margin:4px;
}
body
{
background-image:url("bg.jpg");
}
</style>
<body >
<center>
<h2><b><i><u>Signup</u></i></b></h2>
<div class="ex">
<form action="<?php echo htmlspecialchars($_SERVER["PHP_SELF"]);?>" method="post" >
<table id="rtid1" border="0" cellpadding="5" cellspacing="0" width="600">
<tr id="rtrid1">
<td><b>FirstName*:</b></td>
<td>
<input id="FirstName" name="fname" value="<?php echo htmlspecialchars($fname);?>" type="text" maxlength="60"
style="width:146px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$fnameErr;?></i></font></span>
</td>
</tr>
<tr>
<td><b>lastName*:</b></td>
<td>
<input id="LastName" name="lname" value="<?php echo htmlspecialchars($lname);?>" type="text" maxlength="60"
style="width:146px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$lnameErr;?></i></font></span>
</td>
</tr>
<tr>
<td>
<b>Email address*:</b>

</td>
<td>
<input id="FromEmailAddress" name="email" type="text" value="<?php echo htmlspecialchars($email);?>" maxlength="60"
style="width:200px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$emailErr;?></i></font></span>
</td>
</tr>
<tr id="rtrid2">
<td><b>Cell Phone:</b></td>
<td><input id="CellPhone" name="cell" type="text" maxlength="43" style="width:200px; border:1px solid #999999" /></td>
</tr>
<tr id="rtrid3">
<td><b>Address *:</b></td>
<td><input id="StreetAddress1" name="add" type="textarea" value="<?php echo htmlspecialchars($address);?>"
maxlength="120" style="width:300px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$addressErr;?></i></font></span>
</td>
</tr>
<tr id="rtrid4">
<td><b>Age:</b></td>
<td>
<input id="Age" name="age" type="text" maxlength="120" style="width:300px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$ageErr;?></i></font></span>
</td>
</tr>
<tr id="rtrid5">
<td><b>Gender*:</b></td>
<td>
<input type="radio" name="gen" <?php if (isset($gender) && $gender=="male") echo "checked";?> value="male" id=
"rgm">Male
<input type="radio" name="gen" <?php if (isset($gender) && $gender=="female") echo "checked";?> value="female"
id="rgf">Female
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$genderErr;?></i></font></span>
</td>
</tr>
<tr >

<td><b>UserName*:</b></td>
<td>
<input id="Username" name="username" type="text" value="<?php echo htmlspecialchars($uname);?>" maxlength="60"
style="width:146px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$unameErr;?></i></font></span>
</td>
</tr>
<tr>
<td><b>Password*:</b></td>
<td>
<input id="Password" name="pass" type="password" value="<?php echo htmlspecialchars($passn);?>" maxlength="60"
style="width:146px; border:1px solid #999999" />
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$passnErr;?></i></font></span>
</td><br>
</tr>
<tr id="rtrid6">
<td><b>Membership type*:</b></td>
<td>
<input type="radio" name="mtype" <?php if (isset($memtype) && $memtype=="ordinary") echo "checked";?>
value="ordinary">Ordinary
<input type="radio" name="mtype" <?php if (isset($memtype) && $memtype=="premium") echo "checked";?>
value="premium">Premium
<span class="error"><font color="red"><i><?php echo "&nbsp&nbsp&nbsp".$memtypeErr;?></i></font></span>
</td>
</tr>
<td colspan="2" align="center">
<br />
<br><input id="skip_Submit" name="skip_Submit" type="submit" value="Submit" /></br>
</br>
</td>
</tr>
</table>
<br/>
</form>
</div>
</center>

</body>
</html>

The form will look like this :

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