Commit e980bfb2 authored by Ramani cherala's avatar Ramani cherala
Browse files

edit profile

parent b442e8ea
<!DOCTYPE html>
<html>
<head>
<meta name="viewport" content="width=device-width, initial-scale=1">
<!-- Add icon library -->
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.1.3/css/bootstrap.min.css" integrity="sha384-MCw98/SFnGE8fJT3GXwEOngsV7Zt27NXFoaoApmYm81iuXoPkFOJwJ8ERdknLPMO" crossorigin="anonymous">
<script src="https://code.jquery.com/jquery-3.3.1.slim.min.js" integrity="sha384-q8i/X+965DzO0rT7abK41JStQIAqVgRVzpbzo5smXKp4YfRvH+8abtTE1Pi6jizo" crossorigin="anonymous"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.3/umd/popper.min.js" integrity="sha384-ZMP7rVo3mIykV+2+9J3UJ46jBk0WLaUAdn689aCwoqbBJiSnjAK/l8WvCWPIPm49" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.1.3/js/bootstrap.min.js" integrity="sha384-ChfqqxuZUCnJSK3+MXmPNIyE6ZbWh2IMqE241rYiqJxyMiZ6OW/JmZQ5stwEULTy" crossorigin="anonymous"></script>
<style>
body {font-family: arial, Helvetica, sans-serif; background-image:url(" https://previews.123rf.com/images/scienceboy123rf/scienceboy123rf1709/scienceboy123rf170900018/85115702-group-of-red-blood-cells-isolated-on-white-background-3d-rendering-.jpg")}
* {box-sizing: border-box;background-repeat:no-repeat;background-attachment:fixed;background-size:100% 100%}
.input-container {
display: -ms-flexbox; /* IE10 */
display: flex;
width: 100%;
margin-bottom: 10px;
}
.icon {
padding: 15px;
background: #2ECC71;
color: white;
min-width: 100px;
text-align: center;
}
.input-field {
width: 100%;
padding: 10px;
outline: none;
opacity: 0.8;
box-shadow: 8px 8px 5px black;
}
.input-field:focus {
border: 2px solid dodgerblue;
}
/* Set a style for the submit button */
.btn {
background-color: #ff5c3a;
color: white;
padding: 15px 20px;
border: none;
cursor: pointer;
width: 100%;
opacity: 0.8;
}
.btn:hover {
opacity: 5;
}
</style>
</head>
<body>
<form action="/dreg" method="POST">
<div class="container-fluid text-center bg-grey">
<b><h1 style="color:pink"></h1></b>
<div class="row text-center">
<div class="col-sm-6" style="color:pink">
<h2>Edit Profile</h2>
<div class="input-container col-sm-9">
<i class="fa fa-user icon"></i>
<input class="input-field" type="text" placeholder="Username" name="dusrnm" required>
</div>
<div class="input-container col-sm-9">
<i class="fa fa-envelope icon"></i>
<input class="input-field" type="email" placeholder="Email" name="demail" required>
</div>
<div class="input-container col-sm-9">
<i class="far fa-calendar icon"></i>
<input class="input-field" type="DOB" placeholder="Date of birth" name="ddob" required>
</div>
<div class="input-container col-sm-9 " required>
<i class="far fa-calendar icon"></i>
<select name="dage" required>
<option value=""> Select your age</option>
<option value=" 18">18</option>
<option value="19"> 19</option>
<option value="20"> 20</option>
<option value="21">21</option>
<option value="22"> 22</option>
<option value="23"> 23</option>
<option value="24"> 24</option>
<option value="25"> 25</option>
<option value="26"> 26</option>
<option value="27"> 27</option>
<option value="28"> 28</option>
<option value="29"> 29</option>
<option value="30"> 30</option>
<option value="31"> 31</option>
<option value="32"> 32</option>
<option value="33"> 33</option>
<option value="34"> 34</option>
<option value="35"> 35</option>
<option value="36"> 36</option>
<option value="37"> 37</option>
<option value="38"> 38</option>
<option value="39"> 39</option>
<option value="40"> 40</option>
<option value="41"> 41</option>
<option value="42"> 42</option>
<option value="43"> 43</option>
<option value="44"> 44</option>
<option value="45"> 45</option>
<option value="46"> 46</option>
<option value="47"> 47</option>
<option value="48"> 48</option>
<option value="49"> 49</option>
<option value="50"> 50</option>
</select>
</div>
<div class="input-container col-sm-9 " required>
<i class="far fa-genederless icon"></i>
<select name="Gender" required>
<option value=""> Gender</option>
<option value=" male">male</option>
<option value="female">female</option>
</select>
</div>
<div class="input-container col-sm-9 " required>
<i class="fa fa-plus-square icon"></i>
<select name="donor" required>
<option value=""> Select</option>
<option value=" blood">donor</option>
<option value="plasma"> plasma</option>
<option value="both">both</option>
</select>
</div>
<div class="input-container col-sm-9 " required>
<i class="fa fa-plus-square icon"></i>
<select name="dbg" required>
<option value=""> Select your Blood Group</option>
<option value=" A+">A+</option>
<option value="A-"> A-</option>
<option value="O+"> O+</option>
<option value="O-">O-</option>
<option value="B+"> B+</option>
<option value="B-"> B-</option>
<option value="AB+"> AB+</option>
<option value="AB-"> AB-</option>
</select>
</div>
<div class="input-container col-sm-9" required>
<i class="fa fa-map-marker icon"></i>
<select name="dlocality" required >
<option value=""> Select your Nearby Location</option>
<option value="LB Nagar"> LB Nagar</option>
<option value="Dilshuknagar"> Dilshuknagar</option>
<option value="Secundrabad"> Secundrabad</option>
<option value="Hitex City"> Hitex city</option>
<option value="Miyapur"> Miyapur</option>
<option value="Ghatkesar"> Ghatkesar</option>
<option value="Uppal"> Uppal</option>
<option value="Falauknama"> Falauknama</option>
<option value="Gachibowli"> Gachibowli</option>
<option value="Ibrahimpatnam"> Ibrahimpatnam</option>
<option value="Malakpet"> Malakpet</option>
<option value="Jeedimetla"> Jeedimetla</option>
<option value="kukatpally"> kukatpally</option>
<option value="Adilabad">Adilabad </option>
<option value="Bhadradri Kothagudem"> Bhadradri Kothagudem</option>
<option value="Jagityal"> Jagityal</option>
<option value="Jangaon"> Jangaon</option>
<option value="Jayashankar Bhupalpally"> Jayashankar Bhupalpally</option>
<option value="Gadwal"> Gadwal</option>
<option value="Kamareddy"> Kamareddy</option>
<option value="Karimnagar"> Karimnagar</option>
<option value="Khammam"> Khamman</option>
<option value="Komaram Bheem"> Komaram Bheem</option>
<option value="Mahabubabad"> Mahabubabad</option>
<option value="Mahabubnagar"> Mahabubnagar</option>
<option value="Mancherial"> Mancherial</option>
<option value="Medak"> Medak</option>
<option value="Medchal-Malkajgiri"> Medchal-Malkajgiri</option>
<option value="Mugulu">Mugulu</option>
<option value="Nagarkurnool"> Nagarkurnool</option>
<option value="Narayanpet"> Narayanpet</option>
<option value="Nalgonda"> Nalgonda</option>
<option value="Nirmal">Nirmal</option>
<option value="Nizamabad">Nizamabad</option>
<option value="Pedapelli"> Pedapelli</option>
<option value="Rajanna Sircilla"> Rajanna Sircilla</option>
<option value="Rangareddy"> Rangareddy</option>
<option value="Sangareddy"> Sangareddy</option>
<option value="Siddipet"> Siddipet</option>
<option value="Suryapet">Suryapet</option>
<option value="Vikarabad"> Vikarabad</option>
<option value="Wanaparthy">Wanaparthy</option>
<option value="Warangal">Warangal</option>
<option value="Yadadri Bhuvanagiri">Yadadri Bhuvanagiri</option>
</select>
</div>
<div class="input-container col-sm-9">
<i class="fa fa-mobile icon"></i>
<input class="input-field" type="tel" placeholder="Mobile Number" name="DNumber" maxlength="10" required>
</div>
<div class="col-sm-9">
<a href="/"><button type="submit" class="btn">Submit</button></a>
</div>
</form>
</div>
</body>
</html>
\ No newline at end of file
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