<html>
<head>
<title>加盟申请表</title>
<style type="text/css">
.c{color:blue;font-size:12px;}
.m{font-size:18px;}
p{font-size:24px}
#a{color:red;font-size:14px;}
</style>
</head>
<body>
<table border="0" width="750">
<tr>
<td><img src="apply_1.gif"><td>
</tr>
<tr>
<td><img src="apply_2.gif"></td>
<td><p>加盟申请表</p><br/><p class="c">注: 打*为必填项</p></td>
</tr>
<tr><td><p class="m">代理申请基本信息</p></td></tr>
<tr>
<td >申请人姓名<strong id="a">*</strong></td>
<td><input name="name" type="text" /></td>
</tr>
<td>籍贯<strong id="a">*</strong></td>
<td><select name="version" id="version">省
<option value="b">请选择....</option>
<option value="q">....</option>
</select>
<select name="version" id="version">区
<option value="b">请选择....</option>
<option value="q">其他</option>
</select></td>
<tr>
<td>性别<strong id="a">*</strong></td>
<td><input name="x" type="radio" value="nan" checked="checked" id="ma"><label for="ma">男 </label>
<input name="x" type="radio" value="nv" id="mv"><label for="mv">女</label><br/></td>
</tr>
<tr>
<td>身份证号<strong id="a">*</strong></td>
<td><input name="sfz" type="text" /></</td>
</tr>
<tr>
<td>联系地址<strong id="a">*</strong></td>
<td><input name="dizhi" type="text" /></td>
</tr>
<tr>
<td>电话<strong id="a">*</strong></td>
<td><input name="dizhi" type="text" /></td>
</tr>
<tr>
<td>电子邮件<strong id="a">*</strong></td>
<td><input name="dizhi" type="text" /></td>
</tr>
<tr>
<td>加盟地区<strong id="a">*</strong></td>
<td><input name="dizhi" type="text" /></td>
</tr>
<tr>
<td>你是从哪里了解到我们的？</td>
<td><input name="x" type="checkbox" value="na" checked="checked">报刊
<input name="x" type="checkbox" value="ga" >百度
<input name="x" type="checkbox" value="a" >广告
<input name="x" type="checkbox" value="n" >朋友介绍<br/>
</td>
</tr>
<tr>
<td> </td>
<td><p id="a"><input name="x" type="checkbox" value="k" >点击查看“Android”项目网上加盟免责声明
<a href="http://www.baidu.com">[点击查看]</a></p><br/>
<input type="submit" name="Button" value="提交"></td>
</tr>
</table>
</body>
</html>
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