Men over 50 can sign this form !
Name:
/>
</label>
<label for="email" id="email-label"
><p>Email:</p>
<Input
type="email"
id="email"
placeholder="required"
required
/>
</label>
<label for="age" id="number-label"
><p>Age<em>(optional)</em>:</p>
<input
type="number"
id="number"
placeholder= required
min="66"
max="50"
/>
</label>
<label for="interest" id="interest-label"
><p>which wheelchair do you need?</p>
<select id="dropdown">
<option selected disabled hidden></option>
<option id="Small">Small</option>
<option id="medium">medium</option>
<option id="large">large</option>
<option id="exrta large">exrta large</option>
</select>
</label>
<p>Are you over 50?</p>
<label for="yes">
<input
id="togepi"
type="radio"
name="favorite"
value="togepi"
/>yes
</label>
<label for="no">
<input
id="pikachu"
type="radio"
name="favorite"
value="pikachu"
/>no
</label>
<label for="other">
<input id="other" type="radio" name="favorite" value="other" />Other
</label>
<p>Do you rather online or come to the store?</p>
<label for="store">
<input
id="newsletter"
type="checkbox"
name="communications"
value="newsletter"
/>store
</label>
<label for="online">
<input
id="events"
type="checkbox"
name="communications"
value="events"
/>online
</label>
<label for="either">
<input
id="updates"
type="checkbox"
name="communications"
value="updates"
/>either
</label>
<p>Any other information you would like to share?</p>
<textarea id="additional-information" rows="4" cols="50">
You can provide comments, suggestions, or feedback here.</textarea >
Please note: This form is a proof of concept. Submitting the form will not actually transmit your data.
Submit Return to Project List | Return to HomePagemain { text-align: center; background-color: #92869c; background-blend-mode: lighten; max-width: 500px; margin: 20px auto; border-radius: 50px; box-shadow: 10px 10px rgba(0, 0, 0, 0.5); color: black; } body { text-align: center; background: #3a3240; color: white; } input, textarea, select, button { background: #3a3240; color: white; } a { color: white; }