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REGISTERprotoplasma.html
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REGISTERprotoplasma.html
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<!doctype html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.5.2/css/bootstrap.min.css"
integrity="sha384-JcKb8q3iqJ61gNV9KGb8thSsNjpSL0n8PARn9HuZOnIxN0hoP+VmmDGMN5t9UJ0Z" crossorigin="anonymous">
<title>Plasma Donation</title>
</head>
<body>
<nav class="navbar navbar-expand-lg navbar-dark bg-primary">
<a class="navbar-brand" href="/index.html" style="max-width: 4%;">
<img src="/hospi.png" class="img-fluid">
</a>
<button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarNav"
aria-controls="navbarNav" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse" id="navbarNav">
<ul class="navbar-nav">
<li class="nav-item">
<a class="nav-link" href="/index.html">Home</a>
</li>
<li class="nav-item active">
<a class="nav-link" href="/REGISTERprotoplasma.html">Donate plasma<span class="sr-only">(current)</span></a>
</li>
<li class="nav-item">
<a class="nav-link" href="/REQUESTprotoplasma.html">Search Donors</a>
</li>
<li class="nav-item">
<a class="nav-link" href="/ADMINlogin.html">Admin</a>
</li>
</ul>
</div>
</nav>
<div class="d-flex align-items-center justify-content-center h-100">
</div>
<div class="container col-5 mt-lg-4">
<h1 class="text-danger">Plasma Registration</h1>
<form action="/enterdata.php" method="POST">
<div class="form-group">
<label for="exampleInputname1">Name</label>
<input type="text" class="form-control" id="exampleInputname" placeholder="Enter name" name="first_name" required>
</div>
<div class="form-group">
<label for="exampleInputnumber">Number</label>
<input type="Number" class="form-control" id="exampleInputnumber" placeholder="Enter number" name="mob_number" required>
</div>
<div class="form-group">
<label for="exampleInputEmail1">Email address</label>
<input type="email" class="form-control" id="exampleInputEmail1" aria-describedby="emailHelp"
placeholder="Enter email" name="email_id" required>
</div>
<div class="form-group">
<label for="exampleFormControlSelect1">Blood group</label>
<select class="form-control" id="exampleFormControlSelect1" name="blood_group" required>
<option>A+</option>
<option>A-</option>
<option>B+</option>
<option>B-</option>
<option>O+</option>
<option>O-</option>
<option>AB+</option>
<option>AB-</option>
</select>
</div>
<div class="form-group">
<label for="exampleFormControlInput3">Recovered Date</label>
<input type="date" class="form-control" id="exampleFormControlInput1" name="recovered_date" required>
</div>
<button type="submit" class="btn btn-primary">Submit</button>
</form>
</div>
</body>
</html>