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<script type="text/javascript" language="javascript" src="../js/jquery-1.7.1.js"></script>
<script type="text/javascript" language="javascript" src="../js/scriptFile.js"></script>
<script type="text/javascript" language="javascript" src="../js/scriptLga.js"></script>
<script type="text/javascript" language="javascript" src="../js/scriptPicture.js"></script>
<div id="TabbedPanels1" class="TabbedPanels">
<ul class="TabbedPanelsTabGroup">
<li class="TabbedPanelsTab" tabindex="0">Personal Data</li>
<li class="TabbedPanelsTab" tabindex="1">Sponsor's Data</li>
<li class="TabbedPanelsTab" tabindex="2">School Attended</li>
<li class="TabbedPanelsTab" tabindex="3">O'Level Result</li>
</ul>
<div class="TabbedPanelsContentGroup">
<div class="TabbedPanelsContent">
<table width="80%" align="center" cellpadding="3" cellspacing="5">
<tr>
<td><fieldset>
<legend>Form</legend>
<form action="apply_process.php" method="post" enctype="multipart/form-data" name="form1" id="form1">
<table width="100%" cellspacing="5" cellpadding="3">
<tr>
<td>Programme</td>
<td> </td>
<td><b><?php echo $_SESSION['type'];?>
<input type="hidden" name="level" id="level" value="<?php echo $_SESSION['type'];?>" />
</b></td>
<td rowspan="3" id="load"><p> </p>
<p>
<label for="fileField"></label>
</p></td>
</tr>
<tr>
<td>School</td>
<td> </td>
<td><label for="mStatus"></label>
<select name="txtschools" id="school">
<?php
require('../connect.php');
$query="SELECT distinct dSchool FROM dept";
$rs=mysql_query($query);
echo '<option>'.'Select Option...'.'</option>';
for($i=0;$i<mysql_num_rows($rs);$i++){
$row=mysql_fetch_row($rs);
echo '<option>'.$row[0].'</option>';
}
?>
</select></td>
</tr>
<tr>
<td>Department</td>
<td> </td>
<td id="dept"><select name="dept" id="dept">
<option>Select Option...</option>
</select></td>
</tr>
<tr>
<td>Surname</td>
<td> </td>
<td><label for="surname"></label>
<input type="text" name="surname" id="surname" required="required" /></td>
<td id="load"><label for="fileField">
<input type="hidden" name="MAX_FILE_SIZE2" value="1000000" />
<input type="hidden" name="username1" id="username1" />
<input name="user_file1" type="file" id="user_file1" />
<br />
*Passport must be JPEG format and not more than 50KB. </label></td>
</tr>
<tr>
<td>Other Names</td>
<td> </td>
<td colspan="2"><input type="text" name="otherName" id="otherName" required="required" /></td>
</tr>
<tr>
<td colspan="4">
<?php
if ($_SESSION['type'] =='POST UTME'){
?>
<table width="100%" align="left" cellpadding="3" cellspacing="5">
<tr>
<td width="20%">Jamb Reg No</td>
<td width="2%"> </td>
<td width="78%"><label for="ndMatNo"></label>
<input type="text" name="jambNo" id="jambNo" /></td>
</tr>
<tr>
<td>Jamb Score</td>
<td> </td>
<td><span id="sprytextfield4">
<label for="ndResult"></label>
<input type="text" name="jambScore" id="jambScore" />
<span class="textfieldRequiredMsg">A value is required.</span><span class="textfieldInvalidFormatMsg">Invalid format.</span><span class="textfieldMinValueMsg">The entered value is less than the minimum required.</span><span class="textfieldMaxValueMsg">The entered value is greater than the maximum allowed.</span></span></td>
</tr>
</table>
<?php
}
?>
<?php
if ($_SESSION['type'] =='Higher Diploma FT'){
?>
<table width="100%" align="left" cellpadding="3" cellspacing="5">
<tr>
<td width="20%">ND Matric Number</td>
<td width="3%"> </td>
<td width="77%"><label for="ndMatNo"></label>
<input type="text" name="ndMatNo" id="ndMatNo" /></td>
</tr>
<tr>
<td>ND Grade</td>
<td> </td>
<td><label for="ndResult"></label>
<select name="ndResult" id="ndResult">
<option>Distinction</option>
<option>Upper Credit</option>
<option>Lower Credit</option>
<option>Pass</option>
</select></td>
</tr>
</table>
<?php
}
?>
</td>
</tr>
<tr>
<td>Sex</td>
<td> </td>
<td colspan="2"><label for="sex"></label>
<select name="sex" id="sex">
<option>Male</option>
<option>Female</option>
</select></td>
</tr>
<tr>
<td>Nationality</td>
<td> </td>
<td colspan="2"><input type="text" name="nationality" id="nationality" required="required" /></td>
</tr>
<tr>
<td>State of Origin</td>
<td> </td>
<td colspan="2"><select name="txtstate" id="state">
<?php
require('../connect.php');
$query="SELECT distinct state FROM states";
$rs=mysql_query($query);
echo '<option>'.'Select Option...'.'</option>';
for($i=0;$i<mysql_num_rows($rs);$i++){
$row=mysql_fetch_row($rs);
echo '<option>'.$row[0].'</option>';
}
?>
</select></td>
</tr>
<tr>
<td>Local Govt. Area</td>
<td> </td>
<td colspan="2" id="lga"><select name="lga" id="lga">
<option>Select Option...</option>
</select></td>
</tr>
<tr>
<td>Home Town</td>
<td> </td>
<td colspan="2"><input type="text" name="town" id="town" required="required" /></td>
</tr>
<tr>
<td>Marital Status</td>
<td> </td>
<td colspan="2"><label for="mStatus"></label>
<select name="mStatus" id="mStatus">
<option>Single</option>
<option>Married</option>
<option>Divorce</option>
<option>Separate</option>
<option>Widow</option>
</select></td>
</tr>
<tr>
<td>Religion</td>
<td> </td>
<td colspan="2"><label for="religion"></label>
<select name="religion" id="religion">
<option>Christianity</option>
<option>Islam</option>
<option>Traditional</option>
<option>Others</option>
</select></td>
</tr>
<tr>
<td>Contact Address</td>
<td> </td>
<td colspan="2"><label for="address"></label>
<textarea name="address" id="address" cols="25" rows="3"></textarea></td>
</tr>
<tr>
<td>E-mail</td>
<td> </td>
<td colspan="2"><span id="sprytextfield1">
<label for="email"></label>
<input type="text" name="email" id="email" />
<span class="textfieldRequiredMsg">A value is required.</span><span class="textfieldInvalidFormatMsg">Invalid format.</span></span></td>
</tr>
<tr>
<td>Phone Number</td>
<td> </td>
<td colspan="2"><span id="sprytextfield2">
<label for="phoneNo"></label>
<input type="text" name="phoneNo" id="phoneNo" />
<span class="textfieldRequiredMsg">A value is required.</span><span class="textfieldInvalidFormatMsg">Invalid format.</span></span></td>
</tr>
<tr>
<td>Date of Birth</td>
<td> </td>
<td colspan="2"><span id="sprytextfield3">
<label for="dob"></label>
<input type="text" name="dob" id="dob" />
<span class="textfieldRequiredMsg">A value is required.</span><span class="textfieldInvalidFormatMsg">Invalid format.</span></span></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td colspan="2"><input type="submit" name="button3" id="button3" value="Save" /></td>
</tr>
</table>
</form>
</fieldset></td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="80%" align="center" cellpadding="3" cellspacing="5">
<tr>
<td><form id="form2" name="form2" method="post" action="apply_process2.php">
<table width="100%" cellspacing="5" cellpadding="3">
<tr>
<td>Parent/Guardian's Name</td>
<td> </td>
<td><input type="text" name="name1" id="name1" required="required" /></td>
</tr>
<tr>
<td>Parent/Guardian's Address</td>
<td> </td>
<td><label for="address1"></label>
<textarea name="address1" id="address1" cols="25" rows="3"></textarea></td>
</tr>
<tr>
<td>Parent/Guardians' Phone Number</td>
<td> </td>
<td><span id="sprytextfield6">
<label for="gsm1"></label>
<input type="text" name="gsm1" id="gsm1" />
<span class="textfieldInvalidFormatMsg">Invalid format.</span></span></td>
</tr>
<tr>
<td>Next of Kin's Name</td>
<td> </td>
<td><input type="text" name="name2" id="name2" required="required" /></td>
</tr>
<tr>
<td>Next of Kin's Address</td>
<td> </td>
<td><textarea name="address2" id="address2" cols="25" rows="3"></textarea></td>
</tr>
<tr>
<td>Next of Kin's Phone Number</td>
<td> </td>
<td><span id="sprytextfield5">
<label for="gsm2"></label>
<input type="text" name="gsm2" id="gsm2" />
<span class="textfieldInvalidFormatMsg">Invalid format.</span></span></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td><input type="submit" name="button4" id="button4" value="Save" /></td>
</tr>
</table>
</form></td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<form id="form3" name="form3" method="post" action="">
<table width="80%" align="center" cellpadding="3" cellspacing="5">
<tr>
<td><table width="100%" cellspacing="5" cellpadding="3">
<tr>
<td>Secondary School Name</td>
<td> </td>
<td><input type="text" name="sname" id="sname" required="required" /></td>
</tr>
<tr>
<td>Year Started</td>
<td> </td>
<td><label for="select41"></label>
<select name="sfrom" id="sfrom">
<?php
for ($i=2000;$i<=2015;++$i){ echo '<option>'.$i.'</option>';}?>
</select></td>
</tr>
<tr>
<td>Year of Graduation</td>
<td> </td>
<td><label for="select42"></label>
<select name="sto" id="sto">
<?php
for ($i=2000;$i<=2015;++$i){ echo '<option>'.$i.'</option>';}?>
</select></td>
</tr>
<tr>
<td> </td>
<td colspan="2"><input type="submit" name="button" id="button" value="Save" /></td>
</tr>
</table></td>
</tr>
</table>
</form>
</div>
<div class="TabbedPanelsContent">
<form id="form4" name="form4" method="post" action="">
<table width="100%" cellspacing="5" cellpadding="3">
<tr>
<td>Exam Type</td>
<td><select name="select37" id="select37">
<option>WAEC</option>
<option>NECO</option>
<option>NABTEB</option>
<option selected="selected">Select Type</option>
</select></td>
<td><label for="select37"></label></td>
<td>Exam Type</td>
<td><select name="select38" id="select38">
<option>WAEC</option>
<option>NECO</option>
<option>NABTEB</option>
<option selected="selected">Select Type</option>
</select></td>
</tr>
<tr>
<td>Exam Date</td>
<td>Month
<label for="select43"></label>
<select name="select43" id="select43">
<?php
for ($i=1;$i<=12;++$i){ echo '<option>'.$i.'</option>';}?>
</select>
Year
<label for="select44"></label>
<select name="select44" id="select44">
<?php
for ($i=2000;$i<=2015;++$i){ echo '<option>'.$i.'</option>';}?>
</select></td>
<td> </td>
<td>Exam Date</td>
<td>Month
<label for="select43"></label>
<select name="select45" id="select43">
<?php
for ($i=1;$i<=12;++$i){ echo '<option>'.$i.'</option>';}?>
</select>
Year
<label for="select44"></label>
<select name="select45" id="select44">
<?php
for ($i=2000;$i<=2015;++$i){ echo '<option>'.$i.'</option>';}?>
</select></td>
</tr>
<tr>
<td>Exam Number</td>
<td><label for="textfield"></label>
<input type="text" name="textfield" id="textfield" required="required" /></td>
<td> </td>
<td>Exam Number</td>
<td><input type="text" name="textfield2" id="textfield2" required="required" /></td>
</tr>
<tr>
<td colspan="2" valign="top"><table width="100%" cellspacing="5" cellpadding="3">
<tr>
<td>1</td>
<td><label for="select19"></label>
<select name="select19" id="select19">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><label for="select"></label>
<select name="select" id="select">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>2</td>
<td><select name="select20" id="select20">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select2" id="select2">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>3</td>
<td><select name="select21" id="select21">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select3" id="select3">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>4</td>
<td><select name="select22" id="select22">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select4" id="select4">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>5</td>
<td><select name="select23" id="select23">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select12" id="select12">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>6</td>
<td><select name="select24" id="select24">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select13" id="select13">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>7</td>
<td><select name="select25" id="select25">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select14" id="select14">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>8</td>
<td><select name="select26" id="select26">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select15" id="select15">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>9</td>
<td><select name="select27" id="select27">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select16" id="select16">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
</table></td>
<td bgcolor="#FFFFFF"> </td>
<td colspan="2" valign="top"><table width="100%" cellspacing="5" cellpadding="3">
<tr>
<td>1</td>
<td><select name="select28" id="select28">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select5" id="select5">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>2</td>
<td><select name="select29" id="select29">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select6" id="select6">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>3</td>
<td><select name="select30" id="select30">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select7" id="select7">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>4</td>
<td><select name="select31" id="select31">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select8" id="select8">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>5</td>
<td><select name="select32" id="select32">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select9" id="select9">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>6</td>
<td><select name="select33" id="select33">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select10" id="select10">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>7</td>
<td><select name="select34" id="select34">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select11" id="select11">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>8</td>
<td><select name="select35" id="select35">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select17" id="select17">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td>9</td>
<td><select name="select36" id="select36">
<option selected="selected">Select Subject</option>
<?php
require_once('../connect.php');
$sql="select * from olevelcourses";
$result=mysql_query($sql);
$num=mysql_num_rows($result);
$i=0;
while($i<$num){
?>
<option>
<?php echo mysql_result($result,$i,'subject');?>
</option>
<?php
$i++;
}
?>
</select></td>
<td><select name="select18" id="select18">
<option>A1</option>
<option>B2</option>
<option>B3</option>
<option>C4</option>
<option>C5</option>
<option>C6</option>
<option>D7</option>
<option>E8</option>
<option>F9</option>
<option>AR</option>
<option selected="selected"> </option>
</select></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td><input type="submit" name="button2" id="button2" value="Save" /></td>
</tr>
</table></td>
</tr>
</table>
</form>
</div>
</div>
</div>
<script type="text/javascript">
var TabbedPanels1 = new Spry.Widget.TabbedPanels("TabbedPanels1");
var sprytextfield1 = new Spry.Widget.ValidationTextField("sprytextfield1", "email", {validateOn:["blur"]});
var sprytextfield2 = new Spry.Widget.ValidationTextField("sprytextfield2", "custom", {pattern:"0000-000-0000", validateOn:["blur"], useCharacterMasking:true});
var sprytextfield3 = new Spry.Widget.ValidationTextField("sprytextfield3", "date", {useCharacterMasking:true, format:"yyyy/mm/dd", validateOn:["change"]});
var sprytextfield4 = new Spry.Widget.ValidationTextField("sprytextfield4", "integer", {minValue:0, maxValue:400, validateOn:["blur"]});
var sprytextfield5 = new Spry.Widget.ValidationTextField("sprytextfield5", "phone_number", {format:"phone_custom", pattern:"0000-000-0000", useCharacterMasking:true, validateOn:["blur"], isRequired:false});
var sprytextfield6 = new Spry.Widget.ValidationTextField("sprytextfield6", "phone_number", {format:"phone_custom", pattern:"0000-000-0000", useCharacterMasking:true, validateOn:["blur"], isRequired:false});
</script>