Viewing file: AddThperson.php (41.08 KB) -rw-r--r-- Select action/file-type: (+) | (+) | (+) | Code (+) | Session (+) | (+) | SDB (+) | (+) | (+) | (+) | (+) | (+) |
<?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">
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"> </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"> </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">ÊѪҵ</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"> </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"> </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("homeDistrictTable.php","test","width = 550, height=350,scrollbars=yes")' />
<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"> </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"> </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"> </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>
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<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"> </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"> </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"> </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> </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> </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"> </font></td>
<td> </td>
</tr>
<tr>
<td bgcolor="#ECF5FF"> </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] $rs2[Teacher_name] $rs2[Teacher_lastname]</b></option>\n";
}
?>
</select>
</strong></font></font></td>
<td> </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] $rs2[Name] $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%"> </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> </td>
<td> </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"> </font></td>
<td> </td>
<td> </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"> </font></td>
<td width="26%"> </td>
<td> </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"> </font><font size="2" face="Tahoma"> </font></td>
<td> </td>
<td> </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"> </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" />
<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>
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