Cancelado

Need to create an email list sign up form IN MYSPACE!

I need this to write the Name, Zipcode, DOB and State to a textfile on my server...

here is an example of what the form looks like

[url removed, login to view]

THIS MUST WORK ON MYSPACE!!!!!!!!!!!!!!!

I want a form code that works like:

<form action="link to page saying add was succesful" method="post" target="_blank">

<input type="hidden" name="signup_post" value="49706" />

<input type="hidden" name="emma_account_id" value="29463" />

<input type="hidden" name="username" value="remotekm" />

<input type="hidden" name="password" value="La1h78m*" />

<input type="hidden" name="group[6143542]" value="1" />

<tr>

<td valign="top"><table width="400" border="0" cellspacing="3" cellpadding="0">

<tr>

<td> first name </td> <td valign="top"><input name="emma_member_name_first" type="text" />

</td>

</tr>

<tr>

<td>last name</td> <td valign="top"><input name="emma_member_name_last" type="text" />

</td>

</tr>

<tr>

<td> email</b> </td> <td valign="top"><input name="emma_member_email" type="text" />

</td>

</tr>

<tr>

<td> DOB</td> <td valign="top"><select name="emma_member_dob[M]">

<option value=""> </option>

<option value="1">Jan</option>

<option value="2">Feb</option>

<option value="3">Mar</option>

<option value="4">Apr</option>

<option value="5">May</option>

<option value="6">Jun</option>

<option value="7">Jul</option>

<option value="8">Aug</option>

<option value="9">Sep</option>

<option value="10">Oct</option>

<option value="11">Nov</option>

<option value="12">Dec</option>

</select>

<select name="emma_member_dob[d]">

<option value=""> </option>

<option value="1">01</option>

<option value="2">02</option>

<option value="3">03</option>

<option value="4">04</option>

<option value="5">05</option>

<option value="6">06</option>

<option value="7">07</option>

<option value="8">08</option>

<option value="9">09</option>

<option value="10">10</option>

<option value="11">11</option>

<option value="12">12</option>

<option value="13">13</option>

<option value="14">14</option>

<option value="15">15</option>

<option value="16">16</option>

<option value="17">17</option>

<option value="18">18</option>

<option value="19">19</option>

<option value="20">20</option>

<option value="21">21</option>

<option value="22">22</option>

<option value="23">23</option>

<option value="24">24</option>

<option value="25">25</option>

<option value="26">26</option>

<option value="27">27</option>

<option value="28">28</option>

<option value="29">29</option>

<option value="30">30</option>

<option value="31">31</option>

</select>

<select name="emma_member_dob[Y]">

<option value=""> </option>

<option value="1930">1930</option>

<option value="1931">1931</option>

<option value="1932">1932</option>

<option value="1933">1933</option>

<option value="1934">1934</option>

<option value="1935">1935</option>

<option value="1936">1936</option>

<option value="1937">1937</option>

<option value="1938">1938</option>

<option value="1939">1939</option>

<option value="1940">1940</option>

<option value="1941">1941</option>

<option value="1942">1942</option>

<option value="1943">1943</option>

<option value="1944">1944</option>

<option value="1945">1945</option>

<option value="1946">1946</option>

<option value="1947">1947</option>

<option value="1948">1948</option>

<option value="1949">1949</option>

<option value="1950">1950</option>

<option value="1951">1951</option>

<option value="1952">1952</option>

<option value="1953">1953</option>

<option value="1954">1954</option>

<option value="1955">1955</option>

<option value="1956">1956</option>

<option value="1957">1957</option>

<option value="1958">1958</option>

<option value="1959">1959</option>

<option value="1960">1960</option>

<option value="1961">1961</option>

<option value="1962">1962</option>

<option value="1963">1963</option>

<option value="1964">1964</option>

<option value="1965">1965</option>

<option value="1966">1966</option>

<option value="1967">1967</option>

<option value="1968">1968</option>

<option value="1969">1969</option>

<option value="1970">1970</option>

<option value="1971">1971</option>

<option value="1972">1972</option>

<option value="1973">1973</option>

<option value="1974">1974</option>

<option value="1975">1975</option>

<option value="1976">1976</option>

<option value="1977">1977</option>

<option value="1978">1978</option>

<option value="1979">1979</option>

<option value="1980">1980</option>

<option value="1981">1981</option>

<option value="1982">1982</option>

<option value="1983">1983</option>

<option value="1984">1984</option>

<option value="1985">1985</option>

<option value="1986">1986</option>

<option value="1987">1987</option>

<option value="1988">1988</option>

<option value="1989">1989</option>

<option value="1990">1990</option>

<option value="1991">1991</option>

<option value="1992">1992</option>

<option value="1993">1993</option>

<option value="1994">1994</option>

<option value="1995">1995</option>

<option value="1996">1996</option>

<option value="1997">1997</option>

<option value="1998">1998</option>

<option value="1999">1999</option>

<option value="2000">2000</option>

<option value="2001">2001</option>

<option value="2002">2002</option>

<option value="2003">2003</option>

<option value="2004">2004</option>

<option value="2005">2005</option>

<option value="2006">2006</option>

<option value="2007">2007</option>

<option value="2008">2008</option>

<option value="2009">2009</option>

<option value="2010">2010</option>

<option value="2011">2011</option>

<option value="2012">2012</option>

<option value="2013">2013</option>

<option value="2014">2014</option>

<option value="2015">2015</option>

<option value="2016">2016</option>

<option value="2017">2017</option>

<option value="2018">2018</option>

<option value="2019">2019</option>

<option value="2020">2020</option>

</select></td>

</tr>

<tr>

<td> state</td>

<td valign="top"><select name="emma_member_state">

<option value=""></option>

<option value="AK">AK</option>

<option value="AL">AL</option>

<option value="AR">AR</option>

<option value="AS">AS</option>

<option value="AZ">AZ</option>

<option value="CA">CA</option>

<option value="CO">CO</option>

<option value="CT">CT</option>

<option value="DC">DC</option>

<option value="DE">DE</option>

<option value="FL">FL</option>

<option value="GA">GA</option>

<option value="GU">GU</option>

<option value="HI">HI</option>

<option value="IA">IA</option>

<option value="ID">ID</option>

<option value="IL">IL</option>

<option value="IN">IN</option>

<option value="KS">KS</option>

<option value="KY">KY</option>

<option value="LA">LA</option>

<option value="MA">MA</option>

<option value="ME">ME</option>

<option value="MD">MD</option>

<option value="MI">MI</option>

<option value="MN">MN</option>

<option value="MO">MO</option>

<option value="MS">MS</option>

<option value="MT">MT</option>

<option value="NC">NC</option>

<option value="ND">ND</option>

<option value="NE">NE</option>

<option value="NH">NH</option>

<option value="NJ">NJ</option>

<option value="NM">NM</option>

<option value="NV">NV</option>

<option value="NY">NY</option>

<option value="OH">OH</option>

<option value="OK">OK</option>

<option value="OR">OR</option>

<option value="PA">PA</option>

<option value="PR">PR</option>

<option value="RI">RI</option>

<option value="SC">SC</option>

<option value="SD">SD</option>

<option value="TN">TN</option>

<option value="TX">TX</option>

<option value="UT">UT</option>

<option value="VA">VA</option>

<option value="VT">VT</option>

<option value="WA">WA</option>

<option value="WI">WI</option>

<option value="WV">WV</option>

<option value="WY">WY</option>

</select></td>

</tr>

</table>

*required </td>

<td></td>

</tr>

<tr>

<td colspan="3" align="center" valign="top"><input type="submit" name="Submit" value="signup" /> </td>

</tr>

</form>

Habilidades: Flex, Java, PHP, Design de Sites, XML

Veja mais: www nj com, work wa, what is an ia, top group, sign up code in java, php create table, n. y. post, ny and co, mn works, ma code, la works, i want to sign up, in.com sign in, create www com, create www, create table php, work sign, pa id, md n, up works

Acerca do Empregador:
( 12 comentários ) Raleigh, United States

ID do Projeto: #461206

2 freelancers estão ofertando em média $250 para esse trabalho

sam45

hi, i can do this, please see pm :)

$250 USD em 1 dia
(104 Comentários)
6.4
cygital

Ready to do this.

$250 USD in 2 dias
(38 Comentários)
6.1