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<title>Rekrutacja</title>
<head>
<center>
<font size="7" color="#0000CC">Czy byliby państwo zainteresowani mangą Blame?</font>
</center>
</head>
<body background="123.png">
<form action="mailto:[email protected]" method=post">
<b><font size="4">Dane:</font></b><br>
<b>Podaj imie i naziwsko:</b><br>
<input name="adres" value="" size="30"><br><br>
<fieldset>
<legend align="left">Wiek:</legend><br>
<label>1-35<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>36-50<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>51 i wiecej<input type="radio" name="opcje" maxlenght="1"><br>
</label>
</label><br>
</fieldset>
<br>
<fieldset>
<legend align="left">Płeć:</legend><br>
<label>Kobieta<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>Mężczyzna<input type="radio" name="opcje" maxlenght="1"><br>
</label>
</label><br>
</fieldset>
<br>
<fieldset>
<legend align="left">Czy byliby państwo zainteresowani kupnem?</legend><br>
<label>Tak<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>Nie<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>Nie wiem<input type="radio" name="opcje" maxlenght="1"><br>
</label>
</fieldset>
<br>
<fieldset>
<legend align="left">Miejsce zamieszkania:</legend><br>
<label>Wieś<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>Miasto do 10 000 mieszkańców <input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>Miasto powyżej 10 0000 mieszkańców<input type="radio" name="opcje" maxlenght="1"><br>
</label><br>
</fieldset>
<br>
<fieldset>
<legend align="left">Czy mieli państwo styczność z japońskimi komiksami wcześniej?</legend><br>
<label>Tak<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>Nie<input type="radio" name="opcje" maxlenght="1"><br>
</label>
</fieldset>
<br>
<fieldset>
<legend align="left">W jakiej cenie byliby państwo zainteresowani kupnem Blame!?</legend><br>
<label>15-30zł<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<label>30+<input type="radio" name="opcje" maxlenght="1"><br>
</label>
<br>
</fieldset>
<br>
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