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杏林同学录(八)
作者:采集员 文章来源:来源于网络 点击数: 更新时间:2005-9-10 14:36:02
;      <option>1972</option>
            <option>1971</option>
            <option>1970</option>
            <option>1969</option>
            <option>1968</option>
            <option>1967</option>
            <option>1966</option>
            <option>1965</option>
            <option>1964</option>
            <option>1963</option>
            <option>1962</option>
            <option>1961</option>
            <option>1960</option>
            <option>1959</option>
            <option>1958</option>
            <option>1957</option>
            <option>1956</option>
            <option>1955</option>
            <option>1954</option>
          </select>
          年  
          <select name='month'>
            <option selected>01</option>
            <option>02</option>
            <option>03</option>
            <option>04</option>
            <option>05</option>
            <option>06</option>
            <option>07</option>
            <option>08</option>
            <option>09</option>
            <option>10</option>
            <option>11</option>
            <option>12</option>
          </select>
          月  
          <select name='day'>
            <option selected>01</option>
            <option>02</option>
            <option>03</option>
            <option>04</option>
            <option>05</option>
            <option>06</option>
            <option>07</option>
            <option>08</option>
            <option>09</option>
            <option>10</option>
            <option>11</option>
            <option>12</option>
            <option>13</option>
            <option>14</option>
            <option>15</option>
            <option>16</option>
            <option>17</option>
            <option>18</option>
            <option>19</option>
            <option>20</option>
            <option>21</option>
            <option>22</option>
            <option>23</option>
            <option>24</option>
            <option>25</option>
            <option>26</option>
            <option>27</option>
            <option>28</option>
            <option>29</option>
            <option>30</option>
            <option>31</option>
          </select>
          日<br>
          工作单位:  
          <input type='Text' name='work' size='30' maxlength='50'>
          <br>
          通讯地址:  
          <input type='Text' name='ad' size='30' maxlength='50'>
          <br>
          邮编:  
          <input type='Text' name='post' size='6' maxlength='6'>
          <br>
          电话:  
          <input type='Text' name='ph' size='15' maxlength='30'>
          <br>
          传呼:  
          <input type='Text' name='bp' size='15' maxlength='20'>
          <br>
          Email:  
          <input type='Text' name='email' size='15' maxlength='35'>
          <br>
          oicq:  
          <input type='Text' name='oicq' size='12' maxlength='12'>
          <br>
           </td> </tr> </table>
             <div align="center">
          <br>
          <input type='Submit' name='submit' value='提交'>
          <input type='reset' name='Reset' value='重写 '>
        </div>
      </form>

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