---

<html>
<head>
<title>User Registration</title>
</head>
<body>

<h1>USER REGISTRATION</h1>
* Required Fields<br><br>

<form>
<label>First Name *</label><br>
<input type="text" name="firstname"><br>

<label>Last Name *</label><br>
<input type="text" name="lastname"><br>

<label>E-Mail *</label><br>
<input type="text" name="email"><br>

<label>Zip Code *</label><br>
<input type="text" name="zip"><br>

<label>User Name *</label><br>
<input type="text" name="username"><br>

<label>Password *</label><br>
<input type="password" name="pass"><br>

<label>Confirm Password *</label><br>
<input type="password" name="confpass"><br><br>

<label>What music are you interested in?</label><br>
<input type="checkbox" name="music1" value="Rock"><label>Rock</label>
<input type="checkbox" name="music2" value="Pop"><label>Pop</label>
<input type="checkbox" name="music3" value="Bluegrass"><label>Bluegrass</label><br>
<input type="checkbox" name="music4" value="Blues"><label>Blues</label>
<input type="checkbox" name="music5" value="Jazz"><label>Jazz</label>
<input type="checkbox" name="music6" value="Country"><label>Country</label><br><br>

<label>Would you like to receive e-mail notifications on our special sales?</label><br>
<input type="radio" name="notify" value="Yes" checked><label>Yes</label>
<input type="radio" name="notify" value="No"><label>No</label><br><br>

<input type="submit" value="Submit">
<input type="reset" value="Reset">
</form>

</body>
</html>