<html><head><title>ํผ ์ฐ์ต</title></head><body ><form >
<table background="bg5.gif" width="601" cellspacing=0 cellpadding=0 border=0 align=center><tr><td>
<table cellspacing=0 cellpadding=5 width="100%" border=1>
<tr><td >์ ๋ชฉ </td><td colspan=4><input type="text" size=60> </td></tr>
<tr><td >์์ด๋</td> <td ><input type="text" size=15> </td>
<td >๋น๋ฐ<br>๋ฒํธ</td><td ><input type="password" size=15> </td>
<td rowspan=5 ></td></tr><tr><td>์ฃผ๋ฏผ<br>๋ฒํธ</td><td>
<input type="text" size=6>-<input type="text" size=7></td>
<td >๋ฉ์ผ<br>์ฃผ์ </td><td ><input type="text" size=20></td></tr>
<tr><td >์คํผ์ค</td> <td >
<input type="text" size=3>- <input type="text" size=4>-
<input type="text" size=4></td><td>ํธ๋ํฐ </td>
<td ><select>
<option>011<option>010<option>016<option>017<option>019</select>-
<input type="text" size=4>-<input type="text" size=4></td></tr>
<tr><td>๊ด์ฌ <br>๋ถ์ผ</td>
<td colspan=3 ><input name = "๊ด์ฌ๋ถ์ผ" type="radio">๋ถ๋์ฐ<input name = "๊ด์ฌ๋ถ์ผ" type="radio">์ํฐํ
์ธ๋จผํธ
<input name = "๊ด์ฌ๋ถ์ผ" type="radio">์ฌํํฌ<input name = "๊ด์ฌ๋ถ์ผ" type="radio">๊ฒฐํผ
<input name = "๊ด์ฌ๋ถ์ผ" type="radio">ํ์
๋ฐ ์ง๋ก</td></tr>
<tr><td>์๋ด<br>๋ด์ฉ</td><td colspan=3>
<textarea rows="5" cols="65"></textarea></td></tr></table></td></tr>
<tr ><td align=middle> ์๋ด ์ ์ฒญ ๋ด์ฉ์ ์ ์ํ ์ฒ๋ฆฌํ์ฌ ํต๋ณดํด ๋๋ฆฝ๋๋ค.
</td></tr></table></form></body></html>