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I need a custom web site PHP Registration Form

Need a custom web site PHP Registration Form, example at .... [url removed, login to view]

Doctor's Full Name:

(First Name, Middle Initial, Last Name)

Office Street Address:

City / State / Zip Code:

Office Telephone:

Home Telephone:

Cell Phone:

Email Address:

Confirm Email:

Password:

Comfirm Password:

Once the above information is confirmed, you will be issued a UserName by email.

Kemahiran: Javascript, PHP, Reka Bentuk Laman Web

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Tentang Majikan:
( 11 ulasan ) Raleigh, United States

ID Projek: #1591079

17 pekerja bebas membida secara purata $51 untuk pekerjaan ini

websree

Easy work. We are ready to do it.

$30 USD dalam sehari
(227 Ulasan)
8.0
sritechnocrat

Sri Technocrat is marvelous in its quality. We have been maintaining the quality in every field whether it is services or training. We have proved our stability. We have been working with the same grace & quality. Our Lagi

$30 USD dalam sehari
(71 Ulasan)
7.4
freeworks

hi,i saw your project description. I will do that on time. I will do custom design and coding for you. Please check my profile and portfolio. thanks

$40 USD dalam 0 hari
(223 Ulasan)
7.1
xpertzdevelopers

lets start...:))

$30 USD dalam sehari
(33 Ulasan)
5.9
AdamsK

Ready for service sir, thanks.

$30 USD dalam sehari
(95 Ulasan)
5.7
Wyeoh

Hello, I can help you code up this form in javascript and php to handle the backend. I have more question regarding this project, can you please check your inbox? Thank you.

$35 USD dalam sehari
(41 Ulasan)
5.4
designguru47

Hi, please check pMB

$39 USD dalam sehari
(36 Ulasan)
5.4
tooltor

Expert programer here, please read the private message.

$30 USD dalam sehari
(41 Ulasan)
5.3
Butterfly718

Hello,sir. I can help you. Let's start.

$50 USD dalam sehari
(39 Ulasan)
5.0
dreamcorner

please see pmb

$30 USD dalam sehari
(31 Ulasan)
5.0
serpentscode

Hello, I can deliver today the project.\ Let's start!

$30 USD dalam 0 hari
(34 Ulasan)
4.8
mahmed0715

hello sir,i wanna do this easy job.see inbox for more details.

$30 USD dalam 0 hari
(1 Ulasan)
1.8
naveenchanti

Hi, I can do this project, i have 3+ years experience in PHP,MySQL, JQuery,HTML,CSS. i work hard to complete the project as soon as possible.

$30 USD dalam sehari
(1 Ulasan)
0.0
kaptanzaman

Hi, i want to work your job, if you select me for the position. Thanks

$56 USD dalam 2 hari
(0 Ulasan)
0.0
GLA504oaH

Pls check PMB.

$250 USD dalam sehari
(0 Ulasan)
0.0
akbaralimughal

HI, You need a webpage (Registration form) in which you want to get some information and generate a user name and email to the email address provided. I am a web developer at Rolus Tech. I have 1 year of experience Lagi

$50 USD dalam 2 hari
(0 Ulasan)
0.0
barua

Hello sir, i already have half of the work done. I am fresher so applying for feedback,give me the chance. Regards shawon

$30 USD dalam 2 hari
(0 Ulasan)
0.0
faria4

i can do ths work.i already did ths work many times.waitng for ur response.

$30 USD dalam sehari
(0 Ulasan)
0.0
simon4u92

Easy Task for someone well versed with PHP-MySQL like me!

$80 USD dalam 2 hari
(0 Ulasan)
0.0