CPS 530 Lab 4 Part B: Customer Registration Page

Author: Dante Romita
Contact: dante.romita@ryerson.ca

Name:

What is your first name?
What is your last name?

Address:

What is your street name?
What is your city?
What is your postal code? Enter 6 characters without any spaces.

Gender:

What is your gender? Check all that apply OR type your gender in the "Other" field OR leave all options blank if you prefer not to say.

Male: | Female: | Non-Binary: | Gender-Fluid: | Agender:
Other:

Contact Info:

What is your email? (Ensure it has an @ symbol)
What is your phone number? Numbers only. No spaces, dashes or brackets.

Password:

Enter A Password: