<script src="http://jotform.com/js/form.js?v2.0.772" type="text/javascript"></script><style type="text/css">
html,body{height:100%; margin:0;}
.tbmain{
/* Changes on the form */
background: url(http://jotform.com/images/styles/style4_2_bg.gif) #363535 top repeat-x !important;
}
.left{
/* Changes on the form */
color: #cccccc !important;
font-family: Verdana !important;
font-size: 12px !important;
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td.left {
font-family: "Trebuchet MS";
font-size: 12px;
font-weight:normal;
color:#cccccc;
vertical-align: top;
text-align: left;
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.pagebreak{
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font-size: 12px;
font-weight:bold;
color:black;
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td.right {
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font-size: 12px;
font-weight:normal;
color:#cccccc;
vertical-align: top;
text-align: left;
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.tbmain{
height:100%;
color:#cccccc;
background:url(http://jotform.com/images/styles/style4_2_bg.gif) #363535 top repeat-x;
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.head{
font-family: "Trebuchet MS";
font-size: large;
font-weight:bold;
color:#ffffff;
vertical-align: top;
text-align: left;
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.notvalid{
border:2px red solid;
font-family:"Trebuchet MS";
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.text{
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font-size: 12px;
font-weight:normal;
color:#cccccc;
border:1px #000000 solid;
background:url(http://jotform.com/images/styles/style4_txt_bg.gif) #333333 top repeat-x;
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select.other{
font-family: "Trebuchet MS";
font-size: 12px;
font-weight:normal;
color:#ffffff;
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.btn{
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font-size: 12px;
font-weight:normal;
color:#cccccc;
border:1px #000000 solid;
background: url(http://jotform.com/images/styles/style4_btn_bg.gif) #333333 top repeat-x;
}
span.required{
font-size: 13px !important;
color: red !important;
}</style>
<table width="100%" cellspacing="0" cellpadding="2" class="tbmain">
<tbody>
<tr>
<td width="10" height="10" class="topleft"> </td>
<td class="topmid"> </td>
<td width="10" height="10" class="topright"> </td>
</tr>
<tr>
<td width="10" class="midleft"> </td>
<td valign="top" class="midmid">
<form name="q_form_83264452878" method="post" action="http://jotform.com/submit.php">
<input type="hidden" value="83264452878" name="formID" />
<div id="main">
<table width="520" cellspacing="0" cellpadding="5">
<tbody>
<tr>
<td colspan="2" class="head">Kişisel Bilgiler</td>
</tr>
<tr>
<td width="150" class="left"><label>Adınız: <span class="required">*</span></label></td>
<td class="right"><input type="text" name="q2_Adnz" onblur="validate(this,'Required')" maxsize="100" maxlength="100" id="q2" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Soyadınız:</label></td>
<td class="right"><input type="text" name="q0_Soyadnz" maxsize="100" maxlength="100" id="q0" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Doğum Tarihiniz: <span class="required">*</span></label></td>
<td class="right"><select onchange="getdate(this)" id="month_q10" class="other">
<option selected="selected" value="0">Ay</option>
<option value="Ocak">Ocak</option>
<option value="Şubat">Şubat</option>
<option value="Mart">Mart</option>
<option value="Nisan">Nisan</option>
<option value="Mayıs">Mayıs</option>
<option value="Haziran">Haziran</option>
<option value="Temmuz">Temmuz</option>
<option value="Ağustos">Ağustos</option>
<option value="Eylül">Eylül</option>
<option value="Ekim">Ekim</option>
<option value="Kasım">Kasım</option>
<option value="Aralık">Aralık</option>
</select> <select onchange="getdate(this)" id="day_q10" class="other">
<option selected="selected" value="0">Gün</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select> <select onchange="getdate(this)" id="year_q10" class="other">
<option selected="selected" value="0">Yıl</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
</select><br />
<input type="hidden" name="q10_DoumTarihiniz" id="date_q10" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Doğum Yeriniz:</label></td>
<td class="right"><input type="text" name="q11_DoumYeriniz" maxsize="100" maxlength="100" id="q11" class="text" /></td>
</tr>
<tr>
<td colspan="2" class="head">Üyelik Bilgileri</td>
</tr>
<tr>
<td width="150" class="left"><label>E-Mailiniz: <span class="required">*</span></label></td>
<td class="right"><input type="text" name="q3_EMailiniz" onblur="validate(this,'Required')" maxsize="100" maxlength="100" style="background-color: rgb(255, 255, 160);" title="Your Google Toolbar can fill this in for you. Select AutoFill" id="q3" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>E-mail Tekrar: <span class="required">*</span></label></td>
<td class="right"><input type="text" name="q6_EmailTekrar" onblur="validate(this,'Required')" maxsize="100" maxlength="100" style="background-color: rgb(255, 255, 160);" title="Your Google Toolbar can fill this in for you. Select AutoFill" id="q6" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Şifreniz: <span class="required">*</span></label></td>
<td class="right"><input type="password" name="q8_ifreniz" onblur="validate(this,'Required')" id="q8" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Şifreniz Yeniden: <span class="required">*</span></label></td>
<td class="right"><input type="password" name="q9_ifrenizYeniden" onblur="validate(this,'Required')" id="q9" class="text" /></td>
</tr>
<tr>
<td colspan="2" class="head">İsteğe Bağlı Bölümler</td>
</tr>
<tr>
<td colspan="2" class="left">Boş Bırakılabilir..</td>
</tr>
<tr>
<td width="150" class="left"><label>Hobileriniz:</label></td>
<td class="right"><input type="text" name="q17_Hobileriniz" maxsize="100" maxlength="100" id="q17" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Müzik Tarzınız:</label></td>
<td class="right"><input type="text" name="q18_MzikTarznz" maxsize="100" maxlength="100" id="q18" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>Nerden Katılıyorsunuz:</label></td>
<td class="right"><input type="text" name="q19_NerdenKatlyorsunuz" maxsize="100" maxlength="100" id="q19" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"><label>En Sevdiğiniz Sanatçı</label></td>
<td class="right"><input type="text" name="q20_EnSevdiinizSanat" maxsize="100" maxlength="100" id="q20" class="text" /></td>
</tr>
<tr>
<td colspan="2" class="head">Son Adım</td>
</tr>
<tr>
<td width="150" valign="top" class="left"><label>Yetkiliye Mesaj:</label></td>
<td class="right"><textarea name="q22_YetkiliyeMesaj" onmouseout='hideddrivetip()' cols="30" id="q22" class="text"></textarea></td>
</tr>
<tr>
<td width="150" valign="top" class="left"><label>Site Değerlendirmesi:</label></td>
<td valign="top"><input type="hidden" name="q13_SiteDeerlendirmesi" id="q13" />
<table width="75" cellspacing="0" cellpadding="0" border="0" onmouseout="resetRate(this,'q13')" style="background: transparent url(http://jotform.com/images/star0.gif) repeat scroll 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;" id="starTable_q13">
<tbody>
<tr>
<td width="15" height="15" onclick="rate(this,'1','q13')" onmouseover="changeColor('1','starTable_q13')"> </td>
<td width="15" onclick="rate(this,'2','q13')" onmouseover="changeColor('2','starTable_q13')"> </td>
<td width="15" onclick="rate(this,'3','q13')" onmouseover="changeColor('3','starTable_q13')"> </td>
<td width="15" onclick="rate(this,'4','q13')" onmouseover="changeColor('4','starTable_q13')"> </td>
<td width="15" onclick="rate(this,'5','q13')" onmouseover="changeColor('5','starTable_q13')"> </td>
</tr>
</tbody>
</table>
</td>
<td> </td>
</tr>
<tr>
<td width="150" valign="top" class="left"><label>Güvenlik Kodu:</label></td>
<td valign="top"><script type="text/javascript" src="http://jotform.com/captcha.php"></script><input type="text" name="qCap" id="uword" class="text" /></td>
</tr>
<tr>
<td width="150" class="left"> </td>
<td class="right"><input type="submit" value="Üye Başvurusu Yap" class="btn" /></td>
</tr>
</tbody>
</table>
</div>
</form>
</td>
<td width="10" class="midright"> </td>
</tr>
<tr>
<td width="10" height="10" class="bottomleft"> </td>
<td class="bottommid"> </td>
<td width="10" height="10" class="bottomright"> </td>
</tr>
</tbody>
</table>
<script type="text/javascript">
validate("q_form_83264452878");
</script>
