<fieldset>

            <legend>Üyelik Bilgileri</legend>

            <label>Ad Soyad : </label>

            <input type="text" name="adSoyad" required="required"> <br />

            <label>e-Posta : </label>

            <input type="email" name="ePosta" required="required"> <br />

            <label>Doğum Tarihi : </label>

            <input type="date" name="dogumTarihi" required="required"> <br />

            <input type="submit" value="Gönder" />

            <input type="reset" value="Temizle" />

        </fieldset>