<div class="questionrow">
    <div class="question">Particpant ID</div>
    <div class="answer">
		<input type="hidden" name="id" id="id" value="<?php echo $id; ?>"/>
		<input type="hidden" name="survey_id" id="survey_id" value="<?php echo $survey_id; ?>"/>
		<input type="text" name="partcpnt_id" id="partcpnt_id" value="<?php echo $part_id; ?>" readonly />
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div class="question">Name</div>
    <div class="answer">
        <input type="text" name="name" id="name" value="<?php echo $name; ?>" />
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Address</div>
	<div class="answer">
		<textarea name="addrs" id="addrs"><?php echo $addrs; ?></textarea>
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div class="question">City</div>
    <div class="answer">
        <input type="text" name="city" id="city" value="<?php echo $city; ?>" style="text-transform: uppercase;" />
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div class="question">Pincode</div>
    <div class="answer">
        <input type="text" name="pin_code" id="pin_code" value="<?php echo $pin_code; ?>" onkeyup="return acceptDigits(this);" maxlength="6" />
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div class="question">Mobile No.</div>
    <div class="answer">
        <input type="text" name="mble" id="mble" value="<?php echo $mble; ?>" onkeyup="return acceptDigits(this);" maxlength="11" />
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div class="question">Alternate Mobile No.</div>
    <div class="answer">
        <input type="text" name="phne" id="phne" value="<?php echo $phne; ?>" onkeyup="return acceptPhone(this);" maxlength="12" />
    </div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
    <div style="padding: 5px;" align="center">
        <input type="submit" name="Submit" value="Submit" />
    </div>
</div>