<head>
<title>FORM PENDAFTARAN</title>
</head>
<body>
<table width="auto" height="auto" border="1">
<tr>
<td colspan="2"><img src="p2k.jpg" width="415" height="auto" alt="a" /></td>
</tr>
<tr>
<td width="auto"><p>HOME</p>
<p>ARTIKEL</p>
<p>PENDAFTARAN</p></td>
<td width="auto"><table>
<form action="infut.php" method="post">
</form>
<tbody>
<tr>
<td valign="top" width="auto">Nama</td>
<td width="auto"><input name="nama" placeholder="Masukan nama anda" type="text" /></td>
</tr>
<tr>
<td valign="top">Username</td>
<td><input name="username" placeholder="Masukan username" type="text" /></td>
</tr>
<tr>
<td valign="top">Password</td>
<td><input name="password" placeholder="Password" type="password" /></td>
</tr>
<tr>
<td valign="top">Email</td>
<td><input name="email" placeholder="Masukan email" type="email" /></td>
</tr>
<tr>
<td valign="top">No HP</td>
<td><input name="No HP" placeholder="Masukan nomor HP" type="text" /></td>
</tr>
<tr>
<td valign="top">Jenis Kelamin</td>
<td><input name="l" type="radio" />
Pria<br />
<input name="p" type="radio" />
Perempuan </td>
</tr>
<tr>
<td valign="top">Tanggal Lahir</td>
<td><input name="text" type="text" style="width: 25px;" placeholder="dd" />
<input name="text" type="text" style="width: 25px;" placeholder="mm" />
<input name="text" type="text" style="width: 50px;" placeholder="yyyy" /> </td>
</tr>
<tr>
<td valign="top">Kota</td>
<td><select name="select">
<option>Yogyakarta</option>
<option>Denpasar</option>
<option>Serang</option>
<option>Tangerang</option>
<option>Bengkulu</option>
<option>Gorontalo</option>
<option>Jakarta</option>
<option>Sungai Penuh</option>
<option>Jambi</option>
<option>Bandung</option>
<option>Bekasi</option>
<option>Bogor</option>
<option>Cimahi</option>
<option>Cirebon</option>
<option>Depok</option>
<option>Sukabumi</option>
<option>Tasikmalaya</option>
<option>Banjar</option>
<option>Magelang</option>
<option>Pekalongan</option>
<option>Purwokerto</option>
</select> </td>
</tr>
<tr>
<td valign="top">Biografi</td>
<td><textarea name="textarea" cols="30" rows="5" placeholder="isilah biografi singkat anda"></textarea></td>
</tr>
<tr>
<td colspan="2"><input name="submit" type="submit" value="KIRIM" /></td>
</tr>
</tbody>
</table></td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
</table>
</body>
</html>
Tidak ada komentar:
Posting Komentar