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<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>FORMULIR PENDAFTARAN</title>
<font color="red"<color>
<marquee direction="down"><b>FORMULIR PENDAFTARAN</marquee></b></p>
</head>
<body bgcolor="#4B0082">
<form method="post">
<Font color=red></color>
<p ><b><marquee>Isilah pertanyaan-pertanyaan formulir dibawah ini dengan lengkap dan benar</marquee></b></p>
<table width="300" cellpadding="5" cellspacing="5">
<tr>
<td>Nama lengkap</td><td>:</td><td><input type="text" placeholder="Tulis Nama lengkap" /></td></tr>
<tr>
<td>Nama depan</td><td>:</td><td><input type="text" placeholder="Tulis Nama depan" /></td></tr>
<tr>
<td>Nama Belakang</td><td>:</td><td><input type="text" placeholder="Tulis Nama belakang" /></td></tr>
<tr>
<td>alamat</td><td>:</td><td><input type="text" placeholder="Tulis alamat" /></td></tr>
<tr>
<td>E-mail</td><td>:</td><td><input type="text" placeholder="E-mail" /></td></tr>
<tr>
<td>kata sandi</td><td>:</td><td><input type="kata sandi" /></td>
</tr>
<tr>
<td>Tanggal Lahir</td><td>:</td><td><select name="Tanggal">
<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 name="Bulan">
<option value="Jan">Januari</option>
<option value="Feb">Februari</option>
<option value="mar">Maret</option>
<option value="apr">April</option>
<option value="mei">Mei</option>
<option value="JUn">Juni</option>
<option value="Jul">Juli</option>
<option value="ags">Agustus</option>
<option value="sep">September</option>
<option value="okt">Oktober</option>
<option value="nov">November</option>
<option value="des">Desenber</option>
</select>
<select name="tahun">
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
</select>
</td>
</tr>
<tr>
<td>Jenis Kelamin</td><td>:</td><td><input type="radio" name="JK" value="L" />Laki-laki<input type="radio" name="JK" value="P" />Perempuan</td>
</tr>
<tr>
<td>biodata</td><td>:</td><td><textarea rows="7" cols="25"></textarea></td></tr>
</table>
<p >apakah kamu sudah mengisi pertanyaan di atas dengan benar</p>
<input type="checkbox" name="accept" value="ya" />ya
<input type="checkbox" name="dont accept" value="Tidak" />Tidak <br />
<br />
<br />
<input type="submit" name="Save" value="Simpan"/>
<input type="submit" name="cancel" value="Batal" />
</form>
</body>
</html>
HASIL:::
