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  • Registrasi Dinas

    Uploaded by

    Eva Cahyanti
    1 views2 pages

    Original Title

    registrasi dinas

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    © Attribution Non-Commercial (BY-NC)

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    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    1 views2 pages

    Registrasi Dinas

    Uploaded by

    Eva Cahyanti

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    <html>

    <head>
    <meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
    <title>Registrasi User</title>
    <link href="themes/Green/style.css" type="text/css" rel="stylesheet">
    </head>
    <body>
    <center><b>FORMULIR REGISTRASI</b></center><br>
    <form method="post" action="">
    <table align="center" border="0" cellpadding="0" cellspacing="0" width="95%" b
    gcolor="#E4FAF7">
    <tr>
    <td height="13" width="13">
    <img border="0"
    <td height="13"
    <td height="13"
    <img border="0"
    </tr>

    src="images/a_kiri.gif" width="13" height="13"></td>


    background="images/bar_atas.gif"></td>
    width="13">
    src="images/a_kanan.gif" width="13" height="13"></td>

    <tr>
    <td height="13" background="images/bar_kiri.gif"></td>
    <td>
    <!-- dokumen -->
    <strong>Konfirmasi password lewat email yang anda masukan!</strong><br><br>
    <table align=center width=100% border="0">
    <tr>
    <td>Username</td><td>:</td>
    <td><input size="8" class="text2" type=text name="userna
    me_" maxlength="8"> <font color="red">* max. 8 karakter</font> (tanpa spasi)</td
    >
    </tr>
    <tr><td>Nama</td><td>:</td>
    <td><input class="text2" type=text name="pengguna_"></td
    >
    </tr>
    <tr><td>Email</td><td>:</td>
    <td><input class="text2" type=text name="email_"></td>
    </tr>
    <tr><td>Jenis Kelamin</td><td>:</td>
    <td>
    <select name="jk">
    <option value="L">Laki-laki</option>
    <option value="P">Perempuan</option>
    </select></td>
    </tr>
    <tr><td>TTL</td><td>:</td>
    <td><input class="text2" type=text name="tempat_"> <input maxlength="2" size="2" class="text2" type=text na
    me="tgl_"> <select name="bln_"><option value="Jan">Jan</option><option value="Feb">Feb</opt
    ion><option value="Mar">Mar</option><option value="Apr">Apr</option><option valu
    e="May">May</option><option value="Jun">Jun</option><option value="Jul">Jul</opt
    ion><option value="Aug">Aug</option><option value="Sep">Sep</option><option valu
    e="Oct">Oct</option><option value="Nov">Nov</option><option value="Dec">Dec</opt
    ion></select> -

    <input maxlength="4" size="4" class="text2" type=text na


    me="thn_">
    </td>
    </tr>
    <tr><td>Instansi</td><td>:</td>
    <td><input class="text2" type=text name="instansi_"></td
    >
    </tr>
    <tr><td>Alamat</td><td>:</td>
    <td><textarea class="text2" type=text name="alamat_"></t
    extarea></td>
    </tr>
    <tr><td></td><td></td><td><input class="text2" type="sub
    mit" name="submit"></td>
    </tr>
    </table>
    <!-- dokumen -->
    </td>
    <td height="13" background="images/bar_kanan.gif"></td>
    </tr>
    <tr>
    <td height="13" width="13">
    <img border="0"
    <td height="13"
    <td height="13"
    <img border="0"
    </tr>
    </table></form>
    <p align="center"></p>
    </body>
    </html>

    src="images/b_kiri.gif" width="13" height="13"></td>


    background="images/bar_bawah.gif"></td>
    width="13">
    src="images/b_kanan.gif" width="13" height="13"></td>

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