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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <html> <head> <title>MSM</title> <link href="style.

css" rel="stylesheet"> </head> <body> <div class="container"> <div class="wrapper"> <form name="regestrasi" action="http://infotech.umm.ac.i d/praktikum/web/form.php" method="post" enctype="multipart/data"> <div class="control"> <div class="control-label"> <label>Nama Depan</label> </div> <div class="control-content"> <input type="text" name="nama_de pan" value="" placeholder="Nama Depan" required="required"/> </div> </div> <div class="control"> <div class="control-label"> <label>Nama Belakang</label> </div> <div class="control-content"> <input type="text" name="nama_be lakang" value="" placeholder="Nama Belakang"/> </div> </div> <div class="control"> <div class="control-label"> <label>Tanggal Lahir</label> </div> <div class="control-content"> <input type="date" name="tanggal _lahir" value="" placeholder="Tahun/Bulan/Tanggal" required="required"/> </div> </div> <div class="control"> <div class="control-label"> <label>Jenis Kelamin</label> </div> <div class="control-content"> <input type="radio" name="jk" va lue="" required="required"/>Laki-laki <input type="radio" name="jk" va lue="" required="required"/>Perempuan </div> </div> <div class="control"> <div class="control-label"> <label>Alamat Tinggal</label> </div> <div class="control-content"> <select name="kota" required="re quire"> <option value="">Kota</o

ption> <option value="Blitar">B litar</option> </select> <select name="propinsi" required ="required"> <option value="">Propins i</option> <option value="Jawa Timu r">Jawa Timur</option> </select> <select name="negara" required=" required"> <option value="">Negara< /option> <option value="Indonesia ">Indonesia</option> </select> </div> </div> <div class="control"> <div class="control-label"> <label>E-mail</label> </div> <div class="control-content"> <input type="email" name="email" placeholder="E-mail" required="required"/> </div> </div> <div class="control"> <div class="control-label"> <label>Password</label> </div> <div class="control-content"> <input type="password" name="pas sword" placeholder="Password" required="required"/> </div> </div> <div class="control"> <div class="control-label"> <label>Konfirmasi Password</labe l> </div> <div class="control-content"> <input type="password" name="cpa ssword" placeholder="Konfirmasi Password" required="required"/> </div> </div> <div class="control"> <div class="control-label"> <label>Profile Diri</label> </div> <div class="control-content"> <textarea required="required" na me="profile" cols="30" rows="10"></textarea> </div> </div> <div class="control action"> <input type="submit" value="Submit"/> <input type="reset" value="Reset"/>

</div> </form> </div> </div> </body> </html>

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