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<title>TABEL FORMULIR PENDAFTARAN </title>
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<form name="head"> <table border="0" width="100%" bgcolor="Aqua">
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<td align="center" width="50%"> <font color="white" size="40" face="Berlin Sans FB"> <b>Grup Ngechat!</b> </td>
<td align="right" width="20%"> <input type="text" name="username" value="nama"> </td>
<td align="left" width="20%"> <input type="password" name="password" value="password"> </td>
<td align="left" width="10%"> <input type="submit" name="enter" value="masuk" > </td>
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</table>
<form name="formulir">
<table border="0" width="33%" height="85%" bgcolor="Lightcyan" align="right"> <br>
<tr> </tr>
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<td colspan="3" align="left"> <font color="black" face="Berlin Sans FB"> <h2> <b> FORMULIR PENDAFTARAN </b> <br> <i>Gratis</i> </h2> </td>
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<td width="15%"> Nama depan </td>
<td width="5%" align="center"> : </td>
<td width="15%" align="left"> <input type="text" name="nama" value="Nama depan" size="30"> </td>
</tr>
<tr>
<td width="15%"> Nama belakang </td>
<td width="5%" align="center"> : </td>
<td width="15%" align="left"> <input type="text" name="nama" value="Nama belakang" size="30"> </td>
</tr>
<tr>
<td width="15%"> Email </td>
<td width="5%" align="center"> : </td>
<td width="15%" align="left"> <input type="text" name="email" value="Email" size="30"> </td>
</tr>
<tr>
<td width="15%"> Tempat lahir </td>
<td width="5%" align="center"> : </td>
<td width="15%" align="left"> <input type="text" name="tmptlhr" value="Tempat lahir" size="30"> </td>
</tr>
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<td width="15%"> Tanggal lahir </td>
<td width="5%" align="center"> : </td>
<td width="15%" align="left"> <select> <option value="Tanggal"> Tanggal </option> <option> 1 </option> <option> 2 </option> <option> 3 </option> <option> 4 </option> <option> 5 </option> <option> 6 </option> <option> 7 </option> <option> 8 </option> <option> 9 </option> <option> 10 </option> <option> 11 </option> <option> 12 </option> <option> 13 </option> <option> 14 </option> <option> 15 </option> <option> 16 </option> <option> 17 </option> <option> 18 </option> <option> 19 </option> <option> 20 </option> <option> 21 </option> <option> 22 </option> <option> 23 </option> <option> 24 </option> <option> 25 </option> <option> 26 </option> <option> 27 </option> <option> 28 </option> <option> 29 </option> <option> 30 </option> <option> 31 </option> </select>
<select> <option value="Bulan"> Bulan </option> <option> Januari </option> <option> Februari </option> <option> Maret </option> <option> April </option> <option> Mei </option> <option> Juni </option> <option> Juli </option> <option> Agustus </option> <option> September </option> <option> Oktober </option> <option> Nopember </option> <option> Desember </option> </select>
<select> <option value="Tahun"> Tahun </option> <option> 2014 </option> <option> 2013 </option> <option> 2012 </option> <option> 2011 </option> <option> 2010 </option> <option> 2009 </option> <option> 2008 </option> <option> 2007 </option> <option> 2006 </option> <option> 2005 </option> <option> 2004 </option> <option> 2003 </option> <option> 2002 </option> <option> 2001 </option> <option> 2000 </option> <option> 1999 </option> <option> 1998 </option> <option> 1997 </option> <option> 1996 </option> <option> 1995 </option> <option> 1994 </option> <option> 1993 </option> <option> 1992 </option> <option> 1991 </option> <option> 1990 </option> <option> 1989 </option> <option> 1988 </option> <option> 1987 </option> <option> 1986 </option> <option> 1985 </option> <option> 1984 </option> <option> 1983 </option> <option> 1982 </option> <option> 1981 </option> <option> 1980 </option> <option> 1979 </option> <option> 1978 </option> <option> 1977 </option> <option> 1976 </option> <option> 1975 </option> <option> 1974 </option> <option> 1973 </option> <option> 1972 </option> <option> 1971 </option> <option> 1970 </option> </select>
</tr>
<tr>
<td width="15%"> Jenis kelamin </td>
<td width="5%" align="center"> : </td>
<td width="15%" align="left"> <input type="radio" name="sex"> Laki-laki     <input type="radio" name="sex"> Perempuan </td>
</tr>
<tr>
<td colspan="3" height="130" align="center"> <input type="submit" value="Mendaftar">         <input type="reset" value="Batal"> </td>
</tr>
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<td colspan="3" align="right"> <font color="cyan" size="3"> <u> Grup Ngechat! Demo Edition </u>
</form>
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