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gamamuhammad

pengunjung.php

Jan 17th, 2016
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  1. <form method="post" action="pengunjung/aksi_pengunjung.php" name="pengunjung">
  2.     <center><h3>.:: Dipersilahkan Mengisi Buku Tamu Terlebih Dahulu::.</h3><hr></center>
  3.     <table border="0" width="100%" cellpadding="2" id="table1">
  4.         <tr>
  5.             <td width="35%">Nama (*)</td>
  6.             <td><input type="text" name="nama" required size="20"></td>
  7.         </tr>
  8.         <tr>
  9.             <td width="35%">Jenis Kelamin (*)</td>
  10.             <td><input type="radio" value="L" required name="jk"> Laki-Laki &nbsp;&nbsp;
  11.             <input type="radio" value="P" required name="jk"> Perempuan</td>
  12.         </tr>
  13.         <tr>
  14.             <td width="35%">Kelas (*)</td>
  15.             <td><select size="1" name="kelas" required>
  16.             <option selected value="">- Pilih Pekerjaan -</option>
  17.            
  18.             <option value="Guru">Guru</option>
  19.             <option value="Karyawan">Karyawan</option>
  20.             <option value="Lain">Lainnya</option>
  21.             </select>
  22.             </td>
  23.         </tr>
  24.         <tr>
  25.             <td width="35%" valign="top">Keperluan (*)</td>
  26.             <td>
  27.             <input type="checkbox" name="perlu1" value="Pinjam Buku"> Pinjam Buku<br>
  28.             <input type="checkbox" name="perlu2" value="Baca Buku"> Baca Buku<br>
  29.             <input type="checkbox" name="perlu3" value="Baca Koran"> Baca Koran<br>
  30.             <input type="checkbox" name="perlu4" value="Lainnya"> Lainnya</td>
  31.         </tr>
  32.         <tr>
  33.             <td width="35%">Informasi yang dicari (*)</td>
  34.             <td><textarea rows="5" name="cari" required cols="25"></textarea></td>
  35.         </tr>
  36.         <tr>
  37.             <td width="35%">Saran-saran</td>
  38.             <td><textarea rows="4" name="saran" cols="25"></textarea></td>
  39.         </tr>
  40.         <tr>
  41.             <td width="35%">&nbsp;</td>
  42.             <td><input type="submit" value="Submit" name="B1">&nbsp;&nbsp;&nbsp;
  43.             <input type="reset" value="Reset" name="B2"></td>
  44.         </tr>
  45.         <tr>
  46.             <td colspan="2"><b>Keterangan : (*) Harus diisi</b></td>
  47.         </tr>
  48.     </table>
  49. </form>
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