Untitled

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<html lang="en">
<head>
    <meta charset="UTF-8">
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    <title>Form Pendaftaran Calon Anggota Mapala Raflesia Unindra</title>
    <link rel="stylesheet"
        href="https://stackpath.bootstrapcdn.com/bootstrap/4.1.3/css/bootstrap.min.css">
</head>
<body>
    <div class="container-fluid">
        <h3>Form Tambah Anggota</h3>
        <div class="row">
            <div class="col-md-6">
                <form id="myForm" method="POST" action="tambah_anggota.php">
                    <div class="form-group">
                        <label><strong>Nama Lengkap</strong></label>
                        <div class="input-group mb-3">
                            <input name="nama_depan" type="text" class="form-control" placeholder="Nama Depan" />
                            <input name="nama_belakang" type="text" class="form-control" placeholder="Nama Belakang"  />
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>NPM</strong></label>
                        <div class="input-group mb-3">
                            <input name="npm" type="text" class="form-control" placeholder="Nomor Pokok Mahasiswa" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Password</strong></label>
                        <div class="input-group mb-3">
                            <input name="password" type="password" class="form-control" placeholder="Masukan Password" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>TTL</strong></label>
                        <div class="input-group mb-3">
                            <input name="tempat" type="text" class="form-control" placeholder="Tempat" />
                            <input name="tanggal_lahir" type="date" class="form-control"/>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Jurusan</strong></label>
                        <div class="input-group mb-3">
                            <select class="custom-select" name="jurusan" id="jurusan">
                                <option value="S1 - Bahasa Indonesia">S1 - Bahasa Indonesia</option>
                                <option value="S1 - Bahasa Inggris">S1 - Bahasa Inggris</option>
                                <option value="S1 - Desain Komunikasi Visual">S1 - Desain Komunikasi Visual</option>
                            </select>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Alamat</strong></label>
                        <div class="input-group mb-3">
                            <textarea name="alamat" type="text" class="form-control" placeholder="Masukan Alamat" rows="4"></textarea>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Motivasi Masuk Mapala</strong></label>
                        <div class="input-group mb-3">
                            <textarea name="motivasi" type="text" class="form-control" placeholder="Motivasi Masuk Mapala" rows="4"></textarea>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Pas Foto</strong></label>
                        <div class="input-group mb-3">
                            <input name="foto" type="file" class="form-control"/>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Scan / Foto KTP</strong></label>
                        <div class="input-group mb-3">
                            <input name="ktp" type="file" class="form-control"/>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Surat Izin Orang Tua</strong></label>
                        <div class="input-group mb-3">
                            <input name="siot" type="file" class="form-control"/>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><strong>Surat Keterangan Sehat dari Dokter</strong></label>
                        <div class="input-group mb-3">
                            <input name="skd" type="file" class="form-control"/>
                        </div>
                    </div>
                    <div class="form-group">
                        <button class="btn btn-primary btn-block" type="submit" name="submit" id="submit">Daftar</button>
                    </div>
                </form>
            </div>
        </div>
    </div>
</body>
</html>
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