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  1. <!DOCTYPE html>
  2. <html lang="en">
  3. <head>
  4.     <title>Mikamerah Tutorial</title>
  5.     <meta charset="utf-8">
  6.     <meta name="viewport" content="width=device-width, initial-scale=1">
  7.     <link rel="stylesheet" href="assets/css/bootstrap.min.css">
  8.     <script src="assets/js/vendor/jquery-slim.min.js"></script>
  9.     <script src="assets/js/vendor/popper.min.js"></script>
  10.     <script src="assets/js/bootstrap.min.js"></script>
  11. </head>
  12. <body>
  13.  
  14. <div class="container col-lg-6 my-5 border">
  15.     <h2 class="py-2 my-3 border-bottom">Form Registrasi</h2>
  16.     <form method="post" action="aksi.php" class="">
  17.         <div class="form-group">
  18.             <label for="uname">Username:</label>
  19.             <input type="text" class="form-control" id="uname" placeholder="Masukkan username" name="uname" required>
  20.         </div>
  21.         <div class="form-group">
  22.             <label for="pwd">Password:</label>
  23.             <input type="password" class="form-control" id="pwd" placeholder="Masukkan password" name="pswd" required>
  24.         </div>
  25.         <div class="form-group">
  26.             <label for="pwd">Konfirmasi Password:</label>
  27.             <input type="password" class="form-control" id="copwd" placeholder="Masukkan password" name="copswd" required>
  28.         </div>
  29.         <div class="form-group">
  30.             <label for="email">Email:</label>
  31.             <input type="email" class="form-control" id="email" placeholder="Masukkan Email" name="email" required>
  32.         </div>
  33.         <div class="form-group">
  34.             <label for="tgll">Tanggal Lahir:</label>
  35.             <input type="date" class="form-control" id="tgll" name="tgll" required>
  36.         </div>
  37.         <div class="form-group">
  38.             <label for="jeka">Jenis Kelamin:</label>
  39.             <div class="form-check">
  40.                 <label class="form-check-label">
  41.                     <input type="radio" class="form-check-input" value="L" name="jeka" required>Laki-Laki
  42.                 </label>
  43.             </div>
  44.             <div class="form-check">
  45.                 <label class="form-check-label">
  46.                     <input type="radio" class="form-check-input" value="P" name="jeka" required>Perempuan
  47.                 </label>
  48.             </div>
  49.         </div>
  50.         <div class="form-group">
  51.             <label for="alamat">Alamat:</label>
  52.             <textarea class="form-control" rows="5" id="alamat" name="alamat"></textarea>
  53.         </div>
  54.         <div class="form-group">
  55.             <label for="kota">Kota:</label>
  56.             <input type="text" class="form-control" id="kota" placeholder="masukkan nama kota" name="kota" required>
  57.         </div>
  58.         <div class="form-group">
  59.             <label for="telp">Nomor Telpon:</label>
  60.             <input type="tel" class="form-control" id="telp" placeholder="Masukkan nomor telpon" name="telp" required>
  61.         </div>
  62.         <div class="form-group">
  63.             <label for="paypal">Paypal:</label>
  64.             <input type="text" class="form-control" id="paypal" placeholder="Masukkan id paypal" name="paypal" required>
  65.         </div>
  66.         <div class="form-group text-right">
  67.             <button type="submit" name="reg" class="btn btn-primary">Submit</button>
  68.         </div>
  69.     </form>
  70. </div>
  71.  
  72. </body>
  73. </html>
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