<!DOCTYPE html>
<html>
<head>
<title>Form</title>
<style>
img{padding-right: 700px
}
</style>
</head>
<body>
<h2>Formulir Registrasi</h2>
<img src="http://www.fokatworld.net/wp-content/uploads/2016/02/Deadpool-Hindi-Dubbed-Download-205x300.jpg" align="right" >
<form method="post" action="#">
<ol type="A">
<b><li>Data Diri</li></b>
<table>
<form method="post" action="#">
<ol>
<tr>
<td>1. Nama</td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><input type="text" name"textname" maxlength="15">
</td>
</tr>
<tr>
<td>2. Tempat Lahir</td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><input type="text" name"textname" maxlength="15">
</td>
</tr>
<tr>
<td>3. Tanggal Lahir</td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><select name="tanggal">
<option value="">-Pilih-</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 name="Bulan">
<option>-Pilih-</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>November</option>
<option>Desember</option>
</select>
<select name="tahun">
<option value="">-Pilih-</option>
<option>1980</option>
<option>1981</option>
<option>1982</option>
<option>1983</option>
<option>1984</option>
<option>1985</option>
<option>1986</option>
<option>1987</option>
<option>1988</option>
<option>1989</option>
<option>1990</option>
<option>1991</option>
<option>1992</option>
<option>1993</option>
<option>1994</option>
<option>1995</option>
<option>1996</option>
<option>1997</option>
<option>1998</option>
<option>1999</option>
<option>2000</option>
<option>2001</option>
<option>2002</option>
<option>2003</option>
<option>2004</option>
<option>2005</option>
<option>2006</option>
<option>2007</option>
<option>2008</option>
<option>2009</option>
<option>2010</option>
<option>2011</option>
<option>2012</option>
<option>2013</option>
<option>2014</option>
<option>2015</option>
<option>2016</option>
</select></td>
</tr>
<tr>
<td>4. Jenis Kelamin</td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><input type="radio" name="JK" value="L">Laki-laki
<input type="radio" name="JK" value="P">Perempuan
</td>
</tr>
<tr>
<td>5. Agama</td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td>
<select name="Agama">
<option>-Pilih-</option>
<option>Islam</option>
<option>Keristen</option>
<option>Protestan</option>
<option>Buddha</option>
<option>Hindu</option>
</select>
</td>
</tr>
<tr>
<td>6. Golongan Darah</td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td>
<select name="goldar">
<option>-Pilih-</option>
<option>A</option>
<option>B</option>
<option>O</option>
<option>AB</option>
</select>
</td>
</tr>
</ol>
</form>
</table>
<b><li>Pendidikan</li></b>
<table>
<ol>
<tr>
<td>1. Asal Sekolah</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><input type="text" name"textname" maxlength="15">
</td>
</tr>
<tr>
<td>2. Tahun Masuk</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><input type="text" name"textname" maxlength="4" size="5">
</td>
</tr>
<tr>
<td>3. Tahun Lulus</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>:</td>
<td><input type="text" name"textname" maxlength="4" size="5">
</td>
</tr>
</ol>
</table>
<b><li>Data Orang Tua</li></b>
<table>
<ol>
<tr>
<td>1. Nama Ayah</td>
<td>:</td>
<td><input type="text" name"textname" maxlength="15">
</td>
</tr>
<tr>
<td>2. Nama Ibu</td>
<td>:</td>
<td><input type="text" name"textname" maxlength="15">
</td>
</tr>
<tr>
<td>3. Alamat Orang Tua</td>
<td>:</td>
<td><textarea name="alamat" cols="16"></textarea>
</td>
</tr>
<tr>
<td><input type="button" value="Simpan Data"></td>
</tr>
</ol>
</ol>
</ol>
</body>
</html>
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Formulir Registrasi
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