<!DOCTYPE html>
<html>
<head>
<title>Contoh form pendaftaran</title>
</head>
<body>
<h1>Pendaftaran</h1>
<hr width="20%" align="left">
<p>Isilah seluruh kolom registrasi dengan <br />sebenar-benarnya.</p>
<table>
<tr>
<td valign="top">Nama</td>
<td><input type="text" name="nama" placeholder="Masukan nama anda"></td>
</tr>
<tr>
<td valign="top">Username</td>
<td><input type="text" name="username" placeholder="Masukan username"></td>
</tr>
<tr>
<td valign="top">Password</td>
<td><input type="password" name="password" placeholder="Password"></td>
</tr>
<tr>
<td valign="top">Email</td>
<td><input type="email" name="email" placeholder="Masukan email"></td>
</tr>
<tr>
<td valign="top">Jenis Kelamin</td>
<td>
<input type="radio" name="l">Pria<br />
<input type="radio" name="p">Perempuan
</td>
</tr>
<tr>
<td valign="top">Tanggal Lahir</td>
<td>
<input type="text" style="width: 25px" placeholder="dd">
<input type="text" style="width: 25px" placeholder="mm">
<input type="text" style="width: 50px" placeholder="yyyy">
</td>
</tr>
<tr>
<td valign="top">Negara</td>
<td><input type="text" name="negara" placeholder="Negara tempat tinggal"></td>
</tr>
<tr>
<td valign="top">Kota</td>
<td>
<select>
<option>Banda Aceh</option>
<option>Denpasar</option>
<option>Serang</option>
<option>Tangerang</option>
<option>Bengkulu</option>
<option>Gorontalo</option>
<option>Jakarta</option>
<option>Sungai Penuh</option>
<option>Jambi</option>
<option>Bandung</option>
<option>Bekasi</option>
<option>Bogor</option>
<option>Cimahi</option>
<option>Cirebon</option>
<option>Depok</option>
<option>Sukabumi</option>
<option>Tasikmalaya</option>
<option>Banjar</option>
<option>Magelang</option>
<option>Pekalongan</option>
<option>Purwokerto</option>
</select>
</td>
</tr>
<tr>
<td valign="top">Biografi</td>
<td><textarea placeholder="isilah biografi singkat anda" cols="30" rows="5"></textarea></td>
</tr>
<tr>
<td colspan="2"><input type="submit" value="Simpan"></td>
</tr>
</table>
</body>
</html>