<html>
<head>
<title>...</title>
</head>
<b><font color="purple">1. Tell us about yourself....</b></font>
<table border="0">
<tr>
<td width="200" align="right">My Name</td>
<td><input type="text" name="Nama" size="25" value="First Name">
<input type="text" name="Nama" size="25" value="Last Name"></td>
</tr>
<tr>
<td width="200" align="right">Gender</td>
<td><select name="select">
<option value="-Select One-">-Select One-
<option value="male">Male
<option value="male">Female
</select></td>
</tr>
<tr>
<td width="200" align="right">Birthday</td>
<td><Select name="Birthday">
<option value="-Select Month-">-Select Month-
<option value="Januari">Januari
<option value="Pebruari">Pebruari
<option value="Maret">Maret
<option value="April">April
<option value="Mei">Mei
<option value="Juni">Juni
<option value="Juli">Juli
<option value="Agustus">Agustus
<option value="September">September
<option value="Oktober">Oktober
<option value="November">November
<option value="Desember">Desember
</select>
<input type="text" name="Day" size="10" value="Day">
<input type="text" name="Year" size="10" value="Year">
</td>
</tr>
<tr>
<td width="200" align="right">I live in</td>
<td><select name="select" >
<option value="Pancur Batu">Pancur Batu
<option value="Abri">Abri
<option value="Dewantara">Dewantara
<option value="Franch">Franch
<option value="Rambung Merah">Rambung Merah
<option value="Laucih">Laucih
<option value="Durin Sembelang">Durin Sembelang </option>
</select>
</td>
</tr>
<tr>
<td width="200" align="right">Postal Code</td>
<td><input type="Number" name="Code" size="15"></td>
</tr>
</table>
<br>
<b><font color="purple"> 2. Select an ID and Password</b></font>
<table border="0">
<tr>
<td width="200" align="right">Yahoo! ID and Email</td>
<td><input type="text" name="Day" size="20">
@<select name="select" >
<option value="yahoo.com">yahoo.com
<option value="yahoo.co.id">yahoo.co.id
<option value="gmail.com">gmail.com
<option value="rocketmail.com">rocketmail.com</td>
<td><input type="submit" value="Check"></td>
</tr>
<tr>
<td width="200" align="right">Password</td>
<td><input type="text" name="Password" size="30"></td>
</tr>
<tr>
<td width="200" align="right">Re-type Password</td>
<td><input type="text" name="Re-Password" size="30"></td>
</tr>
</table>
<br>
<b><font color="purple"> 3. In case you forget your ID or password...</b></font>
<table border="0">
<tr>
<td width="200" align="right"><i>Alternate Email</i></td>
<td><input type="text" name="A-Email" size="55"></td>
</tr>
<tr>
<td width="200" align="right">1. Security Question</td>
<td><select size width="200" name="select" >
<option value="-Select One-">-Select One-</option>
<option value="Apa anda sering bermain game pada waktu belajar.?">Apa anda sering bermain game pada waktu belajar.?
<option value="Apa yang anda lakukan setelah bertemu teman lama ?">Apa yang anda lakukan setelah bertemu teman lama ?</td>
</tr>
<tr>
<td width="200" align="right">Your Answer</td>
<td><input type="text" name="Jawab" size="55"></td>
</tr>
<tr>
<td width="200" align="right">2. Security Question</td>
<td><select size width="200" name="select" >
<option value="-Select One-">-Select One-
<option value="akakakkakkkakakakakkaaaaaaaaaaaaaaaaAA ? ">akakakkakkkakakakakkaaaaaaaaaaaaaaaaaaaaaAA?
<option value="apa anda sering begadang ?">apa anda sering begadang ?</td>
</tr>
<tr>
<td width="200" align="right">Your Answer</td>
<td><input type="text" name="Jawab" size="55"></td>
</tr>
<tr>
<td width="200" align="right"></td>
<td><input type="submit" value="batal">
<input type="reset" value="simpan"></td>
</tr>
</body>
</html>
HASIL NYA :
