<head>
<title>Formulir PSB</title>
</head>
<body>
<form name="PSB" action="mailto:aripinalamsyah8@gmail.com">
<table width="50%" border="1">
<tr>
<td colspan="4"><CENTER><B> FORMULIR PENERIMAAN SISWA BARU </B></CENTER></TD>
</TR>
<tr>
<td width="30%">Nama Lengkap</td>
<td width="5%" align="center"> : </td>
<td width="55%">
<input type="text" name="nama_lengkap" MAXLENGTH="50" SIZE="40"> </td>
</tr>
<tr>
<td width="30%">Tanggal Lahir</td>
<td width="5%" align="center"> : </td>
<td width="55%">Tanggal
<select name="Tanggal">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<select name="Bulan"> Bulan
<select>
<option value="Jan">Januari</option>
<option value="feb">Februari</option>
<option value="mar">Maret</option>
<option value="apr">April</option>
<option value="Mei">Mei</option>
<option value="jun">Juni</option>
<option value="jul">Juli</option>
<option value="ags">Agustus</option>
<option value="Sep">September</option>
<option value="okt">Oktober</option>
<option value="Nov">November</option>
<option value="des">Desember</option>
<select name="Tahun"> Tahun
<select>
<option value="90">1990</option>
<option value="91">1991</option>
<option value="92">1992</option>
<option value="93">1993</option>
<option value="94">1994</option>
<option value="95">1995</option>
<option value="96">1996</option>
<option value="97">1997</option>
<option value="98">1998</option>
<option value="99">1999</option>
<option value="00">2000</option>
</select>
</tr>
<tr>
<td width="30%">Jenis Kelamin</td>
<td width="5%" align="center"> : </td>
<td width="55%">
<form>
<input type="radio" name="jk" value="male">Laki-laki<br>
<input type="radio" name="jk" value="female">Perempuan
</form>
</tr>
<tr>
<td width="30%">Agama</td>
<td width="5%" align="center"> : </td>
<td width="55%">
<select name="Agama">
<option value="islam">Islam</option>
<option value="kristen">Kristen</option>
<option value="hindu">Hindu</option>
<option value="budha">Budha</option> </select>
</tr>
<tr>
<td width="30%">Hobi</td>
<td width="5%" align="center"> : </td>
<td width="27%">
<input type="checkbox" name="hobi" value="seni">Seni
<input type="checkbox" name="hobi" value="olah">Olahraga<br>
<input type="checkbox" name="hobi" value="tidur">Tidur
<input type="checkbox" name="hobi" value="Travel">Traveling</td>
</tr>
<TR>
<td> </TD>
<td> </TD>
<TD><input type="submit" name="KIRIM" value="KIRIM">
<input type="RESET" name="BATAL" value="BATAL"></TD>
</TR>
</TABLE>
</BODY>
</HTML
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