<head>
<title>Form Pembuatan Email</title>
</head>
<body>
<form name="EMAIL" action="aripinalamsyah8@gmail.com">
<table width="50%" border="1">
<tr>
<td colspan="4"><CENTER><B> FORMULIR PEMBUATAN EMAIL </B></CENTER></TD>
</TR>
<tr>
<td width="30%">Nama</td>
<td width="55%">
<input type="text" name="Nama Depan" MAXLENGTH="70" SIZE="55"> </td>
</tr>
<tr>
<td width="30%">Pilih nama pengguna Anda</td>
<td width="55%">
<input type="text" name="gmaidotlcom" MAXLENGTH="70" SIZE="55"> </td>
</tr>
<tr>
<td width="30%">Buat sandi</td>
<td width="55%">
<input type="text" name="sandi1" MAXLENGTH="70" SIZE="55"> </td>
</tr>
<tr>
<td width="30%">Konfirmasi sandi Anda</td>
<td width="55%">
<input type="text" name="sandi2" MAXLENGTH="70" SIZE="55"> </td>
</tr>
<tr>
<td width="30%">Tanggal Lahir</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%">Gender</td>
<td width="55%">
<select name="gender">
<option value="perem">Wanita</option>
<option value="laki">Pria</option>
</tr>
<tr>
<td width="30%">Ponsel</td>
<td width="55%">
<input type="text" name="nohp" MAXLENGTH="70" SIZE="55"></td>
</tr>
<tr>
<td width="30%">Alamat email Anda saat ini</td>
<td width="55%">
<input type="text" name="emaildulu" MAXLENGTH="70" SIZE="55"> </td>
</tr>
<tr>
<td width="30%">Lokasi</td>
<td width="55%">
<select name="lokasi">
<option value="ina">Indonesia</option>
<option value="as">Amerika Serikat</option>
<option value="belanda">Belanda</option>
<option value="china">China</option>
<option value="dominika">Dominika</option>
<option value="erit">Eritrea</option>
<option value="filipina">Filiphina</option>
<option value="georgia">Georgia</option>
<option value="hongkong">Hongkong</option>
<option value="inggris">Inggris</option>
<option value="ina">Indonesia</option>
<option value="jerman">Jerman</option>
<option value="korea">Korea</option>
</tr>
<tr>
<td> </TD>
<TD><input type="submit" name="KIRIM" value="KIRIM">
<input type="RESET" name="BATAL" value="BATAL"></TD>
</TR>
</TABLE>
</BODY>
</HTML>
