<head>
</head>
<body>
<form>
<table width="556" height="335" border="0">
<tr>
<td width="93">Nama</td>
<td width="423">: <input type="text" name="nama_mhs" value="" maxlength=30 width=100></input></td>
</tr>
<tr>
<td>Alamat</td>
<td>: <textarea name="alamat" rows=1></textarea></td>
</tr>
<tr>
<td>Tempat Lahir</td>
<td>: <input name="tmp_lahir"></input></td>
</tr>
<tr>
<td>Tgl Lahir</td>
<td>: <input name="tgl_lahir" value="" maxlength=2 width=30></input>
<select name="bln_lahir">
<option value=1>Januari</option>
<option value=2>Februari</option>
<option value=3>Maret</option>
<option value=4>April</option>
<option value=5>Mei</option>
<option value=6>Juni</option>
<option value=7>Juli</option>
<option value=8>Agustus</option>
<option value=9>September</option>
<option value=10>Oktober</option>
<option value=11>November</option>
<option value=12>Desember</option>
</select>
<input type="text" name="thn_lahir" value="" maxlength=4></input>
</td>
</tr>
<tr>
<td>Telepon</td>
<td>: <input type="text" name="telepon" value=""></input></td>
</tr>
<tr>
<td>Jenis Kelamin</td>
<td>: <input type=radio name=jk value=L></input>Laki-Laki
<input type=radio name=jk value=p></input>Perempuan
</td>
</tr>
<tr>
<td height="10" colspan="2"><input type = "submit" name="submit" value="Daftar">
<input type="reset" name="reset" value="Reset"> </input>
</td>
</tr>
</table>
</form>
</body>
</html>
