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<title>Form Input</title>
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<p style="font:bold 30px snap itc;color;black" align="center"/>Form Pendaftaran Penerimaan Peserta Didik Baru SMK Maju Mundur Tahun Ajaran 2015/2016</p>
<table border="0" align="center" bgcolor="white">
<tr>
<td>Nama</td>
<td>:</td>
<td><input type="text" name="inama" size="35"/></td>
<tr>
<td>Alamat</td>
<td>:</td>
<td><input type="text" name="ialamat" size="35"/></td>
<tr>
<td>Tempat Tanggal Lahir</td>
<td>:</td>
<td><input type="text" name="itempat tanggal lahir" size="35"/></td>
<tr>
<td>Jenis Kelamin</td>
<td>:</td>
<td><input type="radio" name="ijekel" value="Laki Laki"/>Laki Laki <input type="radio" name="ijekel" value="Perempuan"/>Perempuan</td>
<tr>
<td>Agama</td>
<td>:</td>
<td><select name="iagama">
<option> </option>
<option value="Islam">Islam</option>
<option value="Kristen">Kristen</option>
<option value="Budha">Budha</option>
<option value="Yang Lain">Yang Lain</option></select></td>
<tr>
<td>Nama Orang Tua</td>
<td>:</td>
<td><input type="text" name="bapak" size="35"/></td>
<tr>
<td>Pekerjaan Orang Tua</td>
<td>:</td>
<td><select name="pekerjaan">
<option> </option>
<option value="PNS">PNS</option>
<option value="Buruh">Buruh</option>
<option value="Petani">Petani</option>
<option value="Pedagang">Pedagang</option>
<option value="Yang Lain">Yang Lain</option></select></td>
<tr>
<td>Nomor Telepon</td>
<td>:</td>
<td><input type="text" name="inomor telepon" size="35"/></td>
<tr>
<td>Asal Sekolah</td>
<td>:</td>
<td><input type="text" name="iasal sekolah" size="35"/></td>
<tr>
<td>Pilihan Jurusan</td>
<td>:</td>
<td><select name="ipilju">
<option> </option>
<option value="TKJ">TKJ</option>
<option value="TKR">TKR</option>
<option value="TGB">TGB</option>
<option value="TEI">TEI</option>
<option value="Akuntansi">Akuntansi</option>
<option value="RPL">RPL</option></select></td>
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<td>Jarak Dari Rumah Kesekolah</td>
<td>:</td>
<td><input type="radio" name="jadaruke" value="0-5 km"/>0-5 km <input type="radio" name="jadaruke" value="5-10 km"/>5-10 km <input type="radio" name="jadaruke" value="10-20 km"/>10-20 km <input type="radio" name="jadaruke" value="lebih dari 20 km"/>lebih dari 20 km</td>
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<td colspan="5" align="right"><input type="button" value="Submit"/></td>
</tr>
</table>
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