[ Mini Kiebo ]
Server: Windows NT AKFAR_SERVER 10.0 build 26200 (Windows 10) AMD64
Path:
D:
/
BACKUP C 19-12
/
XAMPP74
/
htdocs
/
pmb
/
[
Home
]
File: daftar1admin.php
<!DOCTYPE html> <html lang="zxx"> <head> <title>PMB Akfar Bumi Siliwangi</title> <meta charset="UTF-8"> <meta name="description" content="PMB Akfar Bumsil"> <meta name="keywords" content="PMB, bumsil"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <!-- Favicon --> <link href="img/logo_ico.ico" rel="shortcut icon"/> <!-- Google font --> <link href="https://fonts.googleapis.com/css?family=Montserrat:300,300i,400,400i,500,500i,600,600i,700,700i&display=swap" rel="stylesheet"> <!-- Stylesheets --> <link rel="stylesheet" href="css/bootstrap.min.css"/> <link rel="stylesheet" href="css/font-awesome.min.css"/> <link rel="stylesheet" href="css/owl.carousel.min.css"/> <link rel="stylesheet" href="css/slicknav.min.css"/> <!-- Main Stylesheets --> <link rel="stylesheet" href="css/style.css"/> <!--[if lt IE 9]> <script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script> <script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script> <![endif]--> </head> <body> <!-- Page Preloder --> <div id="preloder"> <div class="loader"></div> </div> <!-- Header section --> <header class="header-section clearfix"> <a href="homeadmin.php" class="site-logo"> <img src="img/logokecil.png" alt=""> </a> <div class="header-right"> <div class="user-panel"> <a href="home.php" class="hr-btn">Log Out</a> </div> </div> <ul class="main-menu"> <li><a href="homeadmin.php">Home</a></li> <li><a href="daftar1admin.php">Pendaftaran PMB</a></li> <li><a href="datapendaftar.php">Data Pendaftar</a></li> <li><a href="homekartu.php">Cetak Kartu PMB</a></li> <li><a href="laporan.php">Laporan</a> <ul class="sub-menu"> <li><a href="laporand3farmasi.php">Laporan D3 Farmasi</a></li> </ul> </li> <li><a href="dataadmin.php">Data Admin</a></li> </ul> </header> <!-- Header section end --> <!-- Premium section end --> <section class="premium-section spad"> <div class="container"> <div class="row"> <form action="tambahdaftar1admin.php" method="POST" enctype="multipart/form-data"> <fieldset> <legend>Identitas Mahasiswa </legend> <table cellpadding="8"> <tr> <td>Nomor KTP:</td> <td><input type="text" name="ktp" placeholder="ktp" /></td> </tr> <tr> <td>Nama Lengkap:</td> <td><input type="text" name="nama" placeholder="nama lengkap" /></td> </tr> <tr> <td>Tempat, Tanggal Lahir:</td> <td> <input type="text" name="tempat" placeholder="kota kelahiran" /> <input type="date" name="tanggal" /> </td> </tr> <tr> <td>Umur:</td> <td><input type="text" name="umur" placeholder="umur" /> </td> </tr> <tr> <td>Agama:</td> <td> <select name="agama"> <option value="islam">Islam</option> <option value="katolik">Katolik</option> <option value="kristen">Kristen</option> <option value="hindu">Hindu</option> <option value="budha">Budha</option> <option value="konghucu">Konghucu</option> </select> </td> </tr> <tr> <td>Alamat Sekarang:</td> <td><textarea name="alamat" placeholder="alamat sekarang" rows="3" cols="40"></textarea></td> </tr> <tr> <td>Kelurahan / Desa:</td> <td><input type="text" name="kelurahan" placeholder="kelurahan" /></td> </tr> <tr> <td>Kecamatan:</td> <td><input type="text" name="kecamatan" placeholder="kecamatan" /></td> </tr> <tr> <td>Kota / Kabupaten:</td> <td><input type="text" name="kota" placeholder="kota" /></td> </tr> <tr> <td>Provinsi:</td> <td><input type="text" name="provinsi" placeholder="provinsi" /></td> </tr> <tr> <td>Kode Pos:</td> <td><input type="text" name="kodepos" placeholder="kodepos" /></td> </tr> <tr> <td>Status:</td> <td> <select name="status"> <option value="menikah">Menikah</option> <option value="belummenikah">Belum Menikah</option> </select> </tr> <tr> <td>Jenis kelamin:</td> <td> <label><input type="radio" name="jenis_kelamin" value="laki-laki" /> Laki-laki</label> <label><input type="radio" name="jenis_kelamin" value="perempuan" /> Perempuan</label> </td> </tr> <tr> <td>Tinggi Badan:</td> <td><input type="text" name="tinggibadan" placeholder="tinggi badan" /> <b> cm </td> </tr> <tr> <td>Berat Badan:</td> <td><input type="text" name="beratbadan" placeholder="berat badan" /> <b> Kg </td> </tr> <tr> <td>Ukuran Jas Almamater:</td> <td> <select name="jas"> <option value="s">S</option> <option value="m">M</option> <option value="l">L</option> <option value="xl">XL</option> <option value="xxl">XXL</option> </select> </td> </tr> <tr> <td>Nomor Telepon / Handphone:</td> <td><input type="text" name="telepon" placeholder="nomor telepon / handphone" /></td> </tr> <tr> <td>E-mail:</td> <td><input type="text" name="email" placeholder="e-mail" /></td> </tr> </table> </fieldset> <hr> <input type="submit" value="submit" name="submit"> </form> <p></p> <b>Biaya Pendaftaran PMB Akfar Bumsil sebesar Rp 300.000,-</b> </div> </div> </section> <!-- Premium section end --> <!-- Footer section --> <footer class="footer-section"> <div class="container"> <div class="row"> <div class="col-xl-6 col-lg-5 order-lg-1"> <img src="img/logokecil.png" alt=""> <div class="copyright"><!-- Link back to Colorlib can't be removed. Template is licensed under CC BY 3.0. --> Copyright ©<script>document.write(new Date().getFullYear());</script> All rights reserved | ICT Akfar Bumsil <!-- Link back to Colorlib can't be removed. Template is licensed under CC BY 3.0. --></div> <div class="social-links"> <a href="https://www.instagram.com/akfarbumsil/" target="_blank"><i class="fa fa-instagram"></i></a> <a href=""><i class="fa fa-facebook"></i></a> <a href="https://www.youtube.com/channel/UCH977lptXXP3PuNoOrJSbiQ" target="_blank"><i class="fa fa-youtube"></i></a> </div> </div> </div> </div> </footer> <!-- Footer section end --> <!--====== Javascripts & Jquery ======--> <script src="js/jquery-3.2.1.min.js"></script> <script src="js/bootstrap.min.js"></script> <script src="js/jquery.slicknav.min.js"></script> <script src="js/owl.carousel.min.js"></script> <script src="js/mixitup.min.js"></script> <script src="js/main.js"></script> </body> </html>