<html>
<head>
<title>Form Pendaftaran Anggota</title>
</head>
<body>
<form action="proses.php" method="post" name="form1" id="form1">
<fieldset>
<legend> Form Pendaftaran Anggota </legend>
<table width="100%" border="0" cellspacing="0"
cellpadding="5">
<tr>
<td width="20%">Nama</td>
<td width="1%">:</td>
<td width="79%"><input type="text" name="nama"
id="nama" ></td>
</tr>
<tr>
<td width="20%">Password</td>
<td width="1%">:</td>
<td width="79%"><input type="password"
name="password" id="nama" ></td>
</tr>
<tr>
<td>Alamat</td>
<td>:</td>
<td><textarea name="alamat" id="alamat" cols="45" rows="5">
</textarea></td>
</tr>
<tr>
<td>Jenis Kelamin</td>
<td>:</td>
<td><input type="radio" name="radio" id="jk"
value="Pria" >
Pria
<input type="radio" name="radio" id="jk"
value="Wanita" >
Wanita</td>
</tr>
<tr>
<td>Tgl Lahir</td>
<td>:</td>
<td>
<select name="tgl">
<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="31">31</option>
</select>
-
<select name="bln">
<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>
</select>
-
<select name="thn">
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
</select>
</td>
</tr>
<tr>
<td>Hobi</td>
<td>:</td>
<td><input type="checkbox" name="hobi1" value="Makan" >
Makan
<input type="checkbox" name="hobi2" value="Memancing" >
Memancing
<input type="checkbox" name="hobi3" value="Tidur" >
Tidur
<input type="checkbox" name="hobi4" value="Belanja" >
Belanja
</td>
</tr>
<tr>
<td>Zodiak</td>
<td> </td>
<td><select name="zodiak" id="zodiak">
<option>Leo</option>
<option>Libra</option>
<option>Gemini</option>
<option>Aquarius</option>
<option>Cancer</option>
</select>
</td>
</tr>
<tr>
<td> </td>
<td> </td>
<td><input type="submit" name="submit" id="submit" value="Submit" >
<input type="reset" name="reset" id="reset" value="Reset" ></td>
</tr>
</table>
</fieldset>
</form>
</body>
</html>
script proses.php
<?php
$nama = $_POST["nama"];
$password = $_POST["password"];
$alamat = $_POST["alamat"];
$J_kelamin = $_POST["radio"];
$tgl_lahir = $_POST["tgl"];
$thn_lahir = $_POST["thn"];
$zodiak = $_POST["zodiak"];
switch($_POST['bln'])
{
case "1" :
$bulan = "Januari";
break;
case "2" :
$bulan = "Februari";
break;
case "3" :
$bulan = "Maret";
break;
case "4" :
$bulan = "April";
break;
case "5" :
$bulan = "Mei";
break;
case "6" :
$bulan = "Juni";
break;
case "7" :
$bulan = "Juli";
break;
case "8" :
$bulan = "Agustus";
break;
case "9" :
$bulan = "September";
break;
case "10" :
$bulan = "Oktober";
break;
case "11" :
$bulan = "Nopember";
break;
default :
$bulan = "Desember";
break;
}
?>
<fieldset>
<legend><h1> Data Pendaftaran Anggota </h1></legend>
<table width="100%" border="0" cellspacing="0"
cellpadding="3">
<tr>
<td>Nama</td>
<td>:</td>
<?php echo "<td>$nama</td>"; ?>
</tr>
<tr>
<td>Password</td>
<td>:</td>
<?php echo "<td>$password</td>"; ?>
</tr>
<tr>
<td>Alamat</td>
<td>:</td>
<?php echo "<td>$alamat</td>"; ?>
</tr>
<tr>
<td>Jenis Kelamin</td>
<td>:</td>
<?php echo "<td>$J_kelamin</td>"; ?>
</tr>
<tr>
<td>Tgl Lahir</td>
<td>:</td>
<?php echo "<td>$tgl_lahir $bulan $thn_lahir</td>"; ?>
</tr>
<tr>
<td>Hobi</td>
<td>:</td>
<td>
<?php
if (isset($_POST["hobi1"])) echo $_POST["hobi1"].", ";
if (isset($_POST["hobi2"])) echo $_POST["hobi2"].", ";
if (isset($_POST["hobi3"])) echo $_POST["hobi3"].", ";
if (isset($_POST["hobi4"])) echo $_POST["hobi4"].". ";
?>
</td>
</tr>
<tr>
<td>Zodiak</td>
<td>:</td>
<?php echo "<td>$zodiak</td>"; ?>
</tr>
</table>
</fieldset>
</body>
</html>
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