<html>
<head>
<title> = .:: SIGN UP FACEBOOK ::. = </title>
<body>
<h5 align=center>
<div id="div-regForm">
<div class="form-title"><h1>Mendaftar</h1></div>
<div class="form-sub-title">Gratis, sampai kapan pun</div></h5>
<form id="regForm" action="submit.php" method="post">
<table align="center" border="1">
<tbody>
<tr>
<td><label for="fname">Nama Depan:</label></td>
<td><div class="input-container">
<input name="fname" id="fname" type="text" />
</div></td>
</tr>
<tr>
<td><label for="lname">Nama Belakang:</label></td>
<td><div class="input-container">
<input name="lname" id="lname" type="text" />
</div></td>
</tr>
<tr>
<td><label for="email">Masukkan Emailmu:</label></td>
<td><div class="input-container">
<input name="email" id="email" type="text" />
</div></td>
</tr>
<tr>
<td><label for="pass">Kata Sandi Baru:</label></td>
<td><div class="input-container">
<input name="pass" id="pass" type="password" />
</div></td>
</tr>
<tr>
<td><label for="gender-select">Saya:</label></td>
<td>
<div class="input-container">
<select name="gender-select" id="gender-select">
<option value="0">Pilih Jenis Kelamin:</option>
<option value="1">Perempuan</option>
<option value="2">Laki-laki</option>
<option value="2">Lainnya</option>
</select>
</div>
</td>
</tr>
<tr>
<td><label>Tanggal Lahir:</label></td>
<td>
<div class="input-container">
<select name="Bulan">
<option value="0">Bulan:</option>
<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>
<select name="Tanggal">
<option value="0">Tanggal:</option>
<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>
<select name="Tahun">
<option value="0">Tahun:</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<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>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2000">2009</option>
<option value="2000">2010</option>
<option value="2000">2011</option>
<option value="2000">2012</option>
<option value="2000">2013</option>
</select>
</div>
</td>
</tr>
<tr>
<td> </td>
<td><input type="submit" class="greenButton" value="Sign Up" />
</td>
</tr>
</tbody>
</table>
</form>
<div id="error">
</div>
</div>
</head>
</body>
</html>
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