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Nama : Shafira Ramadhan

Kelas : 05TPLE007

Nim : 171011450081

<!DOCTYPE html>

<html>

<head>

<title>Form Input | UAS</title>

</head>

<body>

<script>

alert("Selamat datang di Form Bagus Budi Pangestu, Klik Oke untuk lanjut");

alert("Selanjutnya, Silakan Isi Form Di Bawah Ini");

</script>

<center>

<div style="background-color: #008080; font-family: Times New Roman; color: white; border: 5px
solid #17202A; height: 1160px; margin: 50px 0px; padding: 5px; text-align: center; width: 400px;">

<div align= "left"><h3>Tour Reservation Bagus Budi Pangestu Form</div></h3>

<div align= "left"><p>Please lets know what you are interested to see</div></p><hr>

<div align= "left">

<p><b>Full Name</b></p>

<input type=text size="10" name="txtname_Bagus Budi Pangestu">

<br><label for="name"><font color="grey">First Name</font></label><br>

<input type=text name="txtname_Bagus Budi Pangestu">

<br><label for="name"><font color="grey">Last Name</font></label><br>

&nbsp
<p><b>E-mail</b></p>

<input type=text size="30" name="txtemail_Bagus Budi Pangestu" placeholder="ex:


myname@example.com"><br>

&nbsp

<p><b>Phone Number</b></p>

<td><input type="txtnumber_Bagus Budi Pangestu" size="5"> -

<input type="txtnumber_Bagus Budi Pangestu" size="10">

</td>

&nbsp

<p><b>When are you planning to visit?</b></p>

<td>

<input type="text" size="5" name="txtmonth_Bagus Budi Pangestu" id="month"> -

<input type="text" size="5" name="txtday_Bagus Budi Pangestu" id="days"> -

<br>

<label for="month"><font color="grey">Month</font></label>


&emsp14;&emsp14;&emsp14;&emsp14;&emsp14;&emsp14;&emsp14;&emsp14;&emsp14; <label
for="days"><font color="grey">Day</font></label>

<br>

<input type="text" size="8" name="txtyears_Bagus Budi Pangestu" id="years">

<br>

<label for="tahun"><font color="grey">Years</font></label>

</td><br>

&nbsp

<p><b>How many people are in your group?</b></p>

<td><input type="text" size="5" name="txtnumber_Bagus Budi Pangestu"></td><br>

&nbsp

<p><b>Which tours or events are you most interested in?</b></p>

<td>

<input type="checkbox" value="">Revolution was jus the beginning

<br><input type="checkbox" value="">Transcendentalism


<br><input type="checkbox" value="">Custom

</td><br><br>

<td>

<b>if phone, when is the</b>&nbsp; <input type="radio" name="txttime_Bagus Budi Pangestu"


value="am">8-11 am<br>

<b>best time of day for</b> &emsp14;&emsp14;&emsp14; <input type="radio"


name="txttime_Bagus Budi Pangestu" value="pm">12-4 pm<br>

<b>a call-back?</b>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n
bsp;

<input type="radio" name="txttime_Bagus Budi Pangestu" value="pm">6-10 pm<br>

</td>

&nbsp

<p><b>Anything else we should know?</p></b>

<td><textarea rows="5" cols="51"></textarea></td>

&nbsp

<br>

<input type="submit" value="Submit">

<input type="reset" value="Reset">

</br><hr>

&nbsp;

&nbsp;

<p><i><center>NotCopyPaste@Bagus Budi Pangestu_Jujur2020</center></i></p>

</div>

</center>

</body>

</html>
Output

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