MIF_E31211896/register.php

80 lines
3.1 KiB
PHP

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8"/>
<meta http-equiv="X-UA-Compatible" content="IE=edge"/>
<meta name="viewport" content="width=device-width, initial-scale=1"/>
<title>Program Sistem Pakar Diagnosa</title>
<link href="assets/css/yeti-bootstrap.min.css" rel="stylesheet"/>
<link href="assets/css/general.css" rel="stylesheet"/>
<link href="assets/css/select2.min.css" rel="stylesheet"/>
<script src="assets/js/jquery.min.js"></script>
<script src="assets/js/bootstrap.min.js"></script>
<script src="assets/js/select2.min.js"></script>
<style type="text/css">
.hi {
background-image: linear-gradient(rgba(0, 0, 0, 0.5),rgba(0, 0, 0, 0.5)), url('vitaminbg.png');
background-size: cover;
background-position: center center;
background-repeat: no-repeat;
background-attachment: fixed;
}
.dark {
background-color: #000;
color: #fff;
}
</style>
</head>
<body class="dark hi">
<div class="container">
<div class="page-header">
<h1>Registrasi</h1>
</div>
<div class="row">
<div class="col-md-4">
<?php if ($_POST) include 'aksi.php'; ?>
<form method="post">
<div class="form-group">
<label for="username">Username</label>
<input type="text" class="form-control" placeholder="Username" name="user" autofocus />
</div>
<div class="form-group">
<label for="password">Password</label>
<input type="password" id="inputPassword" class="form-control" placeholder="Password" name="pass" />
</div>
<div class="form-group">
<label for="nama">Nama</label>
<input type="text" class="form-control" placeholder="Nama" name="nama" />
</div>
<div class="form-group">
<label for="email">Email</label>
<input type="text" class="form-control" placeholder="Email" name="email" />
</div>
<div class="form-group">
<label for="no_hp">No. Hp</label>
<input type="text" class="form-control" placeholder="No. Hp" name="no_hp" />
</div>
<div class="form-group">
<label for="jk">Jenis Kelamin</label><br>
<input type="radio" name="jk" value="Laki - Laki"> Laki - Laki
<input type="radio" name="jk" value="Perempuan"> Perempuan
</div>
<div class="form-group">
<label for="usia">Usia</label>
<input type="text" class="form-control" placeholder="Usia" name="usia" />
</div>
<div class="form-group">
<label for="alamat">Alamat</label>
<input type="text" class="form-control" placeholder="Alamat" name="alamat" />
</div>
<div class="form-group">
<button class="btn edit" type="submit">Registrasi</button>
<a class="btn edit" href="?m=login"><span class="glyphicon glyphicon-arrow-left"></span> Kembali</a>
</div>
</form>
</div>
</div>
</div>
</body>
</html>