<html>
<head>
<title>Pengajuan Judul Thesis</title>
<style>
body {background-color: 00FFFF;}
h1 {color: blue;}
</style>
</head>
<body>
<form>
<img src="ur-gede.gif" width="128" height="128">
<h1 align=center>Formulir Pengajuan Judul</h1>
<table>
<tr>
<td align=left>Nama Lengkap</td>
<td>: <input type="text" name="name" size=35></td>
<tr>
<td align=left>Alamat Kabupaten</td>
<td>: <input type="text" name="alamatkab" size=35></td>
</tr>
<tr>
<td align=left>Instansi/Institusi</td>
<td>: <input type="text" name="student" size=35></td>
</tr>
<tr>
<td align=left>Jenis Kelamin</td>
<td>: <input type="radio" name="jeniskelamin" value="U" checked> Laki-Laki
<input type="radio" name="jeniskelamin" value="N"> Perempuan</td>
</tr>
<tr>
<td align=left>Email Address</td>
<td>: <input type="text" name="emailaddr" size=35></td>
</tr>
<tr>
<td align=left>No Telp</td>
<td>: +62<input type="text" name="notelp" size=35></td>
<tr>
<td align=left>Judul Tesis</td>
<td>: <textarea name="Comments" rows=5 cols=55 wrap="yes"></textarea>
</tr>
<tr>
<td align=left>Bidang Kajian :</td>
<td><input type="radio" name="bidkajian" value="U" checked> Sistem Informasi Manajemen<br>
<input type="radio" name="bidkajian" value="N"> Sistem Pengambilan Keputusan<br>
<input type="radio" name="bidkajian" value="N"> Perencanaan Strategik<br>
<input type="radio" name="bidkajian" value="N"> Total Quality Management</td>
</tr>
<tr>
<td align=left>Abstraksi Tesis</td>
<td>: <textarea name="Comments" rows=5 cols=70 wrap="yes"></textarea></td>
</tr>
</table>
<br>
<input type="reset" value="Reset">
<input type="submit" value="Submit">
</form>
</body>
</html>
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