Ini nih scriptnya, teman - teman bisa langsung copas aja.. :D
<html>
<head>
<titLe></title>
</head>
<body bg
background="Penguins.jpg">
<table border="2"
align="center">
<tr><td
bgcolor="ff0000"><p align ="center">
<font size=18 face="Times
New Roman">Form Pendaftaran Mahasiswa Baru</font>
<br/>
</p></td>
</tr>
<tr><td
bgcolor="00ff00"><p align="left">
<form action=""
method="POST">
<table
align="center">
<tr>
<td>Nama
:</td> <td><input type="Text" name="textbox"
value="" size="65" maxlength="40"></td>
</tr>
<tr>
<td>Alamat
: </td>
<td><TEXTAREA
name="textbox" value="Alamat" cols=65
rows=5></TEXTAREA></td>
</tr>
<tr>
<td>Kecamatan
: </td> <td><input type="Text"
name="textbox" value="" size="40"></td>
</tr>
<tr>
<td>Kabupaten/Kota
: </td> <td><input type="Text"
name="textbox" value="" size="40"></td>
</tr>
<tr>
<td>Provinsi
: </td> <td><select>
<option>-Pilih
Provinsi-</option>
<option>Aceh</option>
<option>Sumatera
Utara</option>
<option>Sumatera
Barat</option>
<option>Kepulauan
Riau</option>
<option>Riau</option>
<option>Jambi</option>
<option>Bengkulu</option>
<option>Lampung</option>
<option>Sumatera
Selatan</option>
<option>Kepulauan Bangka
Belitung</option>
<option>DKI
Jakarta</option>
<option>Banten</option>
<option>Jawa
Barat</option>
<option>Jawa
Tengah</option>
<option>DI Yogyakarta</option>
<option>Jawa
Timur</option>
<option>Kalimantan
Utara</option>
<option>Kalimantan
Barat</option>
<option>Kalimantan
Tengah</option>
<option>Kalimantan
Timur</option>
<option>Kalimantan
Selatan</option>
<option>Kalimantan
Tenggara</option>
<option>Bali</option>
<option>Sulawesi
Utara</option>
<option>Sulawesi
Barat</option>
<option>Sulawesi
Tengah</option>
<option>Sulawesi
Selatan</option>
<option>Sulawesi
Tenggara</option>
<option>Maluku
Utara</option>
<option>Maluku</option>
<option>Nusa Tenggara
Timur</option>
<option>Nusa Tenggara
Barat</option>
<option>Papua</option>
<option>Papua
Barat</option>
</select></td>
</tr>
<tr>
<td
valign="top">Agama :</td> <td><input
type="radio" name="agama" value="Islam"> Islam
<input type="radio"
name="agama" value="Kristen"> Kristen
<input type="radio"
name="agama" value="Katholik"> Katholik
<input type="radio"
name="agama" value="Budha"> Budha
<input type="radio"
name="agama" value="Hindu"> Hindu
<input type="radio"
name="agama" value="Konghuchu"> KonghuChu</td>
</tr>
<tr>
<td>Jenis
Kelamin:</td> <td><select>
<option>-Pilih-</option>
<option>Pria</option>
<option>Wanita</option>
</select></td>
</tr>
<tr>
<td>Asal
Sekolah :</td><td><input type="radio"
name="asalsekolah" value="SMA"> SMA
<input type="radio"
name="asalsekolah" value="SMK"> SMK
<input type="radio"
name="asalsekolah" value="MA"> MA</td>
</tr>
<tr>
<td>Nomor
Telepon : </td><td><input type="Text"
name="textbox" value="" size="12"
maxlength="12"></td>
</tr>
<tr>
<td
colspan=2>Data Orangtua/Wali*</td>
</tr>
<tr>
<td
colspan=2>Ayah</td>
</tr>
<tr>
<td>Nama
Ayah :</td><td><input type="Text"
name="textbox" value="" size="65"
maxlength="40"></td>
</tr>
<tr>
<td>Pekerjaan
Ayah</td> <td><input type="radio" name="PekerjaanAyah"
value="TNI">TNI
<input type="radio"
name="pekerjaanayah" value="POLRI">POLRI
<input type="radio"
name="pekerjaanayah" value="PNS">PNS
<input type="radio"
name="pekerjaanayah" value="SWASTA">SWASTA
<input type="radio"
name="pekerjaanayah"
value="Lain-lain">Lain-lain<input type="Text"
name="textbox" value="" size="15">
</td>
</tr>
<tr>
<td>Alamat
: </td> <td><TEXTAREA name="textbox"
value="Alamat" cols=65 rows=5></TEXTAREA></td>
</tr>
<tr>
<td
colspan=2>Ibu</td>
</tr>
<tr>
<td>Nama
Ibu :</td><td><input type="Text"
name="textbox" value="" size="65"
maxlength="40"></td>
</tr>
<tr>
<td>Pekerjaan
Ibu</td> <td><input type="radio"
name="PekerjaanIbu" value="TNI">TNI
<input type="radio"
name="pekerjaanayah" value="POLRI">POLRI
<input type="radio"
name="pekerjaanayah" value="PNS">PNS
<input type="radio"
name="pekerjaanayah" value="SWASTA">SWASTA
<input type="radio"
name="pekerjaanayah"
value="Lain-lain">Lain-lain<input type="Text"
name="textbox" value="" size="15"></td>
</tr>
<tr>
<td>Alamat
: </td> <td><TEXTAREA name="textbox"
value="Alamat" cols=65 rows=5></TEXTAREA></td>
</tr>
<tr>
<td
colspan=2>PEMILIHAN BIDANG STUDI</td>
</tr>
<tr>
<td>Fakultas
: </td> <td><select>
<option>-Pilih
Fakultas-</option>
<option>Fakultas
Kedokteran</option>
<option>Fakultas Teknologi
Industri</option>
<option>Fakultas
Hukum</option>
<option>Fakultas
Ekonomi</option>
<option>Fakultas
Psikologi</option>
<option>Fakultas Keguruan
dan Ilmu Pendidikan</option>
<option>Fakultas
Farmasi</option>
<option>Fakultas Kesehatan
Masyarakat</option>
<option>Fakultas
MIPA</option>
<option></option>
</select></td>
</tr>
<tr>
<td>Jurusan/Program
Pendidikan : </td> <td><input type="Text"
name="textbox" value="" size="65"
maxlength="30"></td>
</tr>
</p>
</table>
</form>
<p
align="bottom">
<input type="submit"
value="Kirim">
<input type="reset"
value="Batal">
</p></td></tr>
</table>
</body>
</html>
Selamat mencoba :D
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