PHP4
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
</head>
<body>
<form id="Form1" name="Form1" method="post" action="script2php4.php"><table> <tr> <td>
<table width="353" border="0">
<tr>
<td width="84"><b>Nama</b></td>
<td width="15">:</td>
<td width="232"><input type="text" name="nama" id="nama2" /></td>
</tr>
<tr>
<td width="84"><b>Email</b></td>
<td width="15">:</td>
<td width="250"><input type="text" name="email" id="nama" /></td>
</tr>
<tr>
<td width="84"><b>TTL</b></td>
<td width="15">:</td>
<td width="250"><select name="hari" id="hari"/><select name="bulan" id="bulan"/><select name="tahun" id="t"/>
<?php
//membuat array bulan
$bulan=array("Januari" ,"Februari", " Maret" ,"April", "Mei", "Juni", "Juli", "Agustus", "September", "Oktober", "November", "Desember");
//membuat combobox hari
echo '<select name="hari">';
$hari=1;
while($hari<=31){
echo "<option value=\"$hari\">$hari</option>";
$hari++;
}
echo '</select>';
//Membuat combo box bulan
echo '<select name="bulan">';
$jumlah=count($bulan); for($i=0; $i<$jumlah ; $i++){ echo '<option value="'.$bulan[$i].'">'.$bulan[$i].'</option>'; } echo '</select>';
//Membuat combo tahun
echo '<select name="tahun">';
for($tahun=1990; $tahun<2013;
$tahun++)
{
echo "<option value=\"$tahun\">$tahun</option>";
}
echo '</select>';
?>
</td>
</tr>
<tr>
<td width="84"><b>Jenis Kelamin</b></td>
<td width="15">:</td>
<td><b></b>
<input type="radio" name="gender" value="L"/>Laki Laki
<input type="radio" name="gender" value="P"/>Perempuan</td>
</tr>
<tr>
<td width="84"><b>Umur</b></td>
<td width="15">:</td>
<td> <select name="umur">
<option value="0-29">Dibawah 30 </option>
<option value="30-60">Antara 30-60 </option>
<option value="61+">Diatas 60 </option>
</select>
</td>
</tr>
<tr>
<td width="84"><b>Komentar</b></td>
<td width="15">:</td>
<td><textarea name="komentar" cols="22,5" rows="7"></textarea></td
</tr>
<tr>
<td> </td>
<td> </td>
<td><input type="submit" name="submit" value="submit"/></td>
</tr>
</table>
</form>
</body>
</html>
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