<?
//*********************************************************************************
// Original Website By : Niadesain.com Di Jual melalui http://niadesain.com
// Please Call / SMS : 081384745483 (support@niadesain.com)
// Niadesain.com - Jasa Pembuatan Website Paling Murah dan Paling Lengkap
//*********************************************************************************
?>
<link href="responsiveform.css" rel="stylesheet">
<link href="responsiveform1.css" rel="stylesheet">
<link href="responsiveform2.css" rel="stylesheet">
<link href="responsiveform3.css" rel="stylesheet">
<style type="text/css">
<!--
.VGHTRUT {
	font-size: 11px;
	font-weight: bold;
	font-family: Verdana, Arial, Helvetica, sans-serif;
}
.style5 {font-size: 11px; font-family: Verdana, Arial, Helvetica, sans-serif; }
.style7 {font-size: 11px; font-weight: bold; font-family: Verdana, Arial, Helvetica, sans-serif; color: #FFFFFF; }
.style10 {font-family: Verdana, Arial, Helvetica, sans-serif; font-weight: bold;}
.style18 {font-size: 14px; color: #666666; }
.style20 {font-size: 14px; font-weight: bold; font-family: Verdana, Arial, Helvetica, sans-serif; color: #666666; }
-->
</style>
<form method="post" action="">
<div align="center">
  <p align="left" class="VGHTRUT"><span class="cc01">
    
  </span></p>
  <p class="VGHTRUT">PENDAFTARAN</p>
</div>
<table width="100%" border="0" align="center" cellpadding="3" cellspacing="1" class="formjoin">
   
    <tr>
      <td height="33" background="images/actionbuttons.jpg"><center>
        <span class="style7">Data Serial dan Pin </span>
      </center></td>
    </tr>
    <tr>
      <td><div align="center"><span class="style5"><span align="right" class="VGHTRUT">Serial Card <font color="#FF0000"> *</font></span> : <br>
        <input name="serialcardpec" id="serialcardpec" type="text" class="form" value="" size="15" maxlength="10" tooltiptext="Silahkan Serial Number kartu PEC anda. Serial Number tersebut dapat anda lihat pada Bagian belakang Kartu anggota PEC anda" />
      </span></div></td>
    </tr>
    <tr>
      <td width="51%"><div align="center"><span class="style5"><span align="right" class="style5"><strong>&nbsp;Pin Card <font color="#FF0000"> *</font></strong></span> :<br>
        <input name="pincardpec" id="pincardpec" type="text" class="form" value="" size="15" maxlength="10" tooltiptext="Silahkan PIN kartu PEC anda. PIN tersebut dapat anda lihat pada Bagian belakang Kartu anggota PEC anda"/>
      </span></div></td>
    </tr>
</table>
