Berikut ini adalah bentuk HTML dari gambar web form pendaftaran diatas :
<html>
<head>
<title> Form Pendaftaran </title>
</head>
<body>
<table border="1" align="center">
<tr> <td colspan = "2" align="center" bgcolor="black"> <img src ="adidas.jpg" width="600" height="400"> </td> </tr>
<td width="25%,40%" bgcolor="#3090c7" >
<ul >
<li>Home </li>
<li>About</li>
<li>Pendaftaran</li>
</ul> </font>
<td bgcolor="#cccccc">
<b align="center">Selamat Datang di Pendaftaran </b> <br><br>
<table>
<form action="proses.php" method="POST">
<tr>
<td> Nama :</td><td> <input type="text" size="30" name="Nama" placeholder="Nama Lengkap"> </td>
</tr>
<tr>
<td> Tempat Lahir :</td> <td><input type="text" size="30" name="Tempat" placeholder="Tempat Lahir"> </td>
</tr>
<tr>
<td> Tanggal Lahir :</td>
<td>
<select name="selectionField">
<option value="Tanggal">Tanggal</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<select>
<option value="Bulan">Bulan</option>
<option value="Januari">Januari</option>
<option value="Februari">Februari</option>
<option value="Maret">Maret</option>
<option value="April">April</option>
<option value="Mei">Mei</option>
<option value="Juni">Juni</option>
<option value="Juli">Juli</option>
<option value="Agustus">Agustus</option>
<option value="September">September</option>
<option value="Oktober">Oktober</option>
<option value="November">November</option>
<option value="Desember">Desember</option>
</select>
<input type="text" size="4" placeholder="Tahun" >
</td>
</tr>
<tr>
<td> Alamat : </td><td><input type="text" size="50" name="Alamat" placeholder="Alamat"> </td>
</tr>
<tr>
<td> Agama : </td>
<td>
<form method="post" action="#">
<input type="radio" name="jk" value="Islam"> Islam
<input type="radio" name="jk" value="Protestan"> Protestan
<input type="radio" name="jk" value="Katolik"> Katolik
<input type="radio" name="jk" value="Konghucu"> Konghucu
<input type="radio" name="jk" value="Budha"> Budha
<input type="radio" name="jk" value="Hindu"> Hindu
</td>
<tr>
<td>
</tr>
</table>
<input type="submit" name="submit" value="SUBMIT">
<input type="reset" name="reset" value="RESET">
</td>
</tr>
<tr>
<td colspan="2" align="center" bgcolor="#d5a253" style="color:white"><h2> Terima Kasih </h2></td>
</tr>
</table>
</body>
</html>