Sunday, 28 February 2016

<script src="https://cdn.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script>
<script src="https://cdn.jotfor.ms/static/jotform.forms.js?3.3.11577" type="text/javascript"></script>
<script type="text/javascript">
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   JotForm.init(function(){
      setTimeout(function() {
          $('input_7').hint('myname@example.com');
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      JotForm.description('input_7', 'Enter your e-mail here!');
      JotForm.setupRichArea(3);
      JotForm.description('input_3', 'Enter your message here.');
      JotForm.initCaptcha('input_4');
      JotForm.description('input_4', 'Enter the word you see...');
      JotForm.alterTexts({"alphabetic":"This field can only contain letters","alphanumeric":"This field can only contain letters and numbers.","confirmClearForm":"Are you sure you want to clear the form","confirmEmail":"E-mail does not match","email":"Enter a valid e-mail address","incompleteFields":"There are incomplete required fields. Please complete them.","lessThan":"Your score should be less than","numeric":"This field can only contain numeric values","pleaseWait":"Please wait...","required":"Whoops!\nlooks like you missed something!","uploadExtensions":"You can only upload following files:","uploadFilesize":"File size cannot be bigger than:"});
    JotForm.clearFieldOnHide="disable";
    JotForm.onSubmissionError="jumpToSubmit";
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<link href="https://cdn.jotfor.ms/static/formCss.css?3.3.11577" rel="stylesheet" type="text/css" />
<link type="text/css" media="print" rel="stylesheet" href="https://cdn.jotfor.ms/css/printForm.css?3.3.11577" />
<style type="text/css">
    .form-label-left{
        width:130px !important;
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    .form-line{
        padding-top:10px;
        padding-bottom:10px;
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    .form-label-right{
        width:130px !important;
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    .form-all{
        width:600px;
        color:#555 !important;
        font-family:'Verdana';
        font-size:12px;
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    .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{
        color: #555;
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</style>

<form class="jotform-form" action="https://submit.jotform.me/submit/60573797877477/" method="post" enctype="multipart/form-data" name="form_60573797877477" id="60573797877477" accept-charset="utf-8">
  <input type="hidden" name="formID" value="60573797877477" />
  <div class="form-all">
    <ul class="form-section page-section">
      <li class="form-line" data-type="control_textbox" id="id_17">
        <label class="form-label form-label-left form-label-auto" id="label_17" for="input_17"> Nama Lengkap </label>
        <div id="cid_17" class="form-input jf-required">
          <input type="text" class=" form-textbox" data-type="input-textbox" id="input_17" name="q17_namaLengkap17" size="20" value="" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_email" id="id_7">
        <label class="form-label form-label-left form-label-auto" id="label_7" for="input_7">
          E-mail
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_7" class="form-input jf-required">
          <input type="email" class=" form-textbox validate[required, Email]" id="input_7" name="q7_email" size="30" value="" />
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_35">
        <div id="cid_35" class="form-input-wide">
          <div id="text_35" class="form-html">
            <p>Silakan pilih kategori</p>
            <p> </p>
            <p><strong>Kategori</strong></p>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-1" data-type="control_radio" id="id_26">
        <label class="form-label form-label-top" id="label_26" for="input_26"> Pendidikan </label>
        <div id="cid_26" class="form-input-wide jf-required">
          <div class="form-single-column">
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_0" name="q26_pendidikan" value="Agama Islam" />
              <label id="label_input_26_0" for="input_26_0"> Agama Islam </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_1" name="q26_pendidikan" value="Akuntansi" />
              <label id="label_input_26_1" for="input_26_1"> Akuntansi </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_2" name="q26_pendidikan" value="B. Indonesia" />
              <label id="label_input_26_2" for="input_26_2"> B. Indonesia </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_3" name="q26_pendidikan" value="Matematika" />
              <label id="label_input_26_3" for="input_26_3"> Matematika </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_4" name="q26_pendidikan" value="IPA" />
              <label id="label_input_26_4" for="input_26_4"> IPA </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_5" name="q26_pendidikan" value="IPS" />
              <label id="label_input_26_5" for="input_26_5"> IPS </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" disabled class="form-radio" id="input_26_6" name="q26_pendidikan" value="PPKN" />
              <label id="label_input_26_6" for="input_26_6"> PPKN </label>
            </span>
            <span class="form-radio-item" style="clear:left">
              <input type="radio" class="form-radio-other form-radio" name="q26_pendidikan" id="other_26" value="other" />
              <input type="text" class="form-radio-other-input form-textbox" name="q26_pendidikan[other]" data-otherHint="Other" size="15" id="input_26" />
              <br />
            </span>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-2" data-type="control_radio" id="id_32">
        <label class="form-label form-label-top" id="label_32" for="input_32"> Cinta </label>
        <div id="cid_32" class="form-input-wide jf-required">
          <div class="form-single-column">
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_0" name="q32_cinta" value="Arti Cinta" />
              <label id="label_input_32_0" for="input_32_0"> Arti Cinta </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_1" name="q32_cinta" value="Gombalan" />
              <label id="label_input_32_1" for="input_32_1"> Gombalan </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_2" name="q32_cinta" value="Foto" />
              <label id="label_input_32_2" for="input_32_2"> Foto </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_3" name="q32_cinta" value="Kisah Cinta" />
              <label id="label_input_32_3" for="input_32_3"> Kisah Cinta </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_4" name="q32_cinta" value="Puisi" />
              <label id="label_input_32_4" for="input_32_4"> Puisi </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_5" name="q32_cinta" value="Surat" />
              <label id="label_input_32_5" for="input_32_5"> Surat </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_32_6" name="q32_cinta" value="Video" />
              <label id="label_input_32_6" for="input_32_6"> Video </label>
            </span>
            <span class="form-radio-item" style="clear:left">
              <input type="radio" class="form-radio-other form-radio" name="q32_cinta" id="other_32" value="other" />
              <input type="text" class="form-radio-other-input form-textbox" name="q32_cinta[other]" data-otherHint="Other" size="15" id="input_32" />
              <br />
            </span>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-3" data-type="control_radio" id="id_33">
        <label class="form-label form-label-top" id="label_33" for="input_33"> Musik </label>
        <div id="cid_33" class="form-input-wide jf-required">
          <div class="form-single-column">
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_0" name="q33_musik" value="Bondan Prakoso" />
              <label id="label_input_33_0" for="input_33_0"> Bondan Prakoso </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_1" name="q33_musik" value="Drive" />
              <label id="label_input_33_1" for="input_33_1"> Drive </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_2" name="q33_musik" value="Iwan Fals" />
              <label id="label_input_33_2" for="input_33_2"> Iwan Fals </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_3" name="q33_musik" value="Last Child" />
              <label id="label_input_33_3" for="input_33_3"> Last Child </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_4" name="q33_musik" value="Paterpan" />
              <label id="label_input_33_4" for="input_33_4"> Paterpan </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_5" name="q33_musik" value="ST12" />
              <label id="label_input_33_5" for="input_33_5"> ST12 </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_33_6" name="q33_musik" value="Wali" />
              <label id="label_input_33_6" for="input_33_6"> Wali </label>
            </span>
            <span class="form-radio-item" style="clear:left">
              <input type="radio" class="form-radio-other form-radio" name="q33_musik" id="other_33" value="other" />
              <input type="text" class="form-radio-other-input form-textbox" name="q33_musik[other]" data-otherHint="Other" size="15" id="input_33" />
              <br />
            </span>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-4" data-type="control_radio" id="id_31">
        <label class="form-label form-label-top" id="label_31" for="input_31"> Karya Anak Bangsa </label>
        <div id="cid_31" class="form-input-wide jf-required">
          <div class="form-single-column">
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_31_0" name="q31_karyaAnak" value="Cerpen" />
              <label id="label_input_31_0" for="input_31_0"> Cerpen </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_31_1" name="q31_karyaAnak" value="Gambar" />
              <label id="label_input_31_1" for="input_31_1"> Gambar </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_31_2" name="q31_karyaAnak" value="Musik" />
              <label id="label_input_31_2" for="input_31_2"> Musik </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_31_3" name="q31_karyaAnak" value="Puisi" />
              <label id="label_input_31_3" for="input_31_3"> Puisi </label>
            </span>
            <span class="form-radio-item" style="clear:left;">
              <span class="dragger-item">
              </span>
              <input type="radio" class="form-radio" id="input_31_4" name="q31_karyaAnak" value="Video" />
              <label id="label_input_31_4" for="input_31_4"> Video </label>
            </span>
            <span class="form-radio-item" style="clear:left">
              <input type="radio" class="form-radio-other form-radio" name="q31_karyaAnak" id="other_31" value="other" />
              <input type="text" class="form-radio-other-input form-textbox" name="q31_karyaAnak[other]" data-otherHint="Other" size="15" id="input_31" />
              <br />
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_fileupload" id="id_19">
        <label class="form-label form-label-left form-label-auto" id="label_19" for="input_19"> File </label>
        <div id="cid_19" class="form-input jf-required">
          <input class="form-upload" type="file" id="input_19" name="q19_file" file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif" file-maxsize="1024" file-minsize="0" file-limit="0" />
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_textarea" id="id_3">
        <label class="form-label form-label-left form-label-auto" id="label_3" for="input_3">
          Isi Artikel
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_3" class="form-input jf-required">
          <textarea id="input_3" class="form-textarea validate[required]" name="q3_isiArtikel" cols="40" rows="6" style="min-width: 353px; min-height: 150px; background-color: white;" data-richtext="Yes"></textarea>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_captcha" id="id_4">
        <label class="form-label form-label-left form-label-auto" id="label_4" for="input_4">
          Kode Verifikasi
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_4" class="form-input jf-required">
          <div class="form-captcha">
            <label for="input_4"> <img alt="Captcha - Reload if it's not displayed" id="input_4_captcha" class="form-captcha-image" style="background:url(https://cdn.jotfor.ms/images/loader-big.gif) no-repeat center;" src="https://cdn.jotfor.ms/images/blank.gif" width="150" height="41" /> </label>
            <div style="white-space:nowrap;">
              <input type="text" id="input_4" class="form-textbox validate[required]" name="captcha" style="width:130px;" />
              <img src="https://cdn.jotfor.ms/images/reload.png" alt="Reload" align="absmiddle" style="cursor:pointer" onclick="JotForm.reloadCaptcha('input_4');" />
              <input type="hidden" name="captcha_id" id="input_4_captcha_id" value="0" />
            </div>
          </div>
        </div>
      </li>
      <li style="display:none">
        Should be Empty:
        <input type="text" name="website" value="" />
      </li>
    </ul>
  </div>
  <input type="hidden" id="simple_spc" name="simple_spc" value="60573797877477" />
  <script type="text/javascript">
  document.getElementById("si" + "mple" + "_spc").value = "60573797877477-60573797877477";
  </script>
</form>
<script src="https://cdn.jotfor.ms/js/vendor/nicEdit.js?REV=3.3.11577" type="text/javascript"></script>

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