<div class="datakamu">
<form action="<?php bloginfo('url')?>/mydata" enctype="multipart/form-data" method="post" name="data">
<script language="JavaScript"><!--
function validateForm()  
{
 var okSoFar=true 
 with (document.data)
 {
  if (nama.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan isi nama anda")
	nama.focus()
  } 
  if (email.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan isi Email anda")
	email.focus()
  } 
  if (No_Hp.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan No telpon anda")
	No_Hp.focus()
  } 
  if (Kota.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan isi alamat anda")
	Kota.focus()
  }
  var foundAt = email.value.indexOf("@",0)
  if (foundAt < 1 && okSoFar)
  {
	okSoFar = false
	alert ("Masukkan alamat email yang Valid")
	email.focus()
  }
   if (kategorihoby.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan Pilih kategori hobi")
	kategorihoby.focus()
  }
  if (kegiatan.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan isi kegiatan anda")
	kegiatan.focus()
  } 
  if (spesifikkegiatan.value=="" && okSoFar)
  {
	okSoFar=false
	alert("Silahkan isi detail kegiatan anda")
	spesifikkegiatan.focus()
  }
  
  if (security_code.value=="" && okSoFar)
  {
	okSoFar=false
	alert("masukkan kode sekurity")
	security_code.focus()
  }
  
  if (okSoFar==true)  submit();
 }
}
// --></script>			
<table width="100%" cellpadding="2">
	<tr>
		<td width="30%" align="left">Name</td>
		<td width="70%"><input type="text" name="nama" size="30" id="nama" value="<?php echo $_POST['nama']?>"/></td>
	</tr>
	<tr>
		<td width="30%" align="left">E-mail</td>
		<td width="70%"><input type="text" name="email" size="30" id="email" value="<?php echo $_POST['email']?>" /><br />
</td>
	</tr>
	<tr>
		<td width="30%" align="left">alamat</td>
		<td width="70%"><input type="text" name="Kota" size="30" id="Kota" value="<?php echo $_POST['Kota']?>"/></td>
	</tr>
	<tr>
		<td width="30%" align="left">Telpon</td>
		<td width="70%"><input type="text" name="No_Hp" size="30" id="No_Hp" value="<?php echo $_POST['No_Hp']?>"/></td>
	</tr>
		<tr>
	<td width="30%" align="left">Janis</td>
		<td width="70%"><select name="type">
			<option value="0">Laki-laki</option>
			<option value="0">Perempuan</option>
		
		</select></td>
	</tr>
	<tr>
	<td width="30%" align="left" valign="top">Hoby:</td>
		<td width="70%"><select name="kategorihoby" >
<option value="" size="40">====Pilih Kategori====</option>			 
		 <?php 
		  $categories=  get_categories('hide_empty=0'); 
		  foreach ($categories as $cat) {
			$option = '<option value="'.$cat->cat_ID.'">';
			$option .= $cat->cat_name;
			$option .= ' ('.$cat->category_count.')';
			$option .= '</option>';
			echo $option;
		  }
		 ?>
		</select></td>
	</tr>
	<tr>
		<td width="30%" align="left">kegiatan</td>
		<td width="70%"><input type="text" name="kegiatan" size="30" id="kegiatan" value="<?php echo $_POST['kegiatan']?>" /></td>
	</tr>
	<tr>
	  
		<td width="30%" align="left" valign="top">Detail Kegiatan</td>
		<td width="70%"><textarea rows="8" cols="24" name="spesifikkegiatan"><?php echo $_POST['spesifikkegiatan']?></textarea></td>
	</tr>
	<tr>
	  <td width="30%" align="left">Website</td>
		<td width="70%">http://<input type="text" name="website" size="25" id="website" value="<?php echo $_POST['website']?>" /></td>
	</tr>
	<tr>
		<td width="30%" align="left">Foto maks 125 x 125 px</td>
		<td width="70%"><input type="file" name="banner" size="20"></td>
	</tr>
	<tr>
		<td width="30%" align="left">Security Code </td>
		<td width="70%"><img src="<?php bloginfo('template_url')?>/include/CaptchaSecurityImages.php?width=150&height=60&characters=5"/>
		</td>
	</tr>
	<tr>
	  <td width="30%" align="left">Input Code </td>
		<td width="70%"><input id="security_code" name="security_code" type="text" />
		</td>
	</tr>
	<tr>
		<td width="30%" align="left" valign="top">&nbsp;</td>
		<td><input type="button" class="button"
value="Pasang Iklan Gratis" name="B1" ONCLICK="javascript:validateForm()">
		<input type="hidden" id="post_type" name="post_type" value="post" />		
	</td>	</tr>
	
</table></form>
</div>