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Form analysis
1 forms found in the DOM

POST

<form action="" id="form-rsvp-general_custom" method="POST">
  <input type="hidden" name="stp" value="rsvp-general">
  <input type="hidden" name="lang" value="">
  <input type="hidden" name="event_session" value="">
  <input type="hidden" name="category_id" value="">
  <div class="uk-margin wrapper-input-fullname input-rsvp-section input-rsvp-yes input-rsvp-no input-rsvp-virtual">
    <label class="uk-form-label your-fullname">
      <span data-en="bahasa-english">Nama Perusahaan</span>
    </label>
    <div class="uk-form-controls">
      <input type="text" name="fullname" class="uk-input" placeholder="" value="" required="required">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-2286">
    <label class="uk-form-label"> Jumlah Perwakilan </label>
    <div class="uk-form-controls">
      <select name="additional_data[2286]" id="custom-form-elm-2286" class="uk-select" required="required">
        <option value=""> -- Choose -- </option>
        <option value="1"> 1 </option>
        <option value="2"> 2 </option>
      </select>
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-2359" style="display: none;">
    <label class="uk-form-label"> Nama Perwakilan 1 </label>
    <div class="uk-form-controls">
      <input type="text" value="" name="additional_data[2359]" class="uk-input" id="custom-form-elm-2359" placeholder="">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-2283" style="display: none;">
    <label class="uk-form-label"> Jabatan 1 </label>
    <div class="uk-form-controls">
      <input type="text" value="" name="additional_data[2283]" class="uk-input" id="custom-form-elm-2283" placeholder="">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin wrapper-input-whatsapp input-rsvp-section input-rsvp-yes input-rsvp-no input-rsvp-virtual" style="display: none;">
    <label class="uk-form-label your-no-whatsapp"> <span>No. Whatsapp 1</span> </label>
    <div class="uk-form-controls">
      <input type="number" name="telephone" class="uk-input" placeholder="" value="">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-2360" style="display: none;">
    <label class="uk-form-label"> Nama Perwakilan 2 </label>
    <div class="uk-form-controls">
      <input type="text" value="" name="additional_data[2360]" class="uk-input" id="custom-form-elm-2360" placeholder="">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-2406" style="display: none;">
    <label class="uk-form-label"> Jabatan 2 </label>
    <div class="uk-form-controls">
      <input type="text" value="" name="additional_data[2406]" class="uk-input" id="custom-form-elm-2406" placeholder="">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-2407" style="display: none;">
    <label class="uk-form-label"> No. Whatsapp 2 </label>
    <div class="uk-form-controls">
      <input type="number" value="" name="additional_data[2407]" class="uk-input" id="custom-form-elm-2407" placeholder="">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin wrapper-input-email input-rsvp-section input-rsvp-yes input-rsvp-no input-rsvp-virtual">
    <label class="uk-form-label custom-elmidxtitleconasdqwe_lutemail">
      <span data-en=""> Email </span>
    </label>
    <div class="uk-form-controls">
      <input type="email" name="email" class="uk-input" placeholder="" value="" required="required">
    </div>
    <div class="uk-text-meta">
    </div>
  </div>
  <div class="uk-margin input-rsvp-general-submit">
    <button class="uk-button uk-button-theme" type="submit" id="submit_rsvp_general_custom" value="submit_rsvp_general_custom" name="submit_rsvp_general_custom">
      <span> Submit </span>
    </button>
  </div>
</form>

Text Content

LOKASI

Hotel Adimulia Medan
Jl. Pangeran Diponegoro No.8, Petisah Tengah, Kec. Medan Petisah, Kota Medan,
Sumatera Utara 20112

Buka Maps


FORM REGISTRASI

Nama Perusahaan


Jumlah Perwakilan
-- Choose -- 1 2

Nama Perwakilan 1


Jabatan 1


No. Whatsapp 1


Nama Perwakilan 2


Jabatan 2


No. Whatsapp 2


Email


Submit
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