Weddings Reservations

Weddings Reservations

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Protestant   Catholic   Hindu   Muslim   Buddhism  
Simple Balinese   Full Balinese   Simple Western  
Yes   No  
Priest for Blessing   Civil Registration   Priest for Blessing + Civil Registration  

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    <script type="text/javascript">
    $(function() {
        $("#checkin").datepicker({showOn: 'button', buttonImage: '/assets/js/datepicker/images/calendar.gif', buttonImageOnly: true});
        $("#checkout").datepicker({showOn: 'button', buttonImage: '/assets/js/datepicker/images/calendar.gif', buttonImageOnly: true});
    });
    </script>
<form method="post" action="" class="BookingForm" id="BookingForm">
<fieldset>
  <table width="100%" border="0" cellspacing="2" cellpadding="2">
    <tr>
    <td colspan="3"><div align="center" class="validationmasage"></div></td>
    </tr>
    <tr>
      <td width="54">Name</td>
      <td width="3">:</td>
      <td width="1155"><div class="inputleft"></div>
        <input type="text" name="Name" maxlength="60" valform="NonBlank" class="inputbook" id="Name"/>
      <div class="inputright"></div></td>
    </tr>
    <tr>
      <td>Email</td>
      <td>:</td>
      <td><div class="inputleft"></div>        <input type="text" name="email" valform="GoodEmail"  size="40" maxlength="40" class="inputbook" id="email" />
      <div class="inputright"></div></td>
    </tr>
<tr>
      <td>Phone</td>
      <td>:</td>
      <td><div class="inputleft"></div>        <input type="text" name="phone" size="40" maxlength="40" class="inputbook" id="phone" />
      <div class="inputright"></div></td>
    </tr>
<tr>
      <td>Address</td>
      <td>:</td>
      <td><div class="inputleft"></div>        <input type="text" name="address" id="address" size="40" maxlength="40" class="inputbook" />
      <div class="inputright"></div></td>
    </tr>
 
<tr>
  <td>Check in</td>
  <td>&nbsp;</td>
  <td><div class="inputleft"></div>    <input type="text" id="checkin" name="checkin" size="20" maxlength="40" class="inputbook" valform="NonBlank"/>
    <div class="inputright"></div></td>
</tr>
<tr>
  <td>Check out</td>
  <td>&nbsp;</td>
  <td><div class="inputleft"></div>    <input type="text" name="checkout" id="checkout" size="20" maxlength="40" class="inputbook" valform="NonBlank"/>
    <div class="inputright"></div></td>
</tr>
<tr>
  <td>Adult</td>
  <td>&nbsp;</td>
  <td><div class="inputleft"></div>    <input type="text" name="adult" id="adult" size="5" maxlength="2" class="inputbook" value="1" />
    <div class="inputright"></div></td>
</tr>
<tr>
  <td>Child</td>
  <td>&nbsp;</td>
  <td><div class="inputleft"></div>    <input type="text" name="child" id="child" size="5" maxlength="2" class="inputbook" value="0" />
    <div class="inputright"></div></td>
</tr>
<tr>
  <td>Room Choices</td>
  <td>&nbsp;</td>
  <td><div class="inputleft"></div>
   
      <div class="inputright"></div></td>
</tr>
   
    <tr>
      <td valign="top">Message</td>
      <td valign="top">:</td>
      <td valign="top"><textarea cols="40" rows="5" name="comments" id="comments" ></textarea></td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>Please enter the     anti spam code below:</td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td><img id="imagevericode" src="/manager/includes/veriword.php?rand=828117978" border="1" alt="verification code" /></td>
    </tr>
    <tr>
      <td></td>
      <td></td>
      <td class="masuk_code"><div class="inputleft"></div>
    <input id="vericode" class="inputbook" name="vericode" size="20" type="text" valform="NonBlank" />
    <div class="inputright"></div></td>
    </tr>
  </table>
  </fieldset>
  <div class="boxContactButton"><input name="Sendbook" type="button" value="Send" onClick="return Validationform('BookingForm',BookingForm);" id="buttonSend" class="buttonSend"  /><input name="buttonclear" type="button" value="Clear" onClick="return ClearForm('BookingForm')" id="buttonclear" />
  <input name="subject" type="hidden" value="New Inquery" />
  </div>

</form>