<commit_before><!DOCTYPE html>
<html>
  <head>
    <meta charset="utf-8">
    <title>Cepat Sembuh</title>
    <link rel="stylesheet" href="css/bootstrap.css">
    <link rel="stylesheet" href="css/material.css">
    <link rel="stylesheet" href="css/style.css">
    <link rel="stylesheet" href="css/theme.css">
    <link rel="stylesheet" href="bower_components/font-awesome/css/font-awesome.css">
  </head>
  <body align="center">
    <div class="mdl-layout mdl-js-layout mdl-layout--fixed-header
            mdl-layout--fixed-tabs">
      <header class="mdl-layout__header">
        <div class="mdl-layout__header-row">
          <!-- Tobat -->
          <span class="mdl-layout-Tobat"><h4>Cepat Sembuh</h4></span>
        </div>
        <!-- Tabs -->
        <div class="mdl-layout__tab-bar mdl-js-ripple-effect">
          <a href="#fixed-tab-1" class="mdl-layout__tab is-active">Pesan</a>
          <a href="#fixed-tab-2" class="mdl-layout__tab">Lapor</a>
          <!-- <a href="#fixed-tab-3" class="mdl-layout__tab">About</a> -->
        </div>
      </header>
      <div class="mdl-layout__drawer">
        <span class="mdl-layout-Tobat"><h4>Cepat Sembuh</h4></span>
        <h5>Direct Link:</h5>
        <h6><i class="fa fa-comment"></i> <a href="https://kws.kpk.go.id/">Whistle Blower System</a><br> By KPK</h6>
      </div>
      <main class="mdl-layout__content">
        <section class="mdl-layout__tab-panel is-active" id="fixed-tab-1">
          <center>
          <div class="page-content">
          <form action="mailto:<EMAIL>?cc=<EMAIL>">
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="title" name="subject">
                <label class="mdl-textfield__label" for="tite">Subjek..</label>
              </div>
                <br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <textarea class="mdl-textfield__input" type="text" rows= "3" id="text-area" name="body"
                >
Nama =
NIK atau NISN(No KTP) =
                </textarea>
                <label class="mdl-textfield__label" for="text-area">Komplain..</label>
              </div>
              <br>
              <input type="submit" class="mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent" value="Submit" onclick="valid()">
            </form>
          </div>
        </center>
        </section>
        <section class="mdl-layout__tab-panel" id="fixed-tab-2">
          <div class="page-content">
          <center>
            <div class="demo-card-square mdl-card mdl-shadow--2dp">
              <div class="mdl-card__title mdl-card--expand">
                <h2 class="mdl-card__title-text">Royal Progress</h2>
              </div>
              <div class="mdl-card__supporting-text">
                
              </div>
              <!-- Colored FAB button -->
              <div style="display:inline-block;">
                <!-- <button class="mdl-button mdl-js-button mdl-button--fab mdl-button--colored" style="background-color:#009688;" onclick="rate()">
                  <i class="fa fa-thumbs-up"></i>
                </button> --><commit_msg>Added new inputs to the form<commit_after><!DOCTYPE html>
<html>
  <head>
    <meta charset="utf-8">
    <title>Cepat Sembuh</title>
    <link rel="stylesheet" href="css/bootstrap.css">
    <link rel="stylesheet" href="css/material.css">
    <link rel="stylesheet" href="css/style.css">
    <link rel="stylesheet" href="css/theme.css">
    <link rel="stylesheet" href="bower_components/font-awesome/css/font-awesome.css">
  </head>
  <body align="center">
    <div class="mdl-layout mdl-js-layout mdl-layout--fixed-header
            mdl-layout--fixed-tabs">
      <header class="mdl-layout__header">
        <div class="mdl-layout__header-row">
          <!-- Tobat -->
          <span class="mdl-layout-Tobat"><h4>Cepat Sembuh</h4></span>
        </div>
        <!-- Tabs -->
        <div class="mdl-layout__tab-bar mdl-js-ripple-effect">
          <a href="#fixed-tab-1" class="mdl-layout__tab is-active">Pesan</a>
          <a href="#fixed-tab-2" class="mdl-layout__tab">Lapor</a>
          <!-- <a href="#fixed-tab-3" class="mdl-layout__tab">About</a> -->
        </div>
      </header>
      <div class="mdl-layout__drawer">
        <span class="mdl-layout-Tobat"><h4>Cepat Sembuh</h4></span>
        <h5>Direct Link:</h5>
        <h6><i class="fa fa-comment"></i> <a href="https://kws.kpk.go.id/">Whistle Blower System</a><br> By KPK</h6>
      </div>
      <main class="mdl-layout__content">
        <section class="mdl-layout__tab-panel is-active" id="fixed-tab-1">
          <center>
          <div class="page-content">
          <form action="mailto:<EMAIL>?cc=<EMAIL>">
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="title" name="subject">
                <label class="mdl-textfield__label" for="title">Nomor BPJS</label>
              </div><br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="nama" name="subject">
                <label class="mdl-textfield__label" for="nama">NIK</label>
              </div><br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="nama" name="subject">
                <label class="mdl-textfield__label" for="nama">Nama</label>
              </div><br>
              <select class="form-control" style="width:300px;">
                <option>Jakarta Utara</option>
                <option>Jakarta Barat</option>
                <option>Jakarta Timur</option>
                <option>Jakarta Pusat</option>
                <option>Jakarta Selatan</option>
              </select><br>
              <select class="form-control" style="width:300px;">
                <option>Laki-laki</option>
                <option>Perempuan</option>
              </select><br>
              <input type="date" class="form-control" style="width:300px;">
                <br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <textarea class="mdl-textfield__input" type="text" rows= "3" id="text-area" name="body"
                >
Nama =
Kota =
                </textarea>
                <label class="mdl-textfield__label" for="text-area">Komplain..</label>
              </div>
              <br>
              <input type="submit" class="mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent" value="Submit" onclick="valid()">
            </form>
          </div>
        </center>
        </section>
        <section class="mdl-layout__tab-panel" id="fixed-tab-2">
          <div class="page-content">
          <center>
            <div class="demo-card-square mdl-card mdl-shadow--2dp">
              <div class="mdl-card__title mdl-card--expand">
                <h2 class="mdl-card__title-text">Royal Progress</h2>
              </div>
              <div class="mdl-card__supporting-text">
                
              </div>
              <!-- Colored FAB button -->
              <div style="display:inline-block;">
                <!-- <button class="mdl-button mdl-js-button mdl-button--fab mdl-button--colored" style="background-color:#009688;" onclick="rate()">
                  <i class="fa fa-thumbs-up"></i>
                </button> -->
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