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				<h2>Buku Tamu</h2>
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<h3>EMAIL KAMI</h3>
				Admin<br />
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            <b>FORM BUKU TAMU</b><br />
            
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                <td>Name <span class="mandatory">*</span></td>
                <td><input name="txtName" type="text" size="30" value="" maxlength="30"></td>
            </tr>
            <tr>
                <td>Email <span class="mandatory">*</span></td>
                <td><input name="txtEmail" type="text" size="30" value="" maxlength="50"></td>
            </tr>
            <tr>
                <td>Website</td>
                <td><input name="txtUrl" type="text" value="http://" size="30" maxlength="50"></td>
            </tr>
            <tr>
                <td valign="top">Message <span class="mandatory">*</span></td>
                <td><textarea name="mtxMessage" cols="60" rows="5"></textarea></td>
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            <tr>
                <td>Verify <span class="mandatory">*</span></td>
                <td><input name="txtNumber" size="6" type="text" id="txtNumber" value="" class="required">&nbsp;&nbsp;<img src="random_image.php"></td>
            </tr>
            <tr>
                <td>&nbsp;</td>
                <td><br /><input name="btnSign" type="submit" value="Submit My Comment" onClick="return checkForm();"></td>
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            <br />
            <span class="mandatory">*</span> indicates required field
            </form>
            <script language="JavaScript" type="text/javascript">
				//You should create the validator only after the definition of the HTML form
				  var frmvalidator  = new Validator("myform");
					frmvalidator.EnableOnPageErrorDisplaySingleBox();
					frmvalidator.EnableMsgsTogether();
				 
					  frmvalidator.addValidation("txtName","req","Please enter your Name");
					  frmvalidator.addValidation("txtName","maxlen=40",	"Max length for Name is 40");
					  frmvalidator.addValidation("txtName","alpha_s","Name can contain alphabetic chars only");
		  			
					  frmvalidator.addValidation("txtEmail","maxlen=100");
					  frmvalidator.addValidation("txtEmail","req","Please enter your Email");
					  frmvalidator.addValidation("txtEmail","email");
					  
					  frmvalidator.addValidation("mtxMessage","req","Please enter your Message");
					  frmvalidator.addValidation("txtNumber","req","Please enter your Code");
				</script>        </div>           
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        	<h3>TEMUKAN</h3>
        	<table width="100%" cellpadding="5" cellspacing="0">
			<tr>                <td valign="top"><a href="http://www.rs-gandaria.com/content/i.php?mid=2"><b>TENTANG RS. GANDARIA</b></a>
                                </td>
                                <td valign="top"><a href="http://www.rs-gandaria.com/content/i.php?mid=3"><b>FASILITAS DAN PELAYANAN</b></a>
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                                <td valign="top"><a href="http://www.rs-gandaria.com/content/find_doctor.php?&mid=5"><b>PRAKTEK DOKTER</b></a>
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                </tr><tr>                <td valign="top"><a href="http://www.rs-gandaria.com/content/ask_doctor.php?&mid=6"><b>KONSULTASI DOKTER</b></a>
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        	<h3>HUBUNGI</h3>
            <ul class="listsitemap">
			            <li class="address">Jl. GANDARIA TENGAH II  DKI JAKARTA - 12130</li>
            <li class="phone">021-7203311, 7250718</li>
            <li class="fax">021-7222038, 7248175</li>
            <li class="email">gandariahospital@gmail.com</li>
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