- 掃描 ID：
- f54a7d86-4904-48f3-b276-5256c32cbbc3已完成
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- https://wwf.id/bniwwfrenewal/
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| 名稱 | 類型 |
|---|---|
| 0 | object |
| 1 | object |
| 2 | object |
| 3 | object |
| onbeforetoggle | object |
| documentPictureInPicture | object |
| onscrollend | object |
| ___grecaptcha_cfg | object |
| grecaptcha | object |
| __recaptcha_api | string |
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<!DOCTYPE html><html lang="en"><head><meta http-equiv="origin-trial" content="A/kargTFyk8MR5ueravczef/wIlTkbVk1qXQesp39nV+xNECPdLBVeYffxrM8TmZT6RArWGQVCJ0LRivD7glcAUAAACQeyJvcmlnaW4iOiJodHRwczovL2dvb2dsZS5jb206NDQzIiwiZmVhdHVyZSI6IkRpc2FibGVUaGlyZFBhcnR5U3RvcmFnZVBhcnRpdGlvbmluZzIiLCJleHBpcnkiOjE3NDIzNDIzOTksImlzU3ViZG9tYWluIjp0cnVlLCJpc1RoaXJkUGFydHkiOnRydWV9">
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>WWF-Indonesia | MONA</title>
<link rel="icon" href="img/wwf-logo-new.png" type="image/x-icon">
<link href="tools/bootstrap/css/bootstrap.min.css" rel="stylesheet">
<link href="tools/bootstrap/ctt/yetrwwfbni5.css" rel="stylesheet">
<script type="text/javascript" async="" charset="utf-8" src="https://www.gstatic.com/recaptcha/releases/-ZG7BC9TxCVEbzIO2m429usb/recaptcha__en.js" crossorigin="anonymous" integrity="sha384-gaZtYaI7oJHEOo1YO6VuoCE4iZ5fMV9mYHP0BHf+r2ttABnpWWCIkgI6ItNW4ZdO"></script><script src="https://www.google.com/recaptcha/api.js" async="" defer=""></script>
</head>
<body>
<div id="loadingOverlay" style="display: none;">
<div class="spinner-border text-primary spinner-border-custom" role="status">
<span class="visually-hidden">Loading...</span>
</div>
</div>
<!-- Page -->
<div class="custom-card">
<div class="row">
<!-- Kolom Kiri (col-md-7) -->
<div class="col-md-8 ">
<img src="img/01_Form-Sign-bni.jpg" alt="Gambar Utama" style="width:100%; border-radius: 8px; "> <p> </p>
</div>
<!-- Kolom Kanan (col-md-5) -->
<div class="col-md-4">
<span style=" text-transform: uppercase; font-size:22px !important;"> Anda akan memperpanjang keanggotaan <span style=" color:#5A9FBA;"> MoNa </span> Anda </span> <br> <span style=" font-size: 16px; color: #1E5C41; text-transform: uppercase;"> Silakan lengkapi data di bawah ini: </span>
<form id="numberForm" method="POST" class="row g-3 needs-validation" novalidate="">
<div class="col">
<input class="form-control" placeholder="Nama Depan" required="" type="text" name="namadepan" style=" font-family: 'OpenSans'; font-size: 12px;">
</div>
<div class="col">
<input class="form-control" name="namabelakang" placeholder="Nama Belakang" type="text" style=" font-family: 'OpenSans'; font-size: 12px;">
</div>
<div class="col-12">
<input placeholder="Email" name="email" class="form-control" type="email" style=" font-family: 'OpenSans'; font-size: 12px;" required="">
</div>
<div class="col-12">
<input placeholder="No Handphone" name="notlp" class="form-control" type="text" style=" font-family: 'OpenSans'; font-size: 12px;" required="">
<input type="hidden" id="kelompok" name="kelompok" value="Panda Club">
<input type="hidden" id="nilai" name="nilai" value="120000">
</div>
<div class="col-12">
<label for="tanggal-lahir" class="form-label " style=" font-size: 16px; color: #1E5C41; text-transform: uppercase;">Tanggal Lahir</label>
<div class="row">
<div class="col">
<select name="tgl" class="form-control form-select " style=" font-family: 'OpenSans'; font-size: 12px;" required="">
<option value="">Tanggal</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
<div class="col">
<select name="bln" class="form-control form-select " style=" font-family: 'OpenSans'; font-size: 12px;" required="">
<option value="">Bulan</option>
<option value="01">Januari</option>
<option value="02">Februari</option>
<option value="03">Maret</option>
<option value="04">April</option>
<option value="05">Mei</option>
<option value="06">Juni</option>
<option value="07">Juli</option>
<option value="08">Agustus</option>
<option value="09">September</option>
<option value="10">Oktober</option>
<option value="11">November</option>
<option value="12">Desember</option>
</select>
</div>
<div class="col">
<select name="thn" class="form-control form-select " style=" font-family: 'OpenSans'; font-size: 12px;" required="">
<option value="">Tahun</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
</select>
</div>
</div>
</div>
<div class="col-12">
<label for="Pilih-Keanggotaan-MoNa" class="form-label " style=" font-size: 16px; color: #1E5C41; text-transform: uppercase;">Pilih Keanggotaan MoNa</label>
<div class="row ">
<div class="slider-container">
<div class="title-display" id="titleDisplay" style="left: 0px; font-family: OpenSans; width: auto; text-align: center;">Panda Club</div>
<input type="range" id="priceSlider" class="slider" min="1" max="5" step="1" value="1">
<div class="dots">
<span class="dot dot-active" data-value="1" id="dot1"></span>
<span class="dot" data-value="2" id="dot2"></span>
<span class="dot" data-value="3" id="dot3"></span>
<span class="dot" data-value="4" id="dot4"></span>
<span class="dot" data-value="5" id="dot5"></span>
</div>
<div class="labels" style=" font-size: 12px; color: #F89833; font-family: 'OpenSans';">
<span class="label label-active" id="label1">120K</span>
<span class="label" id="label2">540K</span>
<span class="label" id="label3">2.550K</span>
<span class="label" id="label4">5.100K</span>
<span class="label" id="label5">10.200K</span>
</div>
<!-- Price and discount display -->
<div class="price-container">
<div class="price-display" id="priceDisplay">Rp 120.000</div> /
<span style="font-size:11px; position: relative; top: 3px;">Tahun</span>
<div class="btn btn-outline-success btn-sm" id="potonganDisplay" style="border-radius: 8px; font-size: 11px; display: none;">hemat 10%</div>
</div>
</div>
</div>
</div>
<div class="col-12">
<div class="form-check">
<input class="form-check-input" type="checkbox" id="setuju">
<label class="form-check-label " for="gridCheck" style=" font-size: 11px; font-family: 'OpenSans';">
Dengan ini, saya menyatakan bahwa data yang saya isi adalah benar. Saya juga menyetujui pembayaran keanggotaan MoNa otomatis (auto billing) secara berkala setiap tahun sesuai keanggotaan yang saya pilih. Saya memahami dan menyetujui bahwa data ini akan digunakan oleh WWF-Indonesia untuk keperluan informasi terkait keanggotaan MoNa (Members of Nature).
</label>
<div class="g-recaptcha mt-1" data-sitekey="6LdTo9MpAAAAAGWMotJ6eVY6D4eph-yuAMtZkg6x" data-callback="recaptchaCallback" style="transform: scale(0.85); transform-origin: 0 0;"><div style="width: 304px; height: 78px;"><div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-t6cifs50xmye" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation" src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LdTo9MpAAAAAGWMotJ6eVY6D4eph-yuAMtZkg6x&co=aHR0cHM6Ly93d2YuaWQ6NDQz&hl=en&v=-ZG7BC9TxCVEbzIO2m429usb&size=normal&cb=rvllk1m1l9c"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea></div><iframe style="display: none;"></iframe></div>
</div>
</div>
<div class="col-12">
<div class="d-grid gap-2">
<button class="btn orange-btn " type="submit" id="submit-btn" disabled="">PERPANJANG MONA SEKARANG</button>
<a href="https://membership.wwf.id" class="btn orange-btn">TENTANG MONA</a>
</div>
</div>
</form>
</div>
</div>
</div>
<script>
window.onload = function() {
// Mengganti URL tanpa memuat ulang halaman
window.history.replaceState({}, document.title, "/bniwwfrenewal/");
};
</script>
<div class="footer-text">
© 2024 WWF-INDONESIA
</div>
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