{"id":1700,"date":"2015-05-26T15:24:05","date_gmt":"2015-05-26T07:24:05","guid":{"rendered":"http:\/\/www.ukm.my\/ppl\/?page_id=1700"},"modified":"2015-05-26T15:24:05","modified_gmt":"2015-05-26T07:24:05","slug":"borang-tempahan-fasiliti-ppl","status":"publish","type":"page","link":"https:\/\/www.ukm.my\/ppl\/ms\/borang-tempahan-fasiliti-ppl\/","title":{"rendered":"Borang Tempahan Fasiliti PPL"},"content":{"rendered":"<div id=\"vfb-form-1\" class=\"visual-form-builder-container\"><form id=\"borang-tempahan-fasiliti-ppl-1\" class=\"visual-form-builder vfb-form-1 \" method=\"post\" enctype=\"multipart\/form-data\">\n\t  \t<input type=\"hidden\" name=\"form_id\" value=\"1\" \/><fieldset class=\"vfb-fieldset vfb-fieldset-1 butiran-pemohon \" id=\"item-vfb-1\"><div class=\"vfb-legend\"><h3>Butiran Pemohon<\/h3><\/div><ul class=\"vfb-section vfb-section-1\"><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-6\"><label for=\"vfb-6\" class=\"vfb-desc\">Nama Pemohon  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-6\" id=\"vfb-6\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-75\"><label for=\"vfb-75\" class=\"vfb-desc\">Jawatan <\/label><input type=\"text\" name=\"vfb-75\" id=\"vfb-75\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li><li class=\"vfb-item vfb-item-phone  \" id=\"item-vfb-81\"><label for=\"vfb-81\" class=\"vfb-desc\">No. Telefon  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"tel\" name=\"vfb-81\" id=\"vfb-81\" value=\"\" class=\"vfb-text  vfb-medium  required  phone \" \/><\/li><li class=\"vfb-item vfb-item-textarea  \" id=\"item-vfb-88\"><label for=\"vfb-88\" class=\"vfb-desc\">Alamat  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea name=\"vfb-88\" id=\"vfb-88\" class=\"vfb-textarea  vfb-medium  required \"><\/textarea><\/div><\/li><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-18\"><label for=\"vfb-18\" class=\"vfb-desc\">Faks <\/label><input type=\"text\" name=\"vfb-18\" id=\"vfb-18\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li><li class=\"vfb-item vfb-item-email  \" id=\"item-vfb-83\"><label for=\"vfb-83\" class=\"vfb-desc\">E-mel <\/label><input type=\"email\" name=\"vfb-83\" id=\"vfb-83\" value=\"\" class=\"vfb-text  vfb-medium   email \" \/><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-2 butiran-program \" id=\"item-vfb-20\"><div class=\"vfb-legend\"><h3>Butiran Program<\/h3><\/div><ul class=\"vfb-section vfb-section-2\"><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-21\"><label for=\"vfb-21\" class=\"vfb-desc\">Nama Program  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-21\" id=\"vfb-21\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li><li class=\"vfb-item vfb-item-date  \" id=\"item-vfb-84\"><label for=\"vfb-84\" class=\"vfb-desc\">Cadangan Tarikh Mula  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-84\" id=\"vfb-84\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  required \" data-dp-dateFormat=\"dd\/mm\/yy\" \/><\/li><li class=\"vfb-item vfb-item-date  \" id=\"item-vfb-85\"><label for=\"vfb-85\" class=\"vfb-desc\">Cadangan Tarikh Tamat  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-85\" id=\"vfb-85\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  required \" data-dp-dateFormat=\"dd\/mm\/yy\" \/><\/li><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-23\"><label for=\"vfb-23\" class=\"vfb-desc\">Jumlah Peserta Lelaki <\/label><input type=\"text\" name=\"vfb-23\" id=\"vfb-23\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-24\"><label for=\"vfb-24\" class=\"vfb-desc\">Jumlah Peserta Perempuan <\/label><input type=\"text\" name=\"vfb-24\" id=\"vfb-24\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-3 pilihan-bilik-penginapan \" id=\"item-vfb-7\"><div class=\"vfb-legend\"><h3>Pilihan Bilik Penginapan<\/h3><\/div><ul class=\"vfb-section vfb-section-3\"><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-12\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-12[]\" id=\"vfb-12-0\" value=\"Bilik Berdua (sila pilih jumlah bilik)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-12-0\" class=\"vfb-choice\">Bilik Berdua (sila pilih jumlah bilik)<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-select  \" id=\"item-vfb-16\"><label for=\"vfb-16\" class=\"vfb-desc\"> <\/label><select name=\"vfb-16\" id=\"vfb-16\" class=\"vfb-select  vfb-medium  \"><option value=\"-\">-<\/option><option value=\"1 Unit\">1 Unit<\/option><option value=\"2 Unit\">2 Unit<\/option><option value=\"3 Unit\">3 Unit<\/option><option value=\"4 Unit\">4 Unit<\/option><option value=\"5 Unit\">5 Unit<\/option><\/select><\/li><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-14\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-14[]\" id=\"vfb-14-0\" value=\"Bilik Berempat (sila pilih jumlah bilik)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-14-0\" class=\"vfb-choice\">Bilik Berempat (sila pilih jumlah bilik)<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-select  \" id=\"item-vfb-15\"><label for=\"vfb-15\" class=\"vfb-desc\"> <\/label><select name=\"vfb-15\" id=\"vfb-15\" class=\"vfb-select  vfb-medium  \"><option value=\"-\">-<\/option><option value=\"1 Unit\">1 Unit<\/option><option value=\"2 Unit\">2 Unit<\/option><option value=\"3 Unit\">3 Unit<\/option><option value=\"4 Unit\">4 Unit<\/option><option value=\"5 Unit\">5 Unit<\/option><\/select><\/li><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-62\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-62[]\" id=\"vfb-62-0\" value=\"Dormitori Perempuan (sila pilih jumlah orang)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-62-0\" class=\"vfb-choice\">Dormitori Perempuan (sila pilih jumlah orang)<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-select  \" id=\"item-vfb-64\"><label for=\"vfb-64\" class=\"vfb-desc\"> <\/label><select name=\"vfb-64\" id=\"vfb-64\" class=\"vfb-select  vfb-medium  \"><option value=\"-\">-<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/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><\/select><\/li><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-63\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-63[]\" id=\"vfb-63-0\" value=\"Dormitori Lelaki (sila pilih jumlah orang)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-63-0\" class=\"vfb-choice\">Dormitori Lelaki (sila pilih jumlah orang)<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><li class=\"vfb-item vfb-item-select  \" id=\"item-vfb-65\"><label for=\"vfb-65\" class=\"vfb-desc\"> <\/label><select name=\"vfb-65\" id=\"vfb-65\" class=\"vfb-select  vfb-medium  \"><option value=\"-\">-<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/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><\/select><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-4 pilihan-bilik-seminar \" id=\"item-vfb-32\"><div class=\"vfb-legend\"><h3>Pilihan Bilik Seminar<\/h3><\/div><ul class=\"vfb-section vfb-section-4\"><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-27\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-27[]\" id=\"vfb-27-0\" value=\"Bilik Interaksi (maksimum 14 orang)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-27-0\" class=\"vfb-choice\">Bilik Interaksi (maksimum 14 orang)<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-27[]\" id=\"vfb-27-1\" value=\"Bilik Seminar (maksimum 50 orang)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-27-1\" class=\"vfb-choice\">Bilik Seminar (maksimum 50 orang)<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-27[]\" id=\"vfb-27-2\" value=\"Auditorium (maksimum 100 orang)\" class=\"vfb-checkbox  \" \/><label for=\"vfb-27-2\" class=\"vfb-choice\">Auditorium (maksimum 100 orang)<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-5 keperluan-seminar \" id=\"item-vfb-33\"><div class=\"vfb-legend\"><h3>Keperluan Seminar<\/h3><\/div><ul class=\"vfb-section vfb-section-5\"><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-61\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-61[]\" id=\"vfb-61-0\" value=\"LCD Skrin dan LCD Projektor\" class=\"vfb-checkbox  \" \/><label for=\"vfb-61-0\" class=\"vfb-choice\">LCD Skrin dan LCD Projektor<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-61[]\" id=\"vfb-61-1\" value=\"1 Laptop\" class=\"vfb-checkbox  \" \/><label for=\"vfb-61-1\" class=\"vfb-choice\">1 Laptop<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-61[]\" id=\"vfb-61-2\" value=\"Papan Putih\" class=\"vfb-checkbox  \" \/><label for=\"vfb-61-2\" class=\"vfb-choice\">Papan Putih<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-61[]\" id=\"vfb-61-3\" value=\"Carta Selak\" class=\"vfb-checkbox  \" \/><label for=\"vfb-61-3\" class=\"vfb-choice\">Carta Selak<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-61[]\" id=\"vfb-61-4\" value=\"PA Sistem\" class=\"vfb-checkbox  \" \/><label for=\"vfb-61-4\" class=\"vfb-choice\">PA Sistem<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-6 pilihan-katering \" id=\"item-vfb-67\"><div class=\"vfb-legend\"><h3>Pilihan Katering<\/h3><\/div><ul class=\"vfb-section vfb-section-6\"><li class=\"vfb-item vfb-item-checkbox  \" id=\"item-vfb-68\"><label class=\"vfb-desc\"> <\/label><div><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-68[]\" id=\"vfb-68-0\" value=\"Sarapan\" class=\"vfb-checkbox  \" \/><label for=\"vfb-68-0\" class=\"vfb-choice\">Sarapan<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-68[]\" id=\"vfb-68-1\" value=\"Minum Pagi\" class=\"vfb-checkbox  \" \/><label for=\"vfb-68-1\" class=\"vfb-choice\">Minum Pagi<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-68[]\" id=\"vfb-68-2\" value=\"Makan Tengahari\" class=\"vfb-checkbox  \" \/><label for=\"vfb-68-2\" class=\"vfb-choice\">Makan Tengahari<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-68[]\" id=\"vfb-68-3\" value=\"Minum Petang\" class=\"vfb-checkbox  \" \/><label for=\"vfb-68-3\" class=\"vfb-choice\">Minum Petang<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-68[]\" id=\"vfb-68-4\" value=\"Makan Malam\" class=\"vfb-checkbox  \" \/><label for=\"vfb-68-4\" class=\"vfb-choice\">Makan Malam<\/label><\/span><span class=\"vfb-span\"><input type=\"checkbox\" name=\"vfb-68[]\" id=\"vfb-68-5\" value=\"Minum Malam\" class=\"vfb-checkbox  \" \/><label for=\"vfb-68-5\" class=\"vfb-choice\">Minum Malam<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-7 makanan-hari-pertama-bermula-dari \" id=\"item-vfb-69\"><div class=\"vfb-legend\"><h3>Makanan hari pertama bermula dari<\/h3><\/div><ul class=\"vfb-section vfb-section-7\"><li class=\"vfb-item vfb-item-select  \" id=\"item-vfb-70\"><label for=\"vfb-70\" class=\"vfb-desc\"> <\/label><select name=\"vfb-70\" id=\"vfb-70\" class=\"vfb-select  vfb-medium  \"><option value=\"-\">-<\/option><option value=\"Sarapan\">Sarapan<\/option><option value=\"Minum Pagi\">Minum Pagi<\/option><option value=\"Makan Tengahari\">Makan Tengahari<\/option><option value=\"Minum Petang\">Minum Petang<\/option><option value=\"Makan Malam\">Makan Malam<\/option><option value=\"Minum Malam\">Minum Malam<\/option><\/select><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-8 makanan-hari-terakhir-berakhir-dengan \" id=\"item-vfb-71\"><div class=\"vfb-legend\"><h3>Makanan hari terakhir berakhir dengan<\/h3><\/div><ul class=\"vfb-section vfb-section-8\"><li class=\"vfb-item vfb-item-select  \" id=\"item-vfb-72\"><label for=\"vfb-72\" class=\"vfb-desc\"> <\/label><select name=\"vfb-72\" id=\"vfb-72\" class=\"vfb-select  vfb-medium  \"><option value=\"-\">-<\/option><option value=\"Sarapan\">Sarapan<\/option><option value=\"Minum pagi\">Minum pagi<\/option><option value=\"Makan Tengahari\">Makan Tengahari<\/option><option value=\"Minum petang\">Minum petang<\/option><option value=\"Makan Malam\">Makan Malam<\/option><option value=\"Minum Malam\">Minum Malam<\/option><\/select><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-9 catatan \" id=\"item-vfb-74\"><div class=\"vfb-legend\"><h3>Catatan<\/h3><\/div><ul class=\"vfb-section vfb-section-9\"><li class=\"vfb-item vfb-item-textarea  \" id=\"item-vfb-89\"><label for=\"vfb-89\" class=\"vfb-desc\"> <\/label><div><textarea name=\"vfb-89\" id=\"vfb-89\" class=\"vfb-textarea  vfb-medium  \"><\/textarea><\/div><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-10 lampiran-jika-ada \" id=\"item-vfb-90\"><div class=\"vfb-legend\"><h3>Lampiran (jika ada)<\/h3><\/div><ul class=\"vfb-section vfb-section-10\"><li class=\"vfb-item vfb-item-file-upload  \" id=\"item-vfb-87\"><label for=\"vfb-87\" class=\"vfb-desc\">*.pdf, .doc, .docx, .jpg (&lt; 6mb) <\/label><input type=\"file\" name=\"vfb-87\" id=\"vfb-87\" value=\"\" class=\"vfb-text  vfb-medium     {accept:'pdf|doc|docx|jpg'}\" \/><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-11 2 \" id=\"item-vfb-2\" style=\"display:block\"><div class=\"vfb-legend\"><h3><\/h3><\/div><ul class=\"vfb-section vfb-section-11\"><li class=\"vfb-item vfb-item-secret\"  style=\"display:block\"><label for=\"vfb-3\" class=\"vfb-desc\"><\/label><input type=\"hidden\" name=\"_vfb-required-secret\" value=\"0\" \/><input type=\"hidden\" name=\"_vfb-secret\" value=\"vfb-3\" \/><input type=\"text\" name=\"vfb-3\" id=\"vfb-3\" value=\"\" class=\"vfb-text  vfb-medium  {digits:true,maxlength:2,minlength:2} \" style=\"display:block\" \/><li style=\"display:none;\"><label>This box is for spam protection - &lt;strong&gt;please leave it blank&lt;\/strong&gt;:<\/label><div><input name=\"vfb-spam\" \/><\/div><\/li>\n\t\t\t<li class=\"vfb-item vfb-item-submit\" id=\"item-vfb-4\">\n\t\t\t\t<input type=\"submit\" name=\"vfb-submit\" id=\"vfb-4\" value=\"Hantar\" class=\"vfb-submit \" \/>\n\t\t\t\t<\/li><\/ul>\n\t\t\t<\/fieldset><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ppl\/wp-json\/wp\/v2\/pages\/1700\" \/><\/form><\/div> <!-- .visual-form-builder-container 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