
<!DOCTYPE html>
<html>
<head>
  <meta charset="utf-8">
  <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <link rel="icon" type="image/png" sizes="16x16" href="/membership/content/images/logophriheader250px.png">
    <title>PHRI Admin</title>
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</head>

<body class="hold-transition skin-blue sidebar-collapse sidebar-mini">
<div class="wrapper">

  <!-- Main Header -->
  <header class="main-header">

    <!-- Logo -->
    <a href="/membership/auth/login" class="logo">
    	<img src="/membership/content/images/logophriheader250px.png" height="40" alt="Codeig" />
        <span class="hidden-xs">PHRI Admin</span>
    </a>

    <!-- Header Navbar -->
    <nav class="navbar navbar-static-top" role="navigation">
      <!-- Sidebar toggle button-->
      <a href="#" class="sidebar-toggle" data-toggle="offcanvas" role="button">
        <span class="sr-only">Toggle navigation</span>
      </a>
      <!-- Navbar Right Menu -->
      <div class="navbar-custom-menu">
        <ul class="nav navbar-nav">
          
          <!-- User Account Menu -->
          <li class="dropdown user user-menu">
            <!-- Menu Toggle Button -->
            <a href="#" class="dropdown-toggle" data-toggle="dropdown">
              <span class="hidden-xs"></span>
            </a>
            <ul class="dropdown-menu">
              <!-- The user image in the menu -->
              
              <!-- Menu Body -->
              <li class="user-body">
                <div class="pull-right">
                    <a href="/membership/auth/login" class="btn btn-default btn-flat">Change Password</a>
                    &nbsp;&nbsp;&nbsp;
                  <a href="/membership/auth/login" class="btn btn-default btn-flat">Sign out</a>
                </div>
                <!-- /.row -->
              </li>              
            </ul>
          </li>
        </ul>
      </div>
    </nav>
  </header>
  <!-- Left side column. contains the logo and sidebar -->
  <aside class="main-sidebar">

    <!-- sidebar: style can be found in sidebar.less -->
    <section class="sidebar">

      <!-- Sidebar Menu -->
      <ul class="sidebar-menu">
        <!-- Optionally, you can add icons to the links -->
                                              </ul>
      <!-- /.sidebar-menu -->
    </section>
    <!-- /.sidebar -->
  </aside>

  <!-- Content Wrapper. Contains page content -->
  <div class="content-wrapper">
    <!-- Content Header (Page header) -->
    <section class="content-header">
      <h1>
        Registration - Step 1 - Member Data        <!--<small>Optional description</small>-->
      </h1>
      <!--<ol class="breadcrumb">
        <li><a href="#"><i class="fa fa-dashboard"></i> Level</a></li>
        <li class="active">Here</li>
      </ol>-->
    </section>

    <!-- Main content -->
    <section class="content">

        <!--  row ->
        <!-- .row -->
 <div class="row">
    <div class="col-md-12">
       <div class="white-box">

<form class="form-horizontal" method="post" action="/membership/member/step1">
        <input type="hidden" name="registered_by" value="BPP">
    <div class="form-group">
    <label for="radio" class="control-label col-xs-4">Jenis Usaha *</label> 
    <div class="col-xs-8">
       <select class="form-control" id="id_member_type" name="id_member_type" required>
           <option value="">--Pilih Jenis Usaha--</option>
           <option value="1" >Hotel</option>
           <option value="2" >Restoran</option>
           <option value="3" >Lembaga Pendidikan</option>
           <option value="4" >Afiliasi Serikat</option>
           <option value="5" >Afiliasi Gabungan</option>
       </select>
    </div>
  </div>
  <div class="form-group">
      <label class="control-label col-xs-4" for="ctg_risk">Basis Resiko</label>
      <div class="col-xs-8">
      <select name="ctg_risk" id="ctg_risk" class="form-control">
          <option value=""   ></option>
          <option value="27"  >Rendah</option>
          <option value="28"  >Menengah Rendah</option>
          <option value="29"  >Menengah Tinggi</option>
          <option value="30"  >Tinggi</option>
      </select>
      </div>
  </div>
  <div class="form-group">
      <label class="control-label col-xs-4" for="is_lpse">Apakah sudah melakukan registrasi Layanan Penyelenggara Sistem Elektronik (LPSE)?</label>
      <div class="col-xs-8">
      <select name="is_lpse" id="is_lpse" class="form-control">
          <option value="0"></option>
          <option value="1" >Tidak</option>
          <option value="2" >Ya</option>
      </select>
      </div>
  </div>
  <div class="form-group">
    <label for="radio1" class="control-label col-xs-4">Kepemilikan *</label> 
    <div class="col-xs-8">
      <label class="radio-inline">
        <input type="radio"  id="legal_entity1" name="legal_entity" value="1" required >
              Badan Usaha Berbadan Hukum
      </label>
      <label class="radio-inline">
        <input type="radio"  id="legal_entity2" name="legal_entity" value="2" required >
              Badan Usaha Tidak Berbadan Hukum
      </label>
    </div>
  </div>
  <div class="form-group">
    <label for="text" class="control-label col-xs-4">Nama Usaha *</label> 
    <div class="col-xs-8">
      <input id="text" name="text" type="text" class="form-control" required="required" value="">
      <small><strong>Bukan</strong> nama badan hukum</small>
    </div>
  </div>
  <div class="form-group">
    <label for="id_member_class" class="control-label col-xs-4">Klasifikasi Usaha *</label> 
    <div class="col-xs-8">
      <select id="id_member_class" name="id_member_class" class="form-control"  required="required">
          <option value="">--Pilih Klasifikasi Usaha--</option>
                    <option value="1" data-chained="1" >Bintang 5</option>
                    <option value="2" data-chained="1" >Bintang 4</option>
                    <option value="3" data-chained="1" >Bintang 3</option>
                    <option value="4" data-chained="1" >Bintang 2</option>
                    <option value="5" data-chained="1" >Bintang 1</option>
                    <option value="6" data-chained="1" >Non-Bintang</option>
                    <option value="7" data-chained="" >Warung/Rumah Makan</option>
                    <option value="8" data-chained="" >Ukuran Luas 100-200m2</option>
                    <option value="9" data-chained="" >Ukuran Luas >200m2</option>
                    <option value="10" data-chained="" >Ukuran Luas >200m2 + Jual Miras</option>
                    <option value="11" data-chained="3" >Akademi</option>
                    <option value="12" data-chained="3" >Politeknik</option>
                    <option value="13" data-chained="3" >Sekolah Tinggi</option>
                    <option value="14" data-chained="3" >Institut</option>
                    <option value="15" data-chained="3" >Universitas</option>
                    <option value="16" data-chained="3" >Sekolah Menengah Kejuruan</option>
                    <option value="17" data-chained="4" >Pemasok</option>
                    <option value="18" data-chained="4" >Konsultan Pariwisata</option>
                    <option value="19" data-chained="4" >Manajemen Perhotelan</option>
                    <option value="20" data-chained="4" >Manajemen Restoran</option>
                    <option value="21" data-chained="4" >Manajemen Travel</option>
                    <option value="22" data-chained="4" >Manajemen Hiburan</option>
                    <option value="23" data-chained="4" >Media Pariwisata</option>
                    <option value="24" data-chained="4" >Lainnya</option>
                    <option value="25" data-chained="5" >Asosiasi Profesi</option>
                    <option value="26" data-chained="5" >Asosiasi Industri</option>
                    <option value="27" data-chained="2" >Rendah</option>
                    <option value="28" data-chained="2" >Menengah Rendah</option>
                    <option value="29" data-chained="2" >Menengah Tingi</option>
                    <option value="30" data-chained="2" >Tinggi</option>
                </select>
    </div>
  </div>
  <div class="form-group">
    <label for="address" class="control-label col-xs-4">Alamat *</label> 
    <div class="col-xs-8">
      <textarea id="address" name="address" cols="40" rows="5" required class="form-control"></textarea>
    </div>
  </div>
  <div class="form-group">
    <label for="id_province" class="control-label col-xs-4">Provinsi *</label> 
    <div class="col-xs-8">
      <select id="id_province" name="id_province" class="select form-control" required>
      <option value="">--Pilih Provinsi--</option>
              <option value="1" >Bali</option>
              <option value="2" >Bangka Belitung</option>
              <option value="3" >Banten</option>
              <option value="4" >Bengkulu</option>
              <option value="5" >Gorontalo</option>
              <option value="6" >DKI Jakarta</option>
              <option value="7" >Jambi</option>
              <option value="8" >Jawa Barat</option>
              <option value="9" >Jawa Tengah</option>
              <option value="10" >Jawa Timur</option>
              <option value="11" >Kalimantan Barat</option>
              <option value="12" >Kalimantan Selatan</option>
              <option value="13" >Kalimantan Tengah</option>
              <option value="14" >Kalimantan Timur</option>
              <option value="15" >Kalimantan Utara</option>
              <option value="16" >Kepulauan Riau</option>
              <option value="17" >Lampung</option>
              <option value="18" >Maluku</option>
              <option value="19" >Maluku Utara</option>
              <option value="20" >Bali</option>
              <option value="21" >Nusa Tenggara Barat</option>
              <option value="22" >Nusa Tenggara Timur</option>
              <option value="23" >Riau</option>
              <option value="24" >Sulawesi Barat</option>
              <option value="25" >Sulawesi Selatan</option>
              <option value="26" >Sulawesi Tengah</option>
              <option value="27" >Sulawesi Tenggara</option>
              <option value="28" >Sulawesi Utara</option>
              <option value="29" >Sumatera Barat</option>
              <option value="30" >Sumatera Selatan</option>
              <option value="31" >Sumatera Utara</option>
              <option value="32" >Yogyakarta</option>
              <option value="33" >Papua</option>
              <option value="34" >Papua Barat</option>
              <option value="35" >Papua Selatan</option>
              <option value="36" >Papua Tengah</option>
              <option value="37" >Papua Pegunungan</option>
              <option value="38" >Papua Barat Daya</option>
            </select>
    </div>
  </div>
  <div class="form-group">
    <label for="id_city" class="control-label col-xs-4">Kota/Kabupaten *</label> 
    <div class="col-xs-8">
      <select id="id_city" name="id_city" class="select form-control"  required="required">
      <option value="">--Pilih Kota--</option>
              <option value="1" data-chained="1" >Kota Denpasar</option>
              <option value="2" data-chained="1" >Kabupaten Badung</option>
              <option value="3" data-chained="1" >Kabupaten Bangli</option>
              <option value="4" data-chained="1" >Kabupaten Buleleng</option>
              <option value="5" data-chained="1" >Kabupaten Gianyar</option>
              <option value="6" data-chained="1" >Kabupaten Jembrana</option>
              <option value="7" data-chained="1" >Kabupaten Karangasem</option>
              <option value="8" data-chained="1" >Kabupaten Klungkung</option>
              <option value="9" data-chained="1" >Kabupaten Tabanan</option>
              <option value="10" data-chained="2" >Kota Pangkal Pinang</option>
              <option value="11" data-chained="2" >Kabupaten Bangka</option>
              <option value="12" data-chained="2" >Kabupaten Bangka Barat</option>
              <option value="13" data-chained="2" >Kabupaten Bangka Selatan</option>
              <option value="14" data-chained="2" >Kabupaten Bangka Tengah</option>
              <option value="15" data-chained="2" >Kabupaten Belitung</option>
              <option value="16" data-chained="2" >Kabupaten Belitung Timur</option>
              <option value="17" data-chained="3" >Kota Cilegon</option>
              <option value="18" data-chained="3" >Kota Serang</option>
              <option value="19" data-chained="3" >Kota Tangerang</option>
              <option value="20" data-chained="3" >Kota Tangerang Selatan</option>
              <option value="21" data-chained="3" >Kabupaten Lebak</option>
              <option value="22" data-chained="3" >Kabupaten Pandeglang</option>
              <option value="23" data-chained="3" >Kabupaten Serang</option>
              <option value="24" data-chained="3" >Kabupaten Tangerang</option>
              <option value="25" data-chained="4" >Kota Bengkulu</option>
              <option value="26" data-chained="4" >Kabupaten Bengkulu Selatan</option>
              <option value="27" data-chained="4" >Kabupaten Bengkulu Tengah</option>
              <option value="28" data-chained="4" >Kabupaten Bengkulu Utara</option>
              <option value="29" data-chained="4" >Kabupaten Kaur</option>
              <option value="30" data-chained="4" >Kabupaten Kepahiang</option>
              <option value="31" data-chained="4" >Kabupaten Lebong</option>
              <option value="32" data-chained="4" >Kabupaten Mukomuko</option>
              <option value="33" data-chained="4" >Kabupaten Rejang Lebong</option>
              <option value="34" data-chained="4" >Kabupaten Seluma</option>
              <option value="35" data-chained="5" >Kota Gorontalo</option>
              <option value="36" data-chained="5" >Kabupaten Boalemo</option>
              <option value="37" data-chained="5" >Kabupaten Bone Bolango</option>
              <option value="38" data-chained="5" >Kabupaten Gorontalo</option>
              <option value="39" data-chained="5" >Kabupaten Gorontalo Utara</option>
              <option value="40" data-chained="5" >Kabupaten Pohuwatu</option>
              <option value="41" data-chained="6" >Kota Jakarta Utara</option>
              <option value="42" data-chained="6" >Kota Jakarta Timur</option>
              <option value="43" data-chained="6" >Kota Jakarta Selatan</option>
              <option value="44" data-chained="6" >Kota Jakarta Pusat</option>
              <option value="45" data-chained="6" >Kota Jakarta Barat</option>
              <option value="46" data-chained="6" >Kabupaten Administrasi Kepulauan Seribu</option>
              <option value="47" data-chained="7" >Kota Jambi</option>
              <option value="48" data-chained="7" >Kota Sungaipenuh</option>
              <option value="49" data-chained="7" >Kabupaten Batanghari</option>
              <option value="50" data-chained="7" >Kabupaten Bungo</option>
              <option value="51" data-chained="7" >Kabupaten Kerinci</option>
              <option value="52" data-chained="7" >Kabupaten Merangin</option>
              <option value="53" data-chained="7" >Kabupaten Muaro Jambi</option>
              <option value="54" data-chained="7" >Kabupaten Sarolangun</option>
              <option value="55" data-chained="7" >Kabupaten Tanjung Jabung Barat</option>
              <option value="56" data-chained="7" >Kabupaten Tanjung Jabung Timur</option>
              <option value="57" data-chained="7" >Kabupaten Tebo</option>
              <option value="58" data-chained="8" >Kota Bandung</option>
              <option value="59" data-chained="8" >Kota Banjar</option>
              <option value="60" data-chained="8" >Kota Bekasi</option>
              <option value="61" data-chained="8" >Kota Bogor</option>
              <option value="62" data-chained="8" >Kota Cimahi</option>
              <option value="63" data-chained="8" >Kota Cirebon</option>
              <option value="64" data-chained="8" >Kota Depok</option>
              <option value="65" data-chained="8" >Kota Sukabumi</option>
              <option value="66" data-chained="8" >Kota Tasikmalaya</option>
              <option value="67" data-chained="8" >Kabupaten Bandung</option>
              <option value="68" data-chained="8" >Kabupaten Bandung Barat</option>
              <option value="69" data-chained="8" >Kabupaten Bekasi</option>
              <option value="70" data-chained="8" >Kabupaten Bogor</option>
              <option value="71" data-chained="8" >Kabupaten Ciamis</option>
              <option value="72" data-chained="8" >Kabupaten Cianjur</option>
              <option value="73" data-chained="8" >Kabupaten Cirebon</option>
              <option value="74" data-chained="8" >Kabupaten Garut</option>
              <option value="75" data-chained="8" >Kabupaten Indramayu</option>
              <option value="76" data-chained="8" >Kabupaten Karawang</option>
              <option value="77" data-chained="8" >Kabupaten Kuningan</option>
              <option value="78" data-chained="8" >Kabupaten Majalengka</option>
              <option value="79" data-chained="8" >Kabupaten Pangandaran</option>
              <option value="80" data-chained="8" >Kabupaten Purwakarta</option>
              <option value="81" data-chained="8" >Kabupaten Subang</option>
              <option value="82" data-chained="8" >Kabupaten Sukabumi</option>
              <option value="83" data-chained="8" >Kabupaten SuKabupaten Timor Tengah Selatang</option>
              <option value="84" data-chained="8" >Kabupaten Tasikmalaya</option>
              <option value="85" data-chained="9" >Kota Magelang</option>
              <option value="86" data-chained="9" >Kota Pekalongan</option>
              <option value="87" data-chained="9" >Kota Salatiga</option>
              <option value="88" data-chained="9" >Kota Semarang</option>
              <option value="89" data-chained="9" >Kota Surakarta</option>
              <option value="90" data-chained="9" >Kota Tegal</option>
              <option value="91" data-chained="9" >Kabupaten Banjarnegara</option>
              <option value="92" data-chained="9" >Kabupaten Banyumas</option>
              <option value="93" data-chained="9" >Kabupaten Batang</option>
              <option value="94" data-chained="9" >Kabupaten Blora</option>
              <option value="95" data-chained="9" >Kabupaten Boyolali</option>
              <option value="96" data-chained="9" >Kabupaten Brebes</option>
              <option value="97" data-chained="9" >Kabupaten Cilacap</option>
              <option value="98" data-chained="9" >Kabupaten Demak</option>
              <option value="99" data-chained="9" >Kabupaten Grobogan</option>
              <option value="100" data-chained="9" >Kabupaten Jepara</option>
              <option value="101" data-chained="9" >Kabupaten Karanganyar</option>
              <option value="102" data-chained="9" >Kabupaten Kebumen</option>
              <option value="103" data-chained="9" >Kabupaten Kendal</option>
              <option value="104" data-chained="9" >Kabupaten Klaten</option>
              <option value="105" data-chained="9" >Kabupaten Kudus</option>
              <option value="106" data-chained="9" >Kabupaten Magelang</option>
              <option value="107" data-chained="9" >Kabupaten Pati</option>
              <option value="108" data-chained="9" >Kabupaten Pekalongan</option>
              <option value="109" data-chained="9" >Kabupaten Pemalang</option>
              <option value="110" data-chained="9" >Kabupaten Purbalingga</option>
              <option value="111" data-chained="9" >Kabupaten Purworejo</option>
              <option value="112" data-chained="9" >Kabupaten Rembang</option>
              <option value="113" data-chained="9" >Kabupaten Semarang</option>
              <option value="114" data-chained="9" >Kabupaten Sragen</option>
              <option value="115" data-chained="9" >Kabupaten Sukoharjo</option>
              <option value="116" data-chained="9" >Kabupaten Tegal</option>
              <option value="117" data-chained="9" >Kabupaten Temanggung</option>
              <option value="118" data-chained="9" >Kabupaten Wonogiri</option>
              <option value="119" data-chained="9" >Kabupaten Wonosobo</option>
              <option value="120" data-chained="10" >Kota Batu</option>
              <option value="121" data-chained="10" >Kota Blitar</option>
              <option value="122" data-chained="10" >Kota Kediri</option>
              <option value="123" data-chained="10" >Kota Madiun</option>
              <option value="124" data-chained="10" >Kota Malang</option>
              <option value="125" data-chained="10" >Kota Mojokerto</option>
              <option value="126" data-chained="10" >Kota Pasuruan</option>
              <option value="127" data-chained="10" >Kota Probolinggo</option>
              <option value="128" data-chained="10" >Kota Surabaya</option>
              <option value="129" data-chained="10" >Kabupaten Bangkalan</option>
              <option value="130" data-chained="10" >Kabupaten Banyuwangi</option>
              <option value="131" data-chained="10" >Kabupaten Blitar</option>
              <option value="132" data-chained="10" >Kabupaten Bojonegoro</option>
              <option value="133" data-chained="10" >Kabupaten Bondowoso</option>
              <option value="134" data-chained="10" >Kabupaten Gresik</option>
              <option value="135" data-chained="10" >Kabupaten Jember</option>
              <option value="136" data-chained="10" >Kabupaten Jombang</option>
              <option value="137" data-chained="10" >Kabupaten Kediri</option>
              <option value="138" data-chained="10" >Kabupaten Lamongan</option>
              <option value="139" data-chained="10" >Kabupaten Lumajang</option>
              <option value="140" data-chained="10" >Kabupaten Madiun</option>
              <option value="141" data-chained="10" >Kabupaten Magetan</option>
              <option value="142" data-chained="10" >Kabupaten Malang</option>
              <option value="143" data-chained="10" >Kabupaten Mojokerto</option>
              <option value="144" data-chained="10" >Kabupaten Nganjuk</option>
              <option value="145" data-chained="10" >Kabupaten Ngawi</option>
              <option value="146" data-chained="10" >Kabupaten Pacitan</option>
              <option value="147" data-chained="10" >Kabupaten Pamekasan</option>
              <option value="148" data-chained="10" >Kabupaten Pasuruan</option>
              <option value="149" data-chained="10" >Kabupaten Ponorogo</option>
              <option value="150" data-chained="10" >Kabupaten Probolinggo</option>
              <option value="151" data-chained="10" >Kabupaten Sampang</option>
              <option value="152" data-chained="10" >Kabupaten Sidoarjo</option>
              <option value="153" data-chained="10" >Kabupaten Situbondo</option>
              <option value="154" data-chained="10" >Kabupaten Sumenep</option>
              <option value="155" data-chained="10" >Kabupaten Trenggalek</option>
              <option value="156" data-chained="10" >Kabupaten Tuban</option>
              <option value="157" data-chained="10" >Kabupaten Tulungagung</option>
              <option value="158" data-chained="11" >Kota Pontianak</option>
              <option value="159" data-chained="11" >Kota Singkawang</option>
              <option value="160" data-chained="11" >Kabupaten Bengkayang</option>
              <option value="161" data-chained="11" >Kabupaten Kapuas Hulu</option>
              <option value="162" data-chained="11" >Kabupaten Kayong Utara</option>
              <option value="163" data-chained="11" >Kabupaten Ketapang</option>
              <option value="164" data-chained="11" >Kabupaten Kubu Raya</option>
              <option value="165" data-chained="11" >Kabupaten Landak</option>
              <option value="166" data-chained="11" >Kabupaten Melawi</option>
              <option value="167" data-chained="11" >Kabupaten Mempawah</option>
              <option value="168" data-chained="11" >Kabupaten Sambas</option>
              <option value="169" data-chained="11" >Kabupaten Sanggau</option>
              <option value="170" data-chained="11" >Kabupaten Sekadau</option>
              <option value="171" data-chained="11" >Kabupaten Sintang</option>
              <option value="172" data-chained="12" >Kota Banjarbaru</option>
              <option value="173" data-chained="12" >Kota Banjarmasin</option>
              <option value="174" data-chained="12" >Kabupaten Balangan</option>
              <option value="175" data-chained="12" >Kabupaten Banjar</option>
              <option value="176" data-chained="12" >Kabupaten Barito Kuala</option>
              <option value="177" data-chained="12" >Kabupaten Hulu Sungai Selatan</option>
              <option value="178" data-chained="12" >Kabupaten Hulu Sungai Tengah</option>
              <option value="179" data-chained="12" >Kabupaten Hulu Sungai Utara</option>
              <option value="180" data-chained="12" >Kabupaten Kotabaru</option>
              <option value="181" data-chained="12" >Kabupaten Tabalong</option>
              <option value="182" data-chained="12" >Kabupaten Tanah Bumbu</option>
              <option value="183" data-chained="12" >Kabupaten Tanah Laut</option>
              <option value="184" data-chained="12" >Kabupaten Tapin</option>
              <option value="185" data-chained="13" >Kota Palangka Raya</option>
              <option value="186" data-chained="13" >Kabupaten Barito Selatan</option>
              <option value="187" data-chained="13" >Kabupaten Barito Timur</option>
              <option value="188" data-chained="13" >Kabupaten Barito Utara</option>
              <option value="189" data-chained="13" >Kabupaten Gunung Mas</option>
              <option value="190" data-chained="13" >Kabupaten Kapuas</option>
              <option value="191" data-chained="13" >Kabupaten Katingan</option>
              <option value="192" data-chained="13" >Kabupaten Kotawaringin Barat</option>
              <option value="193" data-chained="13" >Kabupaten Kotawaringin Timur</option>
              <option value="194" data-chained="13" >Kabupaten Lamandau</option>
              <option value="195" data-chained="13" >Kabupaten Murung Raya</option>
              <option value="196" data-chained="13" >Kabupaten Pulang Pisau</option>
              <option value="197" data-chained="13" >Kabupaten Sukamara</option>
              <option value="198" data-chained="13" >Kabupaten Seruyan</option>
              <option value="199" data-chained="14" >Kota Balikpapan</option>
              <option value="200" data-chained="14" >Kota Bontang</option>
              <option value="201" data-chained="14" >Kota Samarinda</option>
              <option value="202" data-chained="14" >Kabupaten Berau</option>
              <option value="203" data-chained="14" >Kabupaten Kutai Barat</option>
              <option value="204" data-chained="14" >Kabupaten Kutai Kartanegara</option>
              <option value="205" data-chained="14" >Kabupaten Kutai Timur</option>
              <option value="206" data-chained="14" >Kabupaten Mahakam Ulu</option>
              <option value="207" data-chained="14" >Kabupaten Paser</option>
              <option value="208" data-chained="14" >Kabupaten Penajam Paser Utara</option>
              <option value="209" data-chained="15" >Kota Tarakan</option>
              <option value="210" data-chained="15" >Kabupaten Bulungan</option>
              <option value="211" data-chained="15" >Kabupaten Malinau</option>
              <option value="212" data-chained="15" >Kabupaten Nunukan</option>
              <option value="213" data-chained="15" >Kabupaten Tana Tidung</option>
              <option value="214" data-chained="16" >Kota Batam</option>
              <option value="215" data-chained="16" >Kota Tanjung Pinang</option>
              <option value="216" data-chained="16" >Kabupaten Bintan Kepulauan</option>
              <option value="217" data-chained="16" >Kabupaten Karimun</option>
              <option value="218" data-chained="16" >Kabupaten Kepulauan Anambas</option>
              <option value="219" data-chained="16" >Kabupaten Lingga</option>
              <option value="220" data-chained="16" >Kabupaten Natuna</option>
              <option value="221" data-chained="17" >Kota Bandar Lampung</option>
              <option value="222" data-chained="17" >Kota Metro</option>
              <option value="223" data-chained="17" >Kabupaten Lampung Barat</option>
              <option value="224" data-chained="17" >Kabupaten Lampung Selatan</option>
              <option value="225" data-chained="17" >Kabupaten Lampung Tengah</option>
              <option value="226" data-chained="17" >Kabupaten Lampung Timur</option>
              <option value="227" data-chained="17" >Kabupaten Lampung Utara</option>
              <option value="228" data-chained="17" >Kabupaten Mesuji</option>
              <option value="229" data-chained="17" >Kabupaten Pesawaran</option>
              <option value="230" data-chained="17" >Kabupaten Pesisir Barat</option>
              <option value="231" data-chained="17" >Kabupaten Pringsewu</option>
              <option value="232" data-chained="17" >Kabupaten Tanggamus</option>
              <option value="233" data-chained="17" >Kabupaten Tulang Bawang</option>
              <option value="234" data-chained="17" >Kabupaten Tulang Bawang Barat</option>
              <option value="235" data-chained="17" >Kabupaten Way Kanan</option>
              <option value="236" data-chained="18" >Kota Tuai</option>
              <option value="237" data-chained="18" >Kota Ambon</option>
              <option value="238" data-chained="18" >Kabupaten Buru</option>
              <option value="239" data-chained="18" >Kabupaten Buru Selatan</option>
              <option value="240" data-chained="18" >Kabupaten Aru</option>
              <option value="241" data-chained="18" >Kabupaten Maluku Barat Daya</option>
              <option value="242" data-chained="18" >Kabupaten Maluku Tengah</option>
              <option value="243" data-chained="18" >Kabupaten Maluku Tenggara</option>
              <option value="244" data-chained="18" >Kabupaten Maluku Tenggara Barat</option>
              <option value="245" data-chained="18" >Kabupaten Seram Bagian Barat</option>
              <option value="246" data-chained="18" >Kabupaten Seram Bagian Timur</option>
              <option value="247" data-chained="19" >Kota Ternate</option>
              <option value="248" data-chained="19" >Kota Tidore Kepulauan</option>
              <option value="249" data-chained="19" >Kabupaten Halmahera Barat</option>
              <option value="250" data-chained="19" >Kabupaten Halmahera Tengah</option>
              <option value="251" data-chained="19" >Kabupaten Halmahera Timur</option>
              <option value="252" data-chained="19" >Kabupaten Halmahera Selatan</option>
              <option value="253" data-chained="19" >Kabupaten Halmahera Utara</option>
              <option value="254" data-chained="19" >Kabupaten Kepulauan Sula</option>
              <option value="255" data-chained="19" >Kabupaten Pulau Morotai</option>
              <option value="256" data-chained="19" >Kabupaten Pulau Taliabu</option>
              <option value="257" data-chained="20" >Kota Banda Bali</option>
              <option value="258" data-chained="20" >Kota Langsa</option>
              <option value="259" data-chained="20" >Kota Lhokseumawe</option>
              <option value="260" data-chained="20" >Kota Sabang</option>
              <option value="261" data-chained="20" >Kota Subulussalam</option>
              <option value="262" data-chained="20" >Kabupaten Bali Barat</option>
              <option value="263" data-chained="20" >Kabupaten Bali Barat Daya</option>
              <option value="264" data-chained="20" >Kabupaten Bali Besar</option>
              <option value="265" data-chained="20" >Kabupaten Bali Jaya</option>
              <option value="266" data-chained="20" >Kabupaten Bali Selatan</option>
              <option value="267" data-chained="20" >Kabupaten Bali Singkil</option>
              <option value="268" data-chained="20" >Kabupaten Bali Tamiang</option>
              <option value="269" data-chained="20" >Kabupaten Bali Tengah</option>
              <option value="270" data-chained="20" >Kabupaten Bali Tenggara</option>
              <option value="271" data-chained="20" >Kabupaten Bali Timur</option>
              <option value="272" data-chained="20" >Kabupaten Bali Utara</option>
              <option value="273" data-chained="20" >Kabupaten Bener Meriah</option>
              <option value="274" data-chained="20" >Kabupaten Bireuen</option>
              <option value="275" data-chained="20" >Kabupaten Gayo Lues</option>
              <option value="276" data-chained="20" >Kabupaten Nagan Raya</option>
              <option value="277" data-chained="20" >Kabupaten Pidie</option>
              <option value="278" data-chained="20" >Kabupaten Pidie Jaya</option>
              <option value="279" data-chained="20" >Kabupaten Simeulue</option>
              <option value="280" data-chained="21" >Kota Bima</option>
              <option value="281" data-chained="21" >Kota Mataram</option>
              <option value="282" data-chained="21" >Kabupaten Bima</option>
              <option value="283" data-chained="21" >Kabupaten Dompu</option>
              <option value="284" data-chained="21" >Kabupaten Lombok Barat</option>
              <option value="285" data-chained="21" >Kabupaten Lombok Tengah</option>
              <option value="286" data-chained="21" >Kabupaten Lombok Timur</option>
              <option value="287" data-chained="21" >Kabupaten Lombok Utara</option>
              <option value="288" data-chained="21" >Kabupaten Sumbawa</option>
              <option value="289" data-chained="21" >Kabupaten Sumbawa Barat</option>
              <option value="290" data-chained="22" >Kota Kupang</option>
              <option value="291" data-chained="22" >Kabupaten Alor</option>
              <option value="292" data-chained="22" >Kabupaten Belu</option>
              <option value="293" data-chained="22" >Kabupaten Ende</option>
              <option value="294" data-chained="22" >Kabupaten Flores Timur</option>
              <option value="295" data-chained="22" >Kabupaten Kupang</option>
              <option value="296" data-chained="22" >Kabupaten Lembata</option>
              <option value="297" data-chained="22" >Kabupaten Malaka</option>
              <option value="298" data-chained="22" >Kabupaten Manggarai</option>
              <option value="299" data-chained="22" >Kabupaten Manggarai Barat</option>
              <option value="300" data-chained="22" >Kabupaten Manggarai Timur</option>
              <option value="301" data-chained="22" >Kabupaten Ngada</option>
              <option value="302" data-chained="22" >Kabupaten Nagekeo</option>
              <option value="303" data-chained="22" >Kabupaten Rote Ndao</option>
              <option value="304" data-chained="22" >Kabupaten Sabu Raijua</option>
              <option value="305" data-chained="22" >Kabupaten Sikka</option>
              <option value="306" data-chained="22" >Kabupaten Sumba Barat</option>
              <option value="307" data-chained="22" >Kabupaten Sumba Barat Daya</option>
              <option value="308" data-chained="22" >Kabupaten Sumba Tengah</option>
              <option value="309" data-chained="22" >Kabupaten Sumba Timur</option>
              <option value="310" data-chained="22" >Kabupaten Timor Tengah Selatan</option>
              <option value="311" data-chained="22" >Kabupaten Timor Tengah Utara</option>
              <option value="312" data-chained="23" >Kota Dumai</option>
              <option value="313" data-chained="23" >Kota Pekanbaru</option>
              <option value="314" data-chained="23" >Kabupaten Bengkalis</option>
              <option value="315" data-chained="23" >Kabupaten Indragiri Hilir</option>
              <option value="316" data-chained="23" >Kabupaten Indragiri Hulu</option>
              <option value="317" data-chained="23" >Kabupaten Kampar</option>
              <option value="318" data-chained="23" >Kabupaten Kepulauan Meranti</option>
              <option value="319" data-chained="23" >Kabupaten Kuantan Singingi</option>
              <option value="320" data-chained="23" >Kabupaten Pelalawan</option>
              <option value="321" data-chained="23" >Kabupaten Rokan Hilir</option>
              <option value="322" data-chained="23" >Kabupaten Rokan Hulu</option>
              <option value="323" data-chained="23" >Kabupaten Siak</option>
              <option value="324" data-chained="24" >Kabupaten Majene</option>
              <option value="325" data-chained="24" >Kabupaten Mamasa</option>
              <option value="326" data-chained="24" >Kabupaten Mamuju</option>
              <option value="327" data-chained="24" >Kabupaten Mamuju Tengah</option>
              <option value="328" data-chained="24" >Kabupaten Mamuju Utara</option>
              <option value="329" data-chained="24" >Kabupaten Polewali Mandar</option>
              <option value="330" data-chained="25" >Kota Makassar</option>
              <option value="331" data-chained="25" >Kota Palopo</option>
              <option value="332" data-chained="25" >Kota Parepare</option>
              <option value="333" data-chained="25" >Kabupaten Bantaeng</option>
              <option value="334" data-chained="25" >Kabupaten Barru</option>
              <option value="335" data-chained="25" >Kabupaten Bone</option>
              <option value="336" data-chained="25" >Kabupaten Bulukumba</option>
              <option value="337" data-chained="25" >Kabupaten Enrekang</option>
              <option value="338" data-chained="25" >Kabupaten Gowa</option>
              <option value="339" data-chained="25" >Kabupaten Jeneponto</option>
              <option value="340" data-chained="25" >Kabupaten Kepulauan Selayar</option>
              <option value="341" data-chained="25" >Kabupaten Luwu</option>
              <option value="342" data-chained="25" >Kabupaten Luwu Timur</option>
              <option value="343" data-chained="25" >Kabupaten Luwu Utara</option>
              <option value="344" data-chained="25" >Kabupaten Maros</option>
              <option value="345" data-chained="25" >Kabupaten Pangkajene dan Kepulauan</option>
              <option value="346" data-chained="25" >Kabupaten Pinrang</option>
              <option value="347" data-chained="25" >Kabupaten Sidenreng Rappang</option>
              <option value="348" data-chained="25" >Kabupaten Sinjai</option>
              <option value="349" data-chained="25" >Kabupaten Soppeng</option>
              <option value="350" data-chained="25" >Kabupaten Takalar</option>
              <option value="351" data-chained="25" >Kabupaten Tana Toraja</option>
              <option value="352" data-chained="25" >Kabupaten Toraja Utara</option>
              <option value="353" data-chained="25" >Kabupaten Wajo</option>
              <option value="354" data-chained="26" >Kota Palu</option>
              <option value="355" data-chained="26" >Kabupaten Banggai</option>
              <option value="356" data-chained="26" >Kabupaten Banggai Kepulauan</option>
              <option value="357" data-chained="26" >Kabupaten Banggai Laut</option>
              <option value="358" data-chained="26" >Kabupaten Buol</option>
              <option value="359" data-chained="26" >Kabupaten Donggala</option>
              <option value="360" data-chained="26" >Kabupaten Morowali</option>
              <option value="361" data-chained="26" >Kabupaten Morowali Utara</option>
              <option value="362" data-chained="26" >Kabupaten Parigi Moutong</option>
              <option value="363" data-chained="26" >Kabupaten Poso</option>
              <option value="364" data-chained="26" >Kabupaten Sigi</option>
              <option value="365" data-chained="26" >Kabupaten Tojo Una-Una</option>
              <option value="366" data-chained="26" >Kabupaten Tolitoli</option>
              <option value="367" data-chained="27" >Kota Bau-Bau</option>
              <option value="368" data-chained="27" >Kota Kendari</option>
              <option value="369" data-chained="27" >Kabupaten Bombana</option>
              <option value="370" data-chained="27" >Kabupaten Buton</option>
              <option value="371" data-chained="27" >Kabupaten Buton Selatan</option>
              <option value="372" data-chained="27" >Kabupaten Buton Tengah</option>
              <option value="373" data-chained="27" >Kabupaten Buton Utara</option>
              <option value="374" data-chained="27" >Kabupaten Kolaka</option>
              <option value="375" data-chained="27" >Kabupaten Kolaka Timur</option>
              <option value="376" data-chained="27" >Kabupaten Kolaka Utara</option>
              <option value="377" data-chained="27" >Kabupaten Konawe</option>
              <option value="378" data-chained="27" >Kabupaten Konawe Kepulauan</option>
              <option value="379" data-chained="27" >Kabupaten Konawe Selatan</option>
              <option value="380" data-chained="27" >Kabupaten Konawe Utara</option>
              <option value="381" data-chained="27" >Kabupaten Muna</option>
              <option value="382" data-chained="27" >Kabupaten Muna Barat</option>
              <option value="383" data-chained="27" >Kabupaten Wakatobi</option>
              <option value="384" data-chained="28" >Kota Bitung</option>
              <option value="385" data-chained="28" >Kota Kotamobagu</option>
              <option value="386" data-chained="28" >Kota Manado</option>
              <option value="387" data-chained="28" >Kota Tomohon</option>
              <option value="388" data-chained="28" >Kabupaten Bolaang Mongondow</option>
              <option value="389" data-chained="28" >Kabupaten Bolaang Mongondow Selatan</option>
              <option value="390" data-chained="28" >Kabupaten Bolaang Mongondow Timur</option>
              <option value="391" data-chained="28" >Kabupaten Bolaang Mongondow Utara</option>
              <option value="392" data-chained="28" >Kabupaten Kepulauan Sangihe</option>
              <option value="393" data-chained="28" >Kabupaten Kepulauan Siau Tagulandang Biaro</option>
              <option value="394" data-chained="28" >Kabupaten Kepulauan Talaud</option>
              <option value="395" data-chained="28" >Kabupaten Minahasa</option>
              <option value="396" data-chained="28" >Kabupaten Minahasa Selatan</option>
              <option value="397" data-chained="28" >Kabupaten Minahasa Tenggara</option>
              <option value="398" data-chained="28" >Kabupaten Minahasa Utara</option>
              <option value="399" data-chained="29" >Kota Padang</option>
              <option value="400" data-chained="29" >Kota Bukittinggi</option>
              <option value="401" data-chained="29" >Kota Padangpanjang</option>
              <option value="402" data-chained="29" >Kota Pariaman</option>
              <option value="403" data-chained="29" >Kota Payakumbuh</option>
              <option value="404" data-chained="29" >Kota Sawahlunto</option>
              <option value="405" data-chained="29" >Kota Solok</option>
              <option value="406" data-chained="29" >Kabupaten Agam</option>
              <option value="407" data-chained="29" >Kabupaten Dharmasraya</option>
              <option value="408" data-chained="29" >Kabupaten Kepulauan Mentawai</option>
              <option value="409" data-chained="29" >Kabupaten Lima Puluh Kota</option>
              <option value="410" data-chained="29" >Kabupaten Padang Pariaman</option>
              <option value="411" data-chained="29" >Kabupaten Pasaman</option>
              <option value="412" data-chained="29" >Kabupaten Pasaman Barat</option>
              <option value="413" data-chained="29" >Kabupaten Pesisir Selatan</option>
              <option value="414" data-chained="29" >Kabupaten Sijunjung</option>
              <option value="415" data-chained="29" >Kabupaten Solok</option>
              <option value="416" data-chained="29" >Kabupaten Solok Selatan</option>
              <option value="417" data-chained="29" >Kabupaten Tanah Datar</option>
              <option value="418" data-chained="30" >Kota Lubuklinggau</option>
              <option value="419" data-chained="30" >Kota Pagar Alam</option>
              <option value="420" data-chained="30" >Kota Palembang</option>
              <option value="421" data-chained="30" >Kota Prabumulih</option>
              <option value="422" data-chained="30" >Kabupaten Banyuasin</option>
              <option value="423" data-chained="30" >Kabupaten Empat Lawang</option>
              <option value="424" data-chained="30" >Kabupaten Lahat</option>
              <option value="425" data-chained="30" >Kabupaten Muara Enim</option>
              <option value="426" data-chained="30" >Kabupaten Musi Banyuasin</option>
              <option value="427" data-chained="30" >Kabupaten Musi Rawas</option>
              <option value="428" data-chained="30" >Kabupaten Musi Rawas Utara</option>
              <option value="429" data-chained="30" >Kabupaten Ogan Ilir</option>
              <option value="430" data-chained="30" >Kabupaten Ogan Komering Ilir</option>
              <option value="431" data-chained="30" >Kabupaten Ogan Komering Ulu</option>
              <option value="432" data-chained="30" >Kabupaten Ogan Komering Ulu Selatan</option>
              <option value="433" data-chained="30" >Kabupaten Ogan Komering Ulu Timur</option>
              <option value="434" data-chained="30" >Kabupaten Penukal Abab Lematang Ilir</option>
              <option value="435" data-chained="31" >Kota Binjai</option>
              <option value="436" data-chained="31" >Kota Gunungsitoli</option>
              <option value="437" data-chained="31" >Kota Kabupaten Timor Tengah Selatan</option>
              <option value="438" data-chained="31" >Kota Padangsidempuan</option>
              <option value="439" data-chained="31" >Kota Pematangsiantar</option>
              <option value="440" data-chained="31" >Kota Sibolga</option>
              <option value="441" data-chained="31" >Kota Tanjungbalai</option>
              <option value="442" data-chained="31" >Kota Tebing Tinggi</option>
              <option value="443" data-chained="31" >Kabupaten Asahan</option>
              <option value="444" data-chained="31" >Kabupaten Batubara</option>
              <option value="445" data-chained="31" >Kabupaten Dairi</option>
              <option value="446" data-chained="31" >Kabupaten Deli Serdang</option>
              <option value="447" data-chained="31" >Kabupaten Humbang Hasundutan</option>
              <option value="448" data-chained="31" >Kabupaten Karo</option>
              <option value="449" data-chained="31" >Kabupaten Labuhanbatu</option>
              <option value="450" data-chained="31" >Kabupaten Labuhanbatu Selatan</option>
              <option value="451" data-chained="31" >Kabupaten Labuhanbatu Utara</option>
              <option value="452" data-chained="31" >Kabupaten Langkat</option>
              <option value="453" data-chained="31" >Kabupaten Mandailing Natal</option>
              <option value="454" data-chained="31" >Kabupaten Nias</option>
              <option value="455" data-chained="31" >Kabupaten Nias Barat</option>
              <option value="456" data-chained="31" >Kabupaten Nias Selatan</option>
              <option value="457" data-chained="31" >Kabupaten Nias Utara</option>
              <option value="458" data-chained="31" >Kabupaten Padang Lawas</option>
              <option value="459" data-chained="31" >Kabupaten Padang Lawas Utara</option>
              <option value="460" data-chained="31" >Kabupaten Pakpak Bharat</option>
              <option value="461" data-chained="31" >Kabupaten Samosir</option>
              <option value="462" data-chained="31" >Kabupaten Serdang Bedagai</option>
              <option value="463" data-chained="31" >Kabupaten Simalungun</option>
              <option value="464" data-chained="31" >Kabupaten Tapanuli Selatan</option>
              <option value="465" data-chained="31" >Kabupaten Tapanuli Tengah</option>
              <option value="466" data-chained="31" >Kabupaten Tapanuli Utara</option>
              <option value="467" data-chained="31" >Kabupaten Toba Samosir</option>
              <option value="468" data-chained="32" >Kota Yogyakarta</option>
              <option value="469" data-chained="32" >Kabupaten Bantul</option>
              <option value="470" data-chained="32" >Kabupaten Gunungkidul</option>
              <option value="471" data-chained="32" >Kabupaten Kulon Progo</option>
              <option value="472" data-chained="32" >Kabupaten Sleman</option>
              <option value="473" data-chained="33" >Kota Jayapura</option>
              <option value="474" data-chained="35" >Kabupaten Asmat</option>
              <option value="475" data-chained="33" >Kabupaten Biak Numfor</option>
              <option value="476" data-chained="35" >Kabupaten Boven Digoel</option>
              <option value="477" data-chained="36" >Kabupaten Deiyai</option>
              <option value="478" data-chained="36" >Kabupaten Dogiyai</option>
              <option value="479" data-chained="36" >Kabupaten Intan Jaya</option>
              <option value="480" data-chained="33" >Kabupaten Jayapura</option>
              <option value="481" data-chained="37" >Kabupaten Jayawijaya</option>
              <option value="482" data-chained="33" >Kabupaten Keerom</option>
              <option value="483" data-chained="33" >Kabupaten Kepulauan Yapen</option>
              <option value="484" data-chained="37" >Kabupaten Lanny Jaya</option>
              <option value="485" data-chained="33" >Kabupaten Mamberamo Raya</option>
              <option value="486" data-chained="37" >Kabupaten Mamberamo Tengah</option>
              <option value="487" data-chained="35" >Kabupaten Mappi</option>
              <option value="488" data-chained="35" >Kabupaten Merauke</option>
              <option value="489" data-chained="36" >Kabupaten Mimika</option>
              <option value="490" data-chained="36" >Kabupaten Nabire</option>
              <option value="491" data-chained="37" >Kabupaten Nduga</option>
              <option value="492" data-chained="36" >Kabupaten Paniai</option>
              <option value="493" data-chained="37" >Kabupaten Pegunungan Bintang</option>
              <option value="494" data-chained="36" >Kabupaten Puncak</option>
              <option value="495" data-chained="36" >Kabupaten Puncak Jaya</option>
              <option value="496" data-chained="33" >Kabupaten Sarmi</option>
              <option value="497" data-chained="33" >Kabupaten Supiori</option>
              <option value="498" data-chained="37" >Kabupaten Tolikara</option>
              <option value="499" data-chained="33" >Kabupaten Waropen</option>
              <option value="500" data-chained="37" >Kabupaten Yahukimo</option>
              <option value="501" data-chained="37" >Kabupaten Yalimo</option>
              <option value="502" data-chained="38" >Kota Sorong</option>
              <option value="503" data-chained="34" >Kabupaten Fakfak</option>
              <option value="504" data-chained="34" >Kabupaten Kaimana</option>
              <option value="505" data-chained="34" >Kabupaten Manokwari</option>
              <option value="506" data-chained="34" >Kabupaten Manokwari Selatan</option>
              <option value="507" data-chained="38" >Kabupaten Maybrat</option>
              <option value="508" data-chained="34" >Kabupaten Pegunungan Arfak</option>
              <option value="509" data-chained="38" >Kabupaten Raja Ampat</option>
              <option value="510" data-chained="38" >Kabupaten Sorong</option>
              <option value="511" data-chained="38" >Kabupaten Sorong Selatan</option>
              <option value="512" data-chained="38" >Kabupaten Tambrauw</option>
              <option value="513" data-chained="34" >Kabupaten Teluk Bintuni</option>
              <option value="514" data-chained="34" >Kabupaten Teluk Wondama</option>
            </select>
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