62 lines
1.3 KiB
PHP
62 lines
1.3 KiB
PHP
<table>
|
|
<tr>
|
|
<td>Vorname:</td>
|
|
<td><input type="text" name="vorname" id="vorname" /></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td>Nachname:</td>
|
|
<td><input type="text" name="nachname" id="nachname" /></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td>Pfadi-Name:</td>
|
|
<td><input type="text" name="pfadiname" id="pfadiname" /></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td>Stamm / ABG:</td>
|
|
<td>
|
|
<select name="stamm" required placeholder="Bitte wählen">
|
|
{{beteiligte_gruppen}}
|
|
</select>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td>Geburtsdatum:</td>
|
|
<td><input type="date" name="geburtsdatum" id="geburtsdatum" /></td>
|
|
</tr>
|
|
|
|
|
|
<tr>
|
|
<td>
|
|
Straße, Hausnummer
|
|
</td>
|
|
<td>
|
|
<input type="text" name="strasse" id="strasse" style="width: 285px;" />
|
|
<input type="text" name="hausnummer" id="hausnummer" style="width: 50px;" />
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td>
|
|
PLZ, Wohnort
|
|
</td>
|
|
<td>
|
|
<input type="text" name="plz" id="plz" style="width: 80px;" />
|
|
<input type="text" name="ort" id="ort" style="width: 255px;" />
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td>Telefon:</td>
|
|
<td><input type="text" name="telefon_1" id="telefon_1" /></td>
|
|
</tr>
|
|
<tr>
|
|
<td>E-Mail:</td>
|
|
<td><input type="text" name="email_1" id="email_1" /></td>
|
|
</tr>
|
|
</table>
|
|
|
|
<input type="button" value="Weiter" onclick="checkAddress();" /> |