66 lines
1.5 KiB
PHP
66 lines
1.5 KiB
PHP
<table>
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<tr>
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<td>Vorname:</td>
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<td><input type="text" name="vorname" id="vorname" /></td>
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</tr>
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<tr>
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<td>Nachname:</td>
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<td><input type="text" name="nachname" id="nachname" /></td>
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</tr>
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<tr>
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<td>Pfadi-Name:</td>
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<td><input type="text" name="pfadiname" id="pfadiname" /></td>
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</tr>
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<tr>
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<td>Stamm / ABG:</td>
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<td>
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<select name="stamm" required placeholder="Bitte wählen">
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<option value="ANC">Ancalagon</option>
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<option value="BAN">Bankiva</option>
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<option value="FEU">Feuerland</option>
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<option value="LEO">LEO</option>
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<option value="WM">Wilde Möhre</option>
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</select>
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</td>
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</tr>
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<tr>
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<td>Geburtsdatum:</td>
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<td><input type="date" name="geburtsdatum" id="geburtsdatum" /></td>
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</tr>
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<tr>
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<td>
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Straße, Hausnummer
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</td>
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<td>
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<input type="text" name="strasse" id="strasse" style="width: 285px;" />
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<input type="text" name="hausnummer" id="hausnummer" style="width: 50px;" />
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</td>
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</tr>
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<tr>
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<td>
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PLZ, Wohnort
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</td>
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<td>
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<input type="text" name="plz" id="plz" style="width: 80px;" />
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<input type="text" name="ort" id="ort" style="width: 255px;" />
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</td>
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</tr>
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<tr>
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<td>Telefon:</td>
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<td><input type="text" name="telefon_1" id="telefon_1" /></td>
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</tr>
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<tr>
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<td>E-Mail:</td>
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<td><input type="text" name="email_1" id="email_1" /></td>
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</tr>
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</table>
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<input type="button" value="Weiter" onclick="checkAddress();" /> |