<html>
<head><style>
.smsclub,select {
background: Black;
font: font-family: Verdana, Arial, Helvetica, sans-serif;
font-size: 15px;
color: #FF9900;
border: 1px solid #626262;
}
</style>
<meta name="GENERATOR" content="Microsoft FrontPage 5.0">
<meta name="ProgId" content="FrontPage.Editor.Document">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Tilmelding</title>
</head>
<body bgcolor="#000000" text="#FF9900">
<script language="javascript">
function validate() {
if ((""+document.TilmeldForm.Fornavn.value).replace(/ /g, "") == "") {
alert ("Venligst indtast dit fornavn.");
return (false);
}
else if ((""+document.TilmeldForm.Efternavn.value).replace(/ /g, "") == "") {
alert ("Venligst indtast dit efternavn.");
return (false);
}
else if ((""+document.TilmeldForm.email.value).replace(/ /g, "") == "") {
alert ("Venligst indtast en gyldig emailadresse.");
return (false);
}
else if ((""+document.TilmeldForm.Mobil.value).replace(/ /g, "") == "") {
alert ("Venligst indtast et gyldig mobilnummer.");
return (false);
}
else {
return (true);
}
}
</script>
<h2>Tilmelding</h2>
<table cellpadding="10" cellspacing="0" border="0" class="FormTilmelding">
<tr valign="middle"><td>
<form method="post" name="TilmeldForm" onsubmit="return(validate())" action="
http://cgi.web10.dk/cgi-bin/formmail/FormMail.pl"><input type=hidden name="print_config" value="email">
<input type=hidden name="recipient" value="Henrik@x-party.dk">
<input type=hidden name="subject" value="SMSclub">
<input type=hidden name="env_report" value="REMOTE_HOST,REMOTE_ADDR,
REMOTE_USER,REMOTE_IDENT,HTTP_USER_AGENT">
<input type=hidden name="redirect" value="
http://x-party.dk"> <table cellpadding="0" cellspacing="0" border="0">
<tr valign="middle">
<td></td>
<td>Fornavn: </td>
<td><input type="text" class="smsclub" name="Fornavn" size="30" maxlength="40"></td>
</tr>
<tr valign="middle">
<td></td>
<td>Efternavn: </td>
<td><input type="text" class="smsclub" name="Efternavn" size="30" maxlength="50"></td>
</tr>
<tr valign="middle">
<td></td>
<td>Email: </td>
<td><input type="text" class="smsclub" name="email" size="30" maxlength="80"></td>
</tr>
<tr valign="middle">
<td></td>
<td>Mobiltelefon: </td>
<td><input type="text" class="smsclub" name="Mobil" size="30" maxlength="8"></td>
</tr>
<tr valign="middle">
<td></td>
<td>Postnummer: </td>
<td><input type="text" class="smsclub" name="Postnummer" size="4" maxlength="4"></td>
</tr>
<tr valign="middle">
<td></td>
<td>Landsdel: </td>
<td><select class="smsclub" name="Region">
<option class="smsclub" value="Vestjylland">Vestjylland<br><option class="smsclub" value="Sønderjylland">Sønderjylland<br><option class="smsclub" value="Midtjylland">Midtjylland<br><option class="smsclub" value="Nordvestjylland">Nordvestjylland<br><option class="smsclub" value="Østjylland">Østjylland<br><option class="smsclub" value="Nordjylland">Nordjylland<br><option class="smsclub" value="Fyn">Fyn<br><option value="Vestsjælland">Vestsjælland<br><option class="smsclub" value="Sydsjælland">Sydsjælland<br><option class="smsclub" value="Nordvestjylland">Nordvestjylland<br><option class="smsclub" value="Nordsjælland">Nordsjælland<br><option class="smsclub" value="København">København<br><option class="smsclub" value="Bornholm">Bornholm<br><option class="smsclub" value="Andet">Andet<br></select></td></tr>
<tr valign="middle">
<td></td>
<td>Fødselsdag: </td>
<td><table cellpadding="0" cellspacing="0" border="0">
<tr valign="middle">
<td><input type="text" class="smsclub" name="Dag" size="2" maxlength="2" value=""></td>
<td><select class="smsclub" name="Måned">
<option class="smsclub" value="1">Januar
<option class="smsclub" value="2">Februar
<option class="smsclub" value="3">Marts
<option class="smsclub" value="4">April
<option class="smsclub" value="5">Maj
<option class="smsclub" value="6">Juni
<option class="smsclub" value="7">Juli
<option class="smsclub" value="8">August
<option class="smsclub" value="9">September
<option class="smsclub" value="10">Oktober
<option class="smsclub" value="11">November
<option class="smsclub" value="12">December
</select></td>
<td><select name="År">
<br>
<option class="smsclub" value="1900">1900 <br>
<option class="smsclub" value="1901">1901 <br>
<option class="smsclub" value="1902">1902 <br>
<option class="smsclub" value="1903">1903 <br>
<option class="smsclub" value="1904">1904 <br>
<option class="smsclub" value="1905">1905 <br>
<option class="smsclub" value="1906">1906 <br>
<option class="smsclub" value="1907">1907 <br>
<option class="smsclub" value="1908">1908 <br>
<option class="smsclub" value="1909">1909 <br>
<option class="smsclub" value="1910">1910 <br>
<option class="smsclub" value="1911">1911 <br>
<option class="smsclub" value="1912">1912 <br>
<option class="smsclub" value="1913">1913 <br>
<option class="smsclub" value="1914">1914 <br>
<option class="smsclub" value="1915">1915 <br>
<option class="smsclub" value="1916">1916 <br>
<option class="smsclub" value="1917">1917 <br>
<option class="smsclub" value="1918">1918 <br>
<option class="smsclub" value="1919">1919 <br>
<option class="smsclub" value="1920">1920 <br>
<option class="smsclub" value="1921">1921 <br>
<option class="smsclub" value="1922">1922 <br>
<option class="smsclub" value="1923">1923 <br>
<option class="smsclub" value="1924">1924 <br>
<option class="smsclub" value="1925">1925 <br>
<option class="smsclub" value="1926">1926 <br>
<option class="smsclub" value="1927">1927 <br>
<option class="smsclub" value="1928">1928 <br>
<option class="smsclub" value="1929">1929 <br>
<option class="smsclub" value="1930">1930 <br>
<option class="smsclub" value="1931">1931 <br>
<option class="smsclub" value="1932">1932 <br>
<option class="smsclub" value="1933">1933 <br>
<option class="smsclub" value="1934">1934 <br>
<option class="smsclub" value="1935">1935 <br>
<option class="smsclub" value="1936">1936 <br>
<option class="smsclub" value="1937">1937 <br>
<option class="smsclub" value="1938">1938 <br>
<option class="smsclub" value="1939">1939 <br>
<option class="smsclub" value="1940">1940 <br>
<option class="smsclub" value="1941">1941 <br>
<option class="smsclub" value="1942">1942 <br>
<option class="smsclub" value="1943">1943 <br>
<option class="smsclub" value="1944">1944 <br>
<option class="smsclub" value="1945">1945 <br>
<option class="smsclub" value="1946">1946 <br>
<option class="smsclub" value="1947">1947 <br>
<option class="smsclub" value="1948">1948 <br>
<option class="smsclub" value="1949">1949 <br>
<option class="smsclub" value="1950">1950 <br>
<option class="smsclub" value="1951">1951 <br>
<option class="smsclub" value="1952">1952 <br>
<option class="smsclub" value="1953">1953 <br>
<option class="smsclub" value="1954">1954 <br>
<option class="smsclub" value="1955">1955 <br>
<option class="smsclub" value="1956">1956 <br>
<option class="smsclub" value="1957">1957 <br>
<option class="smsclub" value="1958">1958 <br>
<option class="smsclub" value="1959">1959 <br>
<option class="smsclub" value="1960">1960 <br>
<option class="smsclub" value="1961">1961 <br>
<option class="smsclub" value="1962">1962 <br>
<option class="smsclub" value="1963">1963 <br>
<option class="smsclub" value="1964">1964 <br>
<option class="smsclub" value="1965">1965 <br>
<option class="smsclub" value="1966">1966 <br>
<option class="smsclub" value="1967">1967 <br>
<option class="smsclub" value="1968">1968 <br>
<option class="smsclub" value="1969">1969 <br>
<option class="smsclub" value="1970">1970 <br>
<option class="smsclub" value="1971">1971 <br>
<option class="smsclub" value="1972">1972 <br>
<option class="smsclub" value="1973">1973 <br>
<option class="smsclub" value="1974">1974 <br>
<option class="smsclub" value="1975">1975 <br>
<option class="smsclub" value="1976">1976 <br>
<option class="smsclub" value="1977">1977 <br>
<option class="smsclub" value="1978">1978 <br>
<option class="smsclub" value="1979">1979 <br>
<option class="smsclub" value="1980" selected>1980 <br>
<option class="smsclub" value="1981">1981 <br>
<option class="smsclub" value="1982">1982 <br>
<option class="smsclub" value="1983">1983 <br>
<option class="smsclub" value="1984">1984 <br>
<option class="smsclub" value="1985">1985 <br>
<option class="smsclub" value="1986">1986 <br>
<option class="smsclub" value="1987">1987 <br>
<option class="smsclub" value="1988">1988 <br>
<option class="smsclub" value="1989">1989 <br>
<option class="smsclub" value="1990">1990 <br>
<option class="smsclub" value="1991">1991 <br>
<option class="smsclub" value="1992">1992 <br>
<option class="smsclub" value="1993">1993 <br>
<option class="smsclub" value="1994">1994 <br>
<option class="smsclub" value="1995">1995 <br>
<option class="smsclub" value="1996">1996 <br>
<option class="smsclub" value="1997">1997 <br>
<option class="smsclub" value="1998">1998 <br>
<option class="smsclub" value="1999">1999 <br>
<option class="smsclub" value="2000">2000 <br>
<option class="smsclub" value="2001">2001 <br>
<option class="smsclub" value="2002">2002 <br></select></td>
</tr>
</table>
</td>
</tr>
<tr valign="middle">
<td></td>
<td>Køn: </td>
<td><select name="Køn">
<option class="smsclub" value="Mand">Mand
<option class="smsclub" value="Kvinde">Kvinde
</select></td>
</tr>
<tr valign="middle">
<td></td>
<td></td>
<td><br><input type="submit" value=" Send tilmelding " class="Submit" style="border:1px solid #626262;background:black;color:#f90;"></td>
</tr>
</form>
</td></tr></table>
</body>
</html>
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