medlemmer_opret.php
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<?php include("
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<p> </p></td>
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<blockquote>
<table border="0" width="350" height="350" cellspacing="0" align="center">
<tr>
<td height="213" valign="top"><form action="bekraeft.php" method="post">
<div align="center">
<h3><font face="Verdana" size="1"><b><font color="#993366"><br>
</font></b></font><font color="#993366">
</font><font color="#993366" face="Verdana"><b>
Brugeroplysninger.
</b>
</font></h3>
<div align="center"><font color="#993366" size="1" face="Verdana">
<strong>Alle felter med * skal udfyldes.</strong>
</font> <br>
</div>
<table width="80%" border="1" align="center" cellpadding="0" cellspacing="0" bordercolor="#993366">
<tr>
<td valign="top"><p><font color="#993366"><strong>
Personlige oplysninger</strong></font></p>
<blockquote>
<p align="left"><font color="#993366" size="1" face="Verdana">
Fornavn:<br>
<input name="fornavn" type="text" class="but" id="fornavn">
* <br>
<br>
Efternavn<br>
<input name="efternavn" type="text" class="but" id="efternavn">
* <br>
<br>
Din adresse:<br>
<input name="adresse" type="text" class="but" id="adresse2">
*<br>
<br>
Tlf. nr. <br>
<input name="tlf" type="text" class="but" id="post_by">
* <br>
<br>
Post nr. og by<br>
<input name="post_by" type="text" class="but" id="post_by2">
*<br>
<br>
Din alder:<br>
<input name="alder" type="text" class="but" id="alder2">
*</font></p>
<p align="left"><font color="#993366" size="1" face="Verdana">
Din nuværende situation:<br>
<textarea name="situation" class="but" id="situation2"></textarea>
*<br>
<br>
Din email adresse:<br>
<input type="text" class="but" name="epost">
*<br>
<br>
</font></p>
</blockquote></td>
</tr>
</table>
<br>
<table width="80%" border="1" align="center" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" bordercolor="#993366"><p><font color="#993366"><strong>
Englebarn / Børn</strong></font></p>
<blockquote>
<p align="left"><font color="#993366" size="1" face="Verdana">
Navn på engle barn<br>
<input name="englebarn" type="text" class="but" id="englebarn2">
*<br>
<br>
Fødselsdag<br>
<input name="fodselsdag" type="text" class="but" id="mindedato2">
*<br>
<br>
Dødsdag<br>
<input name="dodsdag" type="text" class="but" id="mindedato3">
*<br>
<br>
Begravelsdag<br>
<input name="begravelsdag" type="text" class="but" id="begravelsdag">
* </font></p>
<p align="left"><font color="#993366" size="1" face="Verdana">
Detaljeret beskrivelse af dødsårsag</font><font color="#993366" size="1" face="Verdana"><br>
<textarea name="aarsag" rows="10" class="but" id="aarsag2"></textarea>
* <br>
Fortæl så meget som muligt. </font></p>
</blockquote></td>
</tr>
</table>
<br>
<table width="80%" height="244" border="1" align="center" cellpadding="0" cellspacing="0" bordercolor="#993366">
<tr>
<td valign="middle"><p><font color="#993366"><strong>
Andre oplysninger</strong></font></p>
<blockquote>
<p><font color="#993366" size="1" face="Verdana">
Navn på andre børn (lever)<br>
<textarea name="barn" class="but" id="barn"></textarea>
</font></p>
<p><font color="#993366" size="1" face="Verdana">
Besked til Admin</font><font color="#993366" size="2" face="Verdana"><br>
<textarea wrap="on" class="but" name="tekst"></textarea>
</font></p>
</blockquote></td>
</tr>
</table>
<br>
<table width="80%" border="1" align="center" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" bordercolor="#993366"><p><font color="#993366"><strong>
Brugeroplysninger</strong></font></p>
<blockquote>
<p><font color="#993366" size="1" face="Verdana">
Brugernavn:<br>
<input name="brugernavn" type="text" class="but" id="brugernavn3">
*<br>
<br>
Adgangskode:<br>
<input name="adgangskode" type="text" class="but" id="adgangskode3">
*<br>
</font></p>
</blockquote></td>
</tr>
</table>
</div>
<blockquote>
<div align="left"><font color="#993366" size="2" face="Verdana">
<INPUT type="hidden" name="recipient" value="info@barnlille.dk">
<INPUT name="send" type="submit" id="send" value="Send">
</font><font color="#993366" size="1" face="Verdana">
</font> </div>
</blockquote>
</form>
<p><font color="#993366">Det brugernavn og adgangskode som
du vælger her bruges til vores forum.<br>
Dine personlige oplysninger, videregives ikke.
</font><font color="#993366"><br>
Dine personlige oplysninger, vil blive kontrolleret på
Krak.dk.</font></p>
<p><font color="#993366">Brugernavnet må kun bruges af den
person, som der søger. </font></p></td>
</tr>
</table>
</blockquote></td>
</tr>
<tr>
<td colspan="4" align="left" valign="top"><img src="/images/diverse/bund1.jpg" width="805" height="26"></td>
</tr>
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</tr>
</table>
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