| Nachname* |
input type="text" size="30" name="name" maxlength="30"> |
| Vorname |
input type="text" size="30" name="name" maxlength="20"> |
| Handy |
input type="text" size="30" name="name" maxlength="30"> |
| E-Mail |
input type="text" size="30" name="name" maxlength="50"> |
| Telefon |
input type="text" size="30" name="name" maxlength="20"> |
|
input type="submit" name="submitter" value="Daten eintragen"> |