<table><br><br>
<form action="baseportal.pl?Id=196&namerein=Dummilein&sid=101042840&htx=/verwitwet/user/register&cmd=add" method="post" enctype="multipart/form-data">
<input type=hidden name="Id=" value="196">
<input type=hidden name="namerein=" value="Dummilein">
<input type=hidden name="sid=" value="101042840">
<input type=hidden name="Nr:=" value="197">
<input type=hidden name="registriert:=" value="28.05.01">
<input type=hidden name="htx=" value="/verwitwet/user/register">
<input type=hidden name="cmd=" value="mod">
<table>
<tr>
<td align=right><p class="text"><font color=000000>Nr.:</font></p></td>
<td>197</td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>registriert am:</font></p></td>
<td>28.05.01</td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Nickname:</font></p></td>
<td><input type="text" name="Nickname:=" size=20 value="Dummilein" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Geschlecht:</font></p></td>
<td><select name="Geschlecht:=">
<option>weiblich
<option>männlich</option> <size=20 value="weiblich" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></select></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Geburtsjahr:</font></p></td>
<td><input type="text" name="Geburtsjahr:=" size=20 value="1964" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Name:</font></p></td>
<td><input type="text" name="Name:=" size=20 value="Dummi" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Vorname:</font></p></td>
<td><input type="text" name="Vorname:=" size=20 value="dddd" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Strasse:</font></p></td>
<td><input type="text" name="Strasse:=" size=20 value="asdkfj" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>PLZ:</font></p></td>
<td><input type="text" name="PLZ:=" size=5 value="12345" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Ort:</font></p></td>
<td><input type="text" name="Ort:=" size=20 value="askldfj" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Staat:</font></p></td>
<td><input type="text" name="Staat:=" size=20 value="aslödkfj" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Bundesland/Kanton:</font></p></td>
<td><input type="text" name="Bundesland:=" size=20 value="asldkfj" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>EMail:</font></p></td>
<td><input type="text" name="EMail:=" size=30 value="sldkfj@sdkfj.de" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Telefon:</font></p></td>
<td><input type="text" name="Telefon:=" size=20 value="1111111" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Handy:</font></p></td>
<td><input type="text" name="Handy:=" size=20 value="2222222" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Fax:</font></p></td>
<td><input type="text" name="FAX:=" size=20 value="3333333" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>verwitwet seit:</font></p></td>
<td><input type="text" name="verwitwet_seit:=" size=30 value="03.01.01" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Kinderzahl:</font></p></td>
<td><input type="text" name="Kinderzahl:=" size=30 value="1" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr>
<td align=right><p class="text"><font color=000000>Gebj. Kinder:</font></p></td>
<td><input type="text" name="Gebj_Kinder:=" size=30 value="1999" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"></td>
</tr>
<tr><td align=right valign=top><p class="text"><font color=000000>Anmerkungen:</font></p></td>
<td><textarea name="Anmerkungen:=" cols=50 rows=9 wrap=virtual style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;SCROLLBAR-FACE-COLOR: #404040;SCROLLBAR-HIGHLIGHT-COLOR: #404040; SCROLLBAR-SHADOW-COLOR: #303030; SCROLLBAR-3DLIGHT-COLOR: #000000; SCROLLBAR-ARROW-COLOR: #FFFFFF; SCROLLBAR-TRACK-COLOR: #404040; SCROLLBAR-DARKSHADOW-COLOR: #000000;">asdlkfjl</textarea></td>
</tr>
<tr>
<td></td>
<td nowrap><br><br><input type=submit value="Abschicken" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"> <input type=reset value="Zurücksetzen" style="border-color:#303030; background-color:#202020; color:#FFFFFF; font-family:arial, helvetica; font-size:12px; font-weight:bold;"> </td>
</tr>
</table>
</form>