Wasserlauf NRW - Stiftung für Gewässerschutz und Wanderfische

<td>
<table border="0" width="100%" cellspacing="0" cellpadding="0" height="100%">
							<tr>
								<td width="9%" height="19"> </td>
								<td width="91%" height="19" colspan="2"> </td>
							</tr>
							<tr>
								<td width="9%"> </td>
								<td class="text" width="90%" align="left" valign="top">
                 <img src="images/seiten/patenschaft_head.jpg" >
                 <br><br>
                  Füllen Sie das Formular aus.
                  <br><br>
                                     <table class="text">

<tr>
                                     <td>
                                     Surname:
                                     </td>
                                     <td>
                                     <input type="text" name="Name" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     First name(s):
                                     </td>
                                     <td>
                                     <input type="text" name="Vorname" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     Organisation:
                                     </td>
                                     <td>
                                     <input type="text" name="Firma" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     Street/house number:
                                     </td>
                                     <td>
                                     <input type="text" name="Straße" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     Postcode/zip:
                                     </td>
                                     <td>
                                     <input type="text" name="PLZ" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     Telephone:
                                     </td>
                                     <td>
                                     <input type="text" name="Telefon" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     e-mail:
                                     </td>
                                     <td>
                                     <input type="text" name="Email" size="40">
                                     </td>
                                     </tr>
                                     
                                     <tr>
                                     <td>
                                     Mention by name on website:
                                     </td>
                                     <td>
                                     <input type="checkbox" name="nennung" value="1">
                                     </td>
                                     </tr>

<tr>
                                     <td colspan="2">
                                     <b>Method of payment</b>
                                     </td>
                                     </tr>
                                     
                                     <tr>
                                     <td>Direct debit</td>
                                     <td><input type="radio" name="zahlung" value="2" onCLick="bank()" checked></td>
                                     </tr>

<tr>
                                     <td>Bank transfer</td>
                                     <td><input type="radio" name="zahlung" value="1" ></td>
                                     </tr>
                                     
                                     <tr>
                                     <td colspan="2"><br></td>
                                     </tr>

<tr>
                                     <td>
                                     Account holder:
                                     </td>
                                     <td>
                                     <input type="text" name="Kontoinhaber" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     Account number:
                                     </td>
                                     <td>
                                     <input type="text" name="Kontonummer" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td>
                                     Bank details:
                                     </td>
                                     <td>
                                     <input type="text" name="Bank" size="40">
                                     </td>
                                     </tr>

<tr>
                                     <td colspan="2">    <br>
                                    Salmon hatchling sponsorship <input type="checkbox" name="lachspatenschaft" value="1">   <br>
                                    Smolt sponsorship   <input type="checkbox" name="smoltpatenschaft" value="1">
                                     
                                     </td>
                                     </tr>
                                     
                                     
                                     
                                     <tr>
                                     <td colspan="2">
                                     <input type="submit" value="Send">
                                     </td>
                                     </tr>

</form>
                                     </table>
                                     <br><br><br><br>

</td>
                                <td class="text" width="17%" align="left" valign="top">
                                </td>
</table>

</td>