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        // Automatische Ort-Suche anhand PLZ
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<title>Online-Anmeldung</title>
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<body onload="document.body.scrollIntoView(true);">

    <div style="text-align: center;">
        <center>
            <table class="ba_extbox">
                <tr class="ba_extnavi">
                    <td><a href=kurse.php?kurstyp=10574&ov=rvnw&sids=btj4155cjo3aeagq2clbenqqggm35g0b onClick='window.close(); return false;' class='zurueck'>&lt;- zur&uuml;ck</a></td>
                </tr>

                <tr>
                    <td style="height: 19px;">
                        <h2>
                            <span id="tnmeld_ueberschrift">Online-Anmeldung</span><br />
                        </h2>
                    </td>
                                    </tr>

                <tr>
                    <td colspan="2" height="123" align="left" id="tnmeld_td_um_tab_oben">
                        Sie haben folgenden Kurs gew&auml;hlt:<br><br>
                        <table border="1" id="tnmeld_tab_oben">
                            <tr>
                                <th>Typ:</th>
                                <td>Erste Hilfe Grundlehrgang Abendkurs</td>
                            </tr>

                            <tr>
                                <th>Veranstalter:</th>
                                <td>Arbeiter-Samariter-Bund Regionalverband Berlin-Nordwest e.V.</td>
                            </tr>

                            <tr>
                                <th>Ort:</th>
                                                                        <td>Mitte (Wedding), Seestra&szlig;e 121, EG, 13353 Berlin&nbsp;&nbsp;&nbsp;<span id="karten_link_tnmeldung"><a href="#" onclick="window.open('https://www.hiorg-server.de/geokarte.php?vortid=383685&amp;veranstid=3940953&amp;ov=rvnw&amp;sids=btj4155cjo3aeagq2clbenqqggm35g0b','detailwin_karte','width=750,height=640,resizable=yes,scrollbars=yes,menubar=yes,location=no,toolbar=no'); return false;" target='detailwin_karte'><img src='https://www.hiorg-server.de/static/content/pics/icon/glyphicons-503-map_schwarz.png' border='0' title='Kartenansicht' height='16px' alt=''></a></span>&nbsp;</td>
                                                            </tr>

                            <tr>
                                <th style='vertical-align: top;'>Termin(e):</th>
                                <td>Mo, 16.10.2017, 17:00 - 21:30 Uhr<br />Di, 17.10.2017, 17:00 - 21:30 Uhr<br /></td>
                            </tr>

                            
                            
                                                            <tr>
                                    <th>Teilnahmegeb&uuml;hren:</th>
                                    <td>
                                                                                                                                                                                                                        normaler Teilnehmer:
                                                30,00 Euro                                                                                                                        </td>
                                </tr>
                                                            <tr>
                                    <th>Hinweise:</th>
                                    <td></td>
                                </tr>
                        </table>
                    </td>
                </tr>
                
                <tr>
                    <td colspan="2" style="text-align: center; height: 123px;"><br>
                                                    <hr>
                            Hiermit melde ich mich verbindlich zu o.g. Kurs an.<br>
                            <h2>Meine Daten:</h2>
                            <form action="tnmeldung.php?ov=rvnw&amp;sids=btj4155cjo3aeagq2clbenqqggm35g0b" method="POST" name="anmeld">
                                <input type="hidden" name="id" value="3940953">
                                <input type="hidden" name="backclose" value="1">
                                <table border="1" id="tnmeld_tab_unten">
                                    <tr>
                                        <th>Anrede:</th>
                                        <td style="text-align: left;">
                                            <select name="anrede">
                                                <option></option>
                                                <option  >Herr</option>
                                                <option >Frau</option>
                                            </select>
                                        </td>
                                    </tr>

                                    <tr>
                                        <th>Vorname:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="vorname" size="30" maxlength="64" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                    <tr>
                                        <th>Name:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="name" size="30" maxlength="64" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                    <tr>
                                        <th>Geburtsdatum:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="gebdat" id="gebdat" size="10" maxlength="10" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                    <tr>
                                        <th>Anschrift:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="strasse" size="30" maxlength="64" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                    <tr>
                                        <th>PLZ Ort:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="plz" size="5" maxlength="5" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                            <input type="text" name="ort" size="30" maxlength="64" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                    <tr>
                                        <th>Telefon:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="telefon" size="20" maxlength="32" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                    <tr>
                                        <th>E-Mail:</th>
                                        <td style="text-align: left;">
                                            <input type="text" name="email" size="30" maxlength="64" value="">
                                            <span style="vertical-align: super; font-size: smaller;" title="Pflichtfeld">*</span>                                        </td>
                                    </tr>

                                                                                                                        <tr>
                                                <td style="text-align: right; vertical-align: top;">
                                                    <input type="checkbox" name="bg" value="checked"  onclick="document.getElementById('div_bem').style.display='';">
                                                </td>
                                                <td>
                                                    Ich nehme im Auftrag meines Arbeitgebers am Kurs teil.<br>
                                                    <small>(In diesem Fall wird i.d.R. die Geb&uuml;hr von der BG &uuml;bernommen)</small> <br>
                                                    <div id="div_bem">
                                                        Bitte <b>Firmenname und Anschrift</b> angeben:<br>
                                                        <textarea name="bemerk" cols="40" rows="3"></textarea>
                                                    </div>
                                                                                                            <script type="text/javascript">
                                                            document.getElementById('div_bem').style.display='none';
                                                        </script>
                                                                                                    </td>
                                            </tr>
                                        
                                                                                    <tr>
                                                <th>Geb&uuml;hr:</th>
                                                <td style="text-align: left;">
                                                    <select name="gebuehr_id">
                                                                                                                    <option value="2636" >
                                                                normaler Teilnehmer:
                                                                30,00                                                                Euro                                                            </option>
                                                                                                            </select>
                                                </td>
                                            </tr>
                                        
                                                                                    <tr>
                                                <th>Bemerkung:</th>
                                                <td style="text-align: left;">
                                                    <textarea name="bemerk2" cols="40" rows="2"></textarea>
                                                </td>
                                            </tr>
                                        
                                                                                    <tr>
                                                <td style="text-align: right; vertical-align: top;">
                                                    <input type="checkbox" name="agbok" value="checked" />
                                                </td>
                                                <td>
                                                    Mit meiner Anmeldung erkenne ich die
                                                    <a href="kursshowagb.php?ov=rvnw&amp;sids=btj4155cjo3aeagq2clbenqqggm35g0b" target="_blank">
                                                        Allgemeinen Gesch&auml;ftsbedingungen (AGB)
                                                    </a>
                                                    des Arbeiter-Samariter-Bund Regionalverband Berlin-Nordwest e.V. an.
                                                </td>
                                            </tr>
                                        
                                        <tr>
                                            <td style="text-align: right; vertical-align: top;">
                                                <input type="checkbox" name="datenschutz" value="checked" />
                                            </td>
                                            <td>
                                                Ich bin damit einverstanden, dass meine Daten zur Planung und Durchf&uuml;hrung des Kurses gespeichert werden.
                                            </td>
                                        </tr>

                                        <tr>
                                            <td colspan="2" style="text-align: center;">
                                                <input type="submit" name="submit" value="Anmeldung speichern">
                                            </td>
                                        </tr>
                                                                    </table>
                            </form>
                    </td>
                </tr>

                <tr class="ba_extnavi">
                    <td>
                        <div style="font-size: smaller; margin-bottom: 5px;">* Pflichtfeld</div>
                        <a href=kurse.php?kurstyp=10574&ov=rvnw&sids=btj4155cjo3aeagq2clbenqqggm35g0b onClick='window.close(); return false;' class='zurueck'>&lt;- zur&uuml;ck</a>                    </td>
                    <td style="text-align: right;">powered by <a href="http://info.hiorg-server.de" target="_blank">HiOrg-Server</a></td>
                </tr>
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