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<head>
<meta http-equiv="Content-Language" content="de">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Registrierung</title>
</head>
<body>
<form action="http://www.ekiwi.de/tools/kontaktformular/formmail.php" method="POST" name="MyForm1">
<input type="hidden" name="redirect" value="http://www.ekiwi.de/tools/kontaktformular/danke.htm">
<input type="hidden" name="typemail" value="html">
<input type="hidden" name="crypt" value="0">
<input type="hidden" name="einleittext" value="">
<input type="hidden" name="admin1" value="">
<input type="hidden" name="admin2" value="">
<input type="hidden" name="subject" value="Registration"><input type="hidden" name="admin" value="achimopel@gmx.de"> <div align="center">
<table border="0" cellpadding="3" cellspacing="2">
<tr>
<td colspan="2"><font face="Arial,helvetica" size="+1">Formular<br>
</font></td>
</tr>
<tr>
<td colspan="2"><font face="Arial,helvetica" size="-1"><br>
</font></td>
</tr>
<tr>
<tr>
<td><strong>Company:</strong></td>
<td><input type="text" size="20" name="Firma" /></td>
</tr>
<tr>
<td><strong>Anrede:</strong></td>
<td> <select name="anrede">
<option value="Herr" selected="selected">Herr</option>
<option value="Frau">Frau</option>
</select> </td>
</tr>
<tr>
<td><strong>Vorname:</strong></td>
<td><input type="text" size="20" name="Vorname" /></td>
</tr>
<tr>
<td><strong>Nachname:</strong></td>
<td><input type="text" size="20" name="Nachname" /></td>
</tr>
<tr>
<td><strong>Anschrift:</strong></td>
<td><input type="text" size="20" name="Strasse" /></td>
</tr>
<tr>
<td><strong>Postleitzahl Ort:</strong></td>
<td><select name="land">
<option value="D" selected="selected">Deutschland</option>
<option value="A">Österreich</option>
<option value="CH">Schweiz</option>
<option value=" "></option>
<option value="FR">France</option>
<option value="IT">Italy</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Cote D'Ivoire (Ivory Coast)</option>
<option value="HR">Croatia (Hrvatska)</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="CS">Czechoslovakia (former)</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="TP">East Timor</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FX">France, Metropolitan</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GB">Great Britain (UK)</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard and McDonald Islands</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IL">Israel</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea (North)</option>
<option value="KR">Korea (South)</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macau</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</option>
<option value="MD">Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NT">Neutral Zone</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand (Aotearoa)</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="GS">S. Georgia and S. Sandwich Isls.</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovak Republic</option>
<option value="SI">Slovenia</option>
<option value="Sb">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SH">St. Helena</option>
<option value="PM">St. Pierre and Miquelon</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen Islands</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="SY">Syria</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UM">US Minor Outlying Islands</option>
<option value="SU">USSR (former)</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="UK">United Kingdom</option>
<option value="US">United States</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican City State (Holy See)</option>
<option value="VE">Venezuela</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands (British)</option>
<option value="VI">Virgin Islands (U.S.)</option>
<option value="WF">Wallis and Futuna Islands</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="YU">Yugoslavia</option>
<option value="ZR">Zaire</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
<option value="XX">sonstige</option>
</select> - <input type="text" size="6" name="plz" /> <input type="text" size="15" name="Ort" /></td>
</tr>
<tr>
<td><strong>e-Mail:</strong></td>
<td><input type="text" size="20" name="E-mail" /></td>
</tr>
<tr>
<td><strong>Telefon:</strong></td>
<td> + <input type="text" size="4" value="49" name="Telefon:" /> (<input type="text" size="6" value="0" name="vorwahl" />) <input type="text" size="15" name="telefon" /></td>
</tr>
<tr>
<td><strong>Sprache:</strong></td>
<td> <select name="sprache">
<option value="deutsch" selected="selected">deutsch</option>
<option value="englisch">englisch</option>
</select> </td>
</tr>
<tr>
<td><strong>Formular created by</strong></td>
<td><font color="#0000ff"><strong>Achim Jakowitz</strong></font></td>
</tr>
<tr>
<td colspan="2"><font size="2"><strong>Die </strong></font><a target="_blank" href="http://www.51.moneypay-europe.com/agb.php?lg=de&n=43915"><font size="2"><strong>AGB</strong></font></a><font size="2"><strong> habe ich gelesen und verstanden </strong></font> <input type="checkbox" name="agb" /> </td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="2"><input type="submit" value="Anmelden" name="anmelden" /></td>
</tr>
<tr>
</table>
</div>
</form>
</body>
</html>
