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<!doctype html>
<html  lang="de">
<head>
		<meta charset="utf-8">
	<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=yes">
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				imageBtnPrev: 'http://baumzeit.info//lib/sdht-jqlightbox/images/prev.gif',
				imageBtnNext: 'http://baumzeit.info//lib/sdht-jqlightbox/images/next.gif',
				containerResizeSpeed: 850,
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			});
			// TinyNav.js 2
			$('#mobNav').tinyNav({
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' // Writing any title with this option triggers the header
			});
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	<h1 style="text-align:center;">Kurs Anmeldung</h1> 
	<form name="anmelde_form" class="anmelde_form" method="post" accept-charset="utf-8" action="akademie-anmelden.html?id=2d5q733fgmb157j5qr9mdgolpi">
			<table class="form_table">
				<tr><th>Kurs</th><td>
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</td></tr>
				<tr><th>Datum</th><td>
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</td></tr>
				<tr><th>Ort</th><td><a href="http://maps.google.de?q=
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" title="zu Google maps">
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</a></td></tr>
				<tr><th>Details</th><td>
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</td></tr>
				<tr><th>Kurspreis</th><td>
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</td></tr>
								<tr>
					<td>Firma / Institution:</td>
					<td><input id="firma" name="firma" type="text" value="">
				</td>
				</tr>
				<tr>
					<td>Anrede*:</td>
					<td><select name="sex" required>
								<option value="1" >Frau</option>
								<option value="2" >Herr</option>
								<option value="3" >Divers</option>	
							</select></td>
				</tr>
				<tr>
					<td>Vorname*:</td>
					<td><input name="vname" type="text" value="" ></td>
				</tr>
				<tr>
					<td>Nachname*:</td>
					<td><input name="nname" type="text" value="" required></td>
				</tr>
								<tr>
					<td>Strasse & Nr*:</td>
					<td><input name="str" type="text" value="" required></td>
				</tr>
				<tr>
					<td>PLZ* </td>
					<td><input name="plz" type="text" value="" required></td>
				</tr>
				<tr>
					<td>Ort*</td>
					<td><input id="ort" name="ort" type="text" value="" required></td>
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					<td><input name="rgadr" id="rgadr" type="checkbox" value="1" checked onclick="toggle()"> ist abweichend von den Kundendaten
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							<tr>
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								<td><input name="rgfirma" type="text" value=""></td>
							</tr>
							<tr>
								<td>Anrede*:</td>
								<td><select name="rgsex" required>
											<option value="1" >Frau</option>
											<option value="2" >Herr</option>
											<option value="3" >Divers</option>	
										</select></td>
							</tr>
							<tr>
								<td>Vorname*:</td>
								<td><input name="rgvname" type="text" value=""></td>
							</tr>
							<tr>
								<td>Nachname*:</td>
								<td><input name="rgnname" type="text" value="" ></td>
							</tr>
							<tr>
								<td>Strasse & Nr*:</td>
								<td><input name="rgstr" type="text" value=""></td>
							</tr>
							<tr>
								<td>PLZ* </td>
								<td><input name="rgplz" type="text" value=""></td>
							</tr>
							<tr>
								<td>Ort* </td>
								<td><input name="rgort" type="text" value=""> </td>
							</tr>
						</table>
					</td>
				</tr>
				<tr>
					<td>Telefon*:</td>
					<td><input id="tel" name="tel" type="text" value="" required></td>
				</tr>
				<tr>
					<td>E-Mail*:</td>
					<td><input id="email" name="email" type="text" value="" required></td>
				</tr>
				<tr>
					<td>Bemerkungen:</td>
					<td><textarea name="note" rows="5" style="width:100%" ></textarea></td>
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				<tr>
					<td>&nbsp;</td>
					<td><input name="agb" type="checkbox" value="agb"  required> Ich akzeptiere die <a href="http://baumzeit.info/akademie-buchungsbedingungen.html" title="BaumZeit Akademie Buchungsbedingungen">Buchungsbedingungen</a>*.
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				<tr><td colspan="2"><hr /></td></tr>
				<tr>
					<td>&nbsp;</td>
					<td class="rechts"><input type="submit"  class="button"  name="submit" value="&raquo; anmelden"/></td>
				</tr>
				<tr>
					<td class="rechts txt_klein">* Pflichtfelder</td>
					<td>&nbsp;</td>
				</tr>
			</table>
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