<HTML>
<HEAD>
<TITLE>#tryout.val_form</TITLE>
<META name="author" content="Maarten Wierda, norecess.com">
<META name="keywords" content="">
<META name="description" content="">
{literal}
<STYLE type="text/css"><!--
BODY, TABLE, TD
{
font-family: Courier New, monospace;
font-size: 10pt;
color: #222222;
}
INPUT.fld
{
font-family: Courier New, monospace;
font-size: 10pt;
color: #222222;
border: 1px solid #000000;
}
INPUT.fld_small
{
font-family: Courier New, monospace;
font-size: 10pt;
color: #222222;
border: 1px solid #000000;
width: 45px;
}
.not_filled_in
{
color: #ff0000;
}
--></STYLE>
{/literal}
</HEAD>
<BODY bgcolor="#ffffff" marginwidth="20" marginheight="20" leftmargin="20" topmargin="20">
<FORM name="theForm" method="post" action="{$form_action}">
<INPUT type="hidden" name="is_sent" value="true">
<TABLE border="0" cellspacing="2" cellpadding="2">
<TR valign="middle">
<TD>username</TD>
<TD> : </TD>
<TD><INPUT class="fld" type="text" name="username" value="{$username}"></TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>zipcode</TD>
<TD> : </TD>
<TD><INPUT class="fld" type="text" name="zipcode" value="{$zipcode}"></TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>e-mail</TD>
<TD> : </TD>
<TD><INPUT class="fld"type="text" name="email" value="{$email}"></TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>website</TD>
<TD> : </TD>
<TD><INPUT class="fld" type="text" name="website" value="{$website}"></TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>birthdate</TD>
<TD> : </TD>
<TD><INPUT class="fld" type="text" name="birthdate" value="{$birthdate}"></TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>date_01</TD>
<TD> : </TD>
<TD>
<INPUT class="fld_small" type="text" name="date_01_01" value="{$date_01_01}">
<INPUT class="fld_small" type="text" name="date_01_02" value="{$date_01_02}">
<INPUT class="fld_small" type="text" name="date_01_03" value="{$date_01_03}">
</TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>gendert</TD>
<TD> : </TD>
<TD>
<INPUT type="radio" name="gender" value="m" {if $gender eq m} checked {/if}> m
<INPUT type="radio" name="gender" value="v" {if $gender eq v} checked {/if}> v
</TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD>books</TD>
<TD> : </TD>
<TD>
<INPUT type="checkbox" name="books[]" value="boek_01" {foreach from=$books item=the_book}{if $the_book eq "boek_01"} checked {/if}{/foreach}> 0
<INPUT type="checkbox" name="books[]" value="boek_02" {foreach from=$books item=the_book}{if $the_book eq "boek_02"} checked {/if}{/foreach}> 1
</TD>
<TD>*</TD>
</TR>
<TR valign="middle">
<TD colspan="3" align="right"><INPUT type="submit" value="sent"></TD>
</TR>
</TABLE>
</FORM>
</BODY>
</HTML>
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