Wasserlauf NRW - Stiftung für Gewässerschutz und Wanderfische

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                 <img src="images/seiten/foerdern.jpg" >
                 <br><br>
                  Füllen Sie hier das Formular für Ihrer Fördermitgliedschaft 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>
                                     
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                                     <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>
                                     
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                                     <td colspan="2"><br></td>
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<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>
                                     Amount of donation <input type="text" name="foerdermitgliedschaft" size="5"> €<br>

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                                     </tr>
                                     
                                     
                                     
                                     <tr>
                                     <td colspan="2">
                                     <input type="submit" value="Send">
                                     </td>
                                     </tr>

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

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