document.write('');
document.write('  <table align="center">');
document.write('<form method="post" action="http://151757.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td><font size="3"><b>Registrieren</b></font></td>');
document.write('      <td>mit*gekennzeichnete Felder sind Pflichtfelder!</td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="2"><b>Name *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="2"><b>Vorname*</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id6]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="2"><b>E-Mail *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="2"><b>Benutzername*</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id10]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="2"><b>Passwort*<br></b></font>mind.7 Zeichen');
document.write('<BR>');
document.write('keine Sonderzeichen!</td>');
document.write('      <td>');
document.write('        <input type="password" name="user_input[id5]" value="" size="20" maxlength="15">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="2"><b>Passwortwiederholung</b></font></td>');
document.write('      <td>');
document.write('        <input type="password" name="user_input[id7]" value="" size="20" maxlength="15">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
document.write('        <input type="hidden" name="mq" value="\'">');
document.write('        <input type="hidden" name="action" value="send_mail">');
document.write('        <input type="hidden" name="entry" value="151757">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center"><font size="-2">Powered by <a href="http://www.onetwomax.de" target="_blank">OneTwoMax</a> Formmailer Script</font></td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');