<div class="inner-heading">
<div class="shadow-top"> <img src="image/bg-top-shadow.png" alt="" /> </div>
<div class="container">
<div class="hosting-selection">
<div class="top-inner">Registrieren</div>
<p><?php echo ''._JOINUSTEXT.''; ?></p>
</div>
</div>
</div>
<div class="clearfix"> </div>
<?php
echo '<div class="conatct-form">
<div class="row">
<div class="col-md-2 col-sm-2">
<div class="box-c">
<form name="form_one" action="'.$joinuspath.'" method="post">
'._JOINUSTITLE.'<select name="title" class="name">
<option value="0">'._JOINUSMR.'</option>
<option value="1">'._JOINUSMRS.'</option>
<option value="2">'._JOINUSFIRM.'</option>
</select><br>
'._JOINUSFIRMNAME.'<input type="text" name="firm" class="name" maxlength="40" ><br>
'._JOINUSSURNAME.'<input type="text" name="surname" class="name" maxlength="40" ><br>
'._JOINUSNAME.'<input type="text" name="lastname" class="name" maxlength="40" ><br>
'._JOINUSBIRTHDAY.'<input name="birthday" type="text" class="name" maxlength="10" value="" placeholder="'._JOINUSBIRTHDAYEXAMPLE.'">
</div></div>
<div class="col-md-2 col-sm-2">
<div class="box-c">
'._JOINUSSTREET.'<input name="street" type="text" class="name" maxlength="40" value="" ><br>
'._JOINUSCITY.'<input name="city" type="text" class="name" maxlength="40" value="" ><br>
'._JOINUSZIPCODE.'<input name="zipcode" type="text" class="name" maxlength="10" value="" ><br>
'._JOINUSCOUNTRY.'<select name="country" class="name"><br>
'.$box_countryselect.'
</div> </div>
<div class="col-md-2 col-sm-2">
<div class="box-c">
'._JOINUSUSERNAME.'<input type="text" name="uname" class="name" maxlength="20" placeholder="Benutzername"><br>
'._JOINUSEMAIL.'<input name="email" type="text" class="name" maxlength="255" value="" >';
if (extension_loaded("gd") AND $gfx_chk == 1) {
echo '
'._JOINUSSECURITY.'<img src="includes/pics.php?op=code&randomnum='.$randomnum.'&sitetheme='.$sitetheme.'" ><br>
<input type="hidden" name="randomnum" value="'.$randomnum.'"><br>
'._JOINUSSECURITY.'<input type="text" name="gfxcheck" class="name" maxlength="6" >';
}
echo '
<input type="checkbox" name="terms" value="1"> '._JOINUSGENERALTERMS.'<br>
<input type="hidden" name="save" value="2"><br>';
if (file_exists("themes/$sitetheme/images/$language/button-msgsend.png")) {
echo '<input id="noborder" src="themes/'.$sitetheme.'/images/'.$language.'/button-msgsend.png" type="image">';
}elseif (file_exists("themes/$sitetheme/images/button-msgsend.png")) {
echo '<input id="noborder" src="themes/'.$sitetheme.'/images/button-msgsend.png" type="image">';
}else{
echo '<a href="javascript:document.form_one.submit();" class="snd-btn">'._SEND.'</a>';
}
echo '</form>';
?>
</div>
</div>
</div>
</div>
