Koha/koha-tmpl/opac-tmpl/prog/en/modules/opac-userupdate.tmpl

<!-- TMPL_INCLUDE name="doc-head-open.inc" --><!-- TMPL_IF NAME="LibraryNameTitle" --><!-- TMPL_IF NAME="LibraryNameTitle" --><!-- TMPL_VAR NAME="LibraryNameTitle" --><!-- TMPL_ELSE -->Koha Online<!-- /TMPL_IF --><!-- TMPL_ELSE -->Koha Online<!-- /TMPL_IF --> Catalog &rsaquo;  Updating Details for <!-- TMPL_LOOP name="BORROWER_INFO" --><!-- TMPL_VAR name="firstname" --> <!-- TMPL_VAR name="surname" --><!-- /TMPL_LOOP -->
<!-- TMPL_INCLUDE NAME="doc-head-close.inc" -->
</head>
<!-- TMPL_INCLUDE name="masthead.inc" -->

<div id="doc3" class="yui-t1">
   <div id="bd">
	<div id="yui-main">
	<div class="yui-b"><div class="yui-g" id="userupdate">

<!-- TMPL_LOOP name="BORROWER_INFO" -->

<h3><a href="/cgi-bin/koha/opac-user.pl"><!-- TMPL_VAR NAME="firstname" --> <!-- TMPL_VAR NAME="surname" -->'s account</a> <img src="<!-- TMPL_VAR NAME="themelang" -->../../images/caret.gif" width="16" height="16" alt="&gt;" border="0" /> Your Personal Details</h3>

<div class="yui-u first">

<form action="/cgi-bin/koha/opac-userupdate.pl" method="get">
<input type="hidden" name="modify" value="yes" />
<fieldset class="brief"><legend>Name</legend><ol>
<li><label for="firstname">First Name:</label> <input id="firstname" type="text" value="<!-- TMPL_VAR name="firstname" -->"  name="firstname" /></li>
<li><label for="surname">Last Name:</label> <input id="surname" type="text" value="<!-- TMPL_VAR name="surname" -->"  name="surname" /></li>
</ol>
</fieldset>

<fieldset class="brief"><legend>Contact Information</legend>
<ol>
<li>
    <label for="streetaddress">Address:</label>
	<input type="text" name="address" value="<!-- TMPL_VAR NAME="address" -->" id="address" />
	<input type="text" name="address2" value="<!-- TMPL_VAR NAME="address2" -->" id="address2" /></li>
<li><label for="city">City, State:</label> <input id="city" type="text" value="<!-- TMPL_VAR name="city" -->"  name="city" /></li>
<li><label for="zipcode">Zip Code: </label><input id="zipcode" name="zipcode" value="<!-- TMPL_VAR NAME="zipcode" -->" /></li>
<li><label for="phone">Home Phone:</label> <input id="phone" type="text" value="<!-- TMPL_VAR name="phone" -->"  name="phone" /></li>
<li><label for="mobile">Mobile Phone:</label> <input id="mobile" type="text" value="<!-- TMPL_VAR name="mobile" -->"  name="mobile" /></li>
<li><label for="fax">Fax:</label> <input id="fax" type="text" value="<!-- TMPL_VAR name="fax" -->"  name="fax" /></li>

<li><label for="phonepro">Work phone:</label> <input id="phonepro"  type="text" value="<!-- TMPL_VAR name="phonepro" -->"  name="phonepro" /></li>

<li><label for="emailaddress">Email:</label> <input id="emailaddress" type="text" value="<!-- TMPL_VAR name="email" -->"  name="emailaddress" /></li>
</ol>
</fieldset>
</div>
<div class="yui-u">
<fieldset class="brief">
<legend>Permanent Address</legend>
<ol>
<li>
    <label for="B_streetaddress">Permanent or Alternate Address:</label>
        <textarea id="B_streetaddress" cols="25"  name="B_streetaddress"><!--TMPL_VAR NAME="B_streetnumber"--> <!-- TMPL_VAR name="B_address" --></textarea>
</li>

<li><label for="B_city">City, State:</label> <input id="B_city" type="text" value="<!-- TMPL_VAR name="B_city" -->"  name="B_city" /></li>
<li><label for="B_zipcode">Zip Code</label> <input type="text" id="B_zipcode" name="B_zipcode" value="<!-- TMPL_VAR NAME="B_zipcode" -->" /></li>
</ol>
</fieldset>
<fieldset class="brief">
<ol>
<li><label for="dob">Date of Birth: </label> <input id="dob" type="text" size="10" value="<!-- TMPL_VAR NAME="dateofbirth" -->" name="dateofbirth" /></li>
<li><label for="sex">Sex: </label> <select name="sex" id="sex"><option></option>
<!-- TMPL_IF EXPR="sex eq 'F'" --><option value="F" selected="selected">Female</option><!-- TMPL_ELSE --><option value="F">Female</option><!-- /TMPL_IF -->
<!-- TMPL_IF EXPR="sex eq 'M'" --><option value="M" selected="selected">Male</option><!-- TMPL_ELSE --><option value="M">Male</option><!-- /TMPL_IF -->
</select></li>
</ol></fieldset>
<fieldset class="brief">
<legend>Library Use:</legend>
<ol>
	<li><label for="borrowernumber">Patron Number:</label><input type="text" id="borrowernumber" disabled="disabled" readonly="readonly" value="<!-- TMPL_VAR NAME="borrowernumber" -->" /></li>
	<li><label for="categorycode">Patron Category:</label><input type="text" id="categorycode" disabled="disabled" readonly="readonly" value="<!-- TMPL_VAR NAME="categorycode" -->" /></li>
	<li><label for="dateenrolled">Joined: </label><input type="text" id="dateenrolled" disabled="disabled" readonly="readonly" value="<!-- TMPL_VAR NAME="dateenrolled" -->" /></li>
	<li><label for="dateexpiry">Expires: </label><input type="text" id="dateexpiry" disabled="disabled" readonly="readonly" value="<!-- TMPL_VAR NAME="dateexpiry" -->" /></li>
</ol>
</fieldset>
<fieldset class="action">
<p>Please make any necessary changes to your record.  Submitting the form will notify a library staff member, who will make the changes permanent.</p>
<input type="submit" value="Submit Changes" /> <a class="cancel" href="/cgi-bin/koha/opac-user.pl">Cancel</a></fieldset>

</div>
</form>

<!-- /TMPL_LOOP -->

</div>
</div>
</div>
<div class="yui-b">
<!--TMPL_INCLUDE NAME="navigation.inc" -->
<!-- TMPL_INCLUDE name="usermenu.inc" -->
</div>
</div>
<!-- TMPL_INCLUDE NAME="opac-bottom.inc" -->