207 lines
7.4 KiB
Cheetah
207 lines
7.4 KiB
Cheetah
<TMPL_INCLUDE NAME="members-top.inc">
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<h1><TMPL_VAR NAME=header></h1><br>
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<form action=/cgi-bin/koha/newmember.pl method=post>
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<input type=hidden name=joining value="<TMPL_VAR NAME=dateenrolled>">
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<input type=hidden name=expiry value="<TMPL_VAR NAME=expiry>">
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<input type=hidden name=type value="borrowers">
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<input type=hidden name=borrowernumber value="<TMPL_VAR NAME=member>">
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<input type=hidden name=updtype value="<TMPL_VAR NAME=updtype>">
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<table border=0 cellspacing=0 cellpadding=5 >
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<tr valign=top>
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<td COLSPAN=2><input type=reset value="Clear all Fields"></td>
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<td COLSPAN=3 ALIGN=RIGHT><font size=4 face='arial,helvetica'>Member# <TMPL_VAR NAME=member>, Card Number* <input type=text name=cardnumber size=10 value="<TMPL_VAR NAME=cardnumber>"><br></td>
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</tr>
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<tr valign=top>
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<td COLSPAN=3 background="<TMPL_VAR name="themelang">/images/background-mem.gif"><B>MEMBER PERSONAL DETAILS</b></td>
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<td COLSPAN=2 ALIGN=RIGHT background="<TMPL_VAR name="themelang">/images/background-mem.gif">*
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<input type="radio" name="sex" value="F"<TMPL_IF NAME=female> checked</TMPL_IF>>F
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<input type="radio" name="sex" value="M"<TMPL_UNLESS NAME=female> checked</TMPL_UNLESS>> M
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<B>Date of Birth</B> (<TMPL_VAR NAME=dateformat>)
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<input type=text name=dateofbirth size=10 value="<TMPL_VAR NAME=dateofbirth>">
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</td>
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</tr>
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<tr valign=top bgcolor=white>
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<td><FONT SIZE=2>Title</FONT></td>
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<td><FONT SIZE=2>Initials</FONT></td>
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<td><FONT SIZE=2><b>Given Names*</b></FONT></td>
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<td><FONT SIZE=2><b>Surname*</b></FONT></td>
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<td><FONT SIZE=2>Prefered Name</FONT></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td><TMPL_VAR name="Mr">
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<SELECT NAME="title">
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<option<TMPL_VAR name="title_selected_ "> value=" ">No Title</option>
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<option value="Miss"<TMPL_VAR name="title_Miss">>Miss</option>
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<option value="Mrs"<TMPL_VAR name="title_Mrs">>Mrs</option>
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<option value="Ms"<TMPL_VAR name="title_Ms">>Ms</option>
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<option <TMPL_VAR name="title_Mr"> value="Mr" >Mr</option>
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<option value="Dr" <TMPL_VAR name="title_Dr">>Dr</option>
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<option value="Sir" <TMPL_VAR name="title_Sir">>Sir</option>
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</SELECT>
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</td>
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<td><input type=text name=initials size=5 value="<TMPL_VAR NAME=initials>"></td>
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<td><input type=text name=firstname size=20 value="<TMPL_VAR NAME=firstname>"></td>
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<td><input type=text name=surname size=20 value="<TMPL_VAR NAME=surname>"></td>
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<td><input type=text name=othernames size=20 value="<TMPL_VAR NAME=othernames>"></td>
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</tr>
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<tr valign=top bgcolor=white>
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<TMPL_IF NAME=ethcatpopup><TMPL_VAR NAME=ethcatpopup>
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<td colspan=2><FONT SIZE=2>Ethnicity</FONT></td>
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<td colspan=2><FONT SIZE=2>Ethnicity Notes</FONT></td>
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<TMPL_ELSE>
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<td colspan=2> </td><td colspan=2> </td>
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</TMPL_IF>
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<td><FONT SIZE=2><b>Membership Category*</b></FONT></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td colspan=2>
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<TMPL_IF name="ethcatpopup">
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<select name="ethnicity" size=1>
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<TMPL_LOOP NAME=ethnicityloop>
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<option value=<TMPL_VAR NAME=value><TMPL_VAR NAME=selected>><TMPL_VAR NAME=label>
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</TMPL_LOOP>
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</select>
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</TMPL_IF>
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</td>
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<TMPL_IF NAME=ethcatpopup><TMPL_VAR NAME=ethcatpopup>
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<td colspan=2><input type=text name=ethnicnotes size=40 ></td>
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<TMPL_ELSE>
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<td colspan=2> </td>
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</TMPL_IF>
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<td><TMPL_VAR NAME=catcodepopup></td>
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</tr>
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<tr valign=top bgcolor="99cc33" >
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<td COLSPAN=5 background="<TMPL_VAR name="themelang">/images/background-mem.gif"><B>MEMBER ADDRESS</b></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=3><FONT SIZE=2><b>Postal Address*</b></FONT></td>
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<td><FONT SIZE=2><b>Zipcode / Town*</b></FONT></td>
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<td><FONT SIZE=2>Joining Branch</FONT></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=3><input type=text name=address size=40 value="<TMPL_VAR NAME=address>"></td>
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<td>
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<input type=text name="zipcode" size=20 value="<TMPL_VAR NAME="zipcode">"><br />
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<input type=text name=city size=20 value="<TMPL_VAR NAME=city>">
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</td>
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<td>
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<TMPL_VAR name="CGIbranch">
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</td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=3><FONT SIZE=2>Street Address if different</FONT></td>
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<td><FONT SIZE=2>Zipcode / Town</FONT></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=3><input type=text name=streetaddress size=40 value="<TMPL_VAR NAME=streetaddress>"></td>
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<td>
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<input type=text name="homezipcode" size=20 value="<TMPL_VAR NAME="homezipcode">"></br/>
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<input type=text name=streetcity size=20 value="<TMPL_VAR NAME=streetcity>"></td>
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</tr>
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<tr valign=top bgcolor="99cc33">
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<td COLSPAN=5 background="<TMPL_VAR name="themelang">/images/background-mem.gif"><B>MEMBER CONTACT DETAILS</b></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=2 ><FONT SIZE=2>Phone (Home)</td>
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<td><FONT SIZE=2>Fax</td>
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<td><FONT SIZE=2>Email</td>
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<td><FONT SIZE=2>Text Messaging</td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=2><input type=text name=phone size=20 value="<TMPL_VAR NAME=phone>"></td>
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<td><input type=text name=faxnumber size=20 value="<TMPL_VAR NAME=faxnumber>"></td>
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<td><input type=text name=emailaddress size=20 value="<TMPL_VAR NAME=emailaddress>"></td>
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<td><input type=text name=textmessaging size=20 value="<TMPL_VAR NAME=textmessaging>"></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=2 ><FONT SIZE=2>Phone (Daytime)</td>
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<td></td>
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<td></td>
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<td></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=2><input type=text name=phoneday size=20 value="<TMPL_VAR NAME=phoneday>"></td>
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<td></td>
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<td></td>
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<td></td>
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</tr>
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<tr valign=top bgcolor="99cc33">
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<td COLSPAN=5 background="<TMPL_VAR name="themelang">/images/background-mem.gif"><B>ALTERNATE CONTACT DETAILS</b></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=3 ><FONT SIZE=2><b>Name*</b></td>
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<td><FONT SIZE=2>Phone</td>
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<td><FONT SIZE=2><b>Relationship*</b></td>
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</tr>
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<tr valign=top bgcolor=white>
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<td COLSPAN=3 ><input type=text name=contactname size=40 value="<TMPL_VAR NAME=contactname>"></td>
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<td><input type=text name=altphone size=20 value="<TMPL_VAR NAME=altphone>"></td>
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<td>
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<select name=altrelationship size=1>
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<TMPL_LOOP NAME=relshiploop>
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<OPTION <TMPL_VAR NAME=selected>><TMPL_VAR NAME=relationship>
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</TMPL_LOOP>
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</select>
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</td>
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</tr>
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<tr valign=top bgcolor=white>
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<td><FONT SIZE=2>Notes</font></td>
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<td COLSPAN=4><textarea name=altnotes wrap=physical cols=70 rows=3><TMPL_VAR NAME=altnotes></textarea></td>
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</tr>
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<tr valign=top bgcolor="99cc33">
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<td COLSPAN=5 background="<TMPL_VAR name="themelang">/images/background-mem.gif"><B>LIBRARY USE</B></td>
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</tr>
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<tr valign=top >
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<td><FONT SIZE=2>Notes</font></td>
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<td COLSPAN=4><textarea name=borrowernotes wrap=physical cols=70 rows=3><TMPL_VAR NAME=borrowernotes></textarea></td>
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</tr>
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<TMPL_IF NAME=modify>
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<tr><td COLSPAN=5><Font size=2>FLAGS</font></td></tr>
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<TMPL_LOOP NAME=flagloop>
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<tr>
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<td COLSPAN=2><TMPL_VAR NAME=html></td>
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<td COLSPAN=3><input type=radio name="<TMPL_VAR NAME=name>" value="1" <TMPL_VAR NAME=yes>>Yes
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<input type=radio name="<TMPL_VAR NAME=name>" value="0" <TMPL_VAR NAME=no>>No
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</td>
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</tr>
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</TMPL_LOOP>
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</TMPL_IF>
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<tr>
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<td></td>
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<td>
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<input type=hidden name=type value=<TMPL_VAR NAME="type">>
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<input type=image src="<TMPL_VAR name="interface">/<TMPL_VAR name="theme">/images/2rightarrow.png" ALT="Add New Member" border=0 >
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</td>
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</tr>
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</table>
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</form>
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<TMPL_INCLUDE NAME="members-bottom.inc">
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