Koha/koha-tmpl/intranet-tmpl/default/en/members/imemberentry.tmpl

<!-- TMPL_INCLUDE name="members-top.inc" -->
<BLOCKQUOTE>

<!-- TMPL_IF name="surname" -->
	<h1>Edit Institution</h1><br>
<!-- TMPL_ELSE -->
	<h1>Add new Institution</h1><br>
<!-- /TMPL_IF -->
<form action=/cgi-bin/koha/newimember.pl method=post>
  <input type=hidden name=joining value="">
  <input type=hidden name=expiry value="">
  <input type=hidden name=type value="borrowers">
  <input type=hidden name=borrowernumber value="<!-- TMPL_VAR NAME=member -->">
  <input type=hidden name=updtype value=I>

  <table border=0 cellspacing=0 cellpadding=5>

    <tr valign=top>
      <td ><input type=reset value="Clear all Fields"></td>
    </tr>

    <tr align=right>
      <td COLSPAN=2 ALIGN=RIGHT><font size=3 face='arial,helvetica'>
        <STRONG>Member# <!-- TMPL_VAR NAME="member" -->, Card number*</STRONG>
      </TD>
      <TD align=right><input type=text name=cardnumber_institution size=20 value=<!-- TMPL_VAR NAME=cardnumber_institution -->><br></td>
    </TR>

    <tr><td>&nbsp;</TD></TR>

    <tr valign=top bgcolor="99cc33" >
      <td  COLSPAN=5 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif">
        <B>INSTITUTION DETAILS</b>
      </td>
      <td  COLSPAN=2  ALIGN=RIGHT background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif">
      </td>
    </tr>

    <tr valign=top bgcolor=white>
      <td><FONT SIZE=2>Institution Name</FONT></td>
    </tr>
    <tr valign=top bgcolor=white>
      <td colspan=3><input type=text name=institution_name size=50 value="<!-- TMPL_VAR name="surname" -->"></td>
    </tr>
    <tr><td>&nbsp;</TD></TR>

    <tr valign=top bgcolor="99cc33" >
      <td  COLSPAN=5 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif">
	  <B>INSTITUTION ADDRESS</b>
      </td>
    </tr>

    <tr valign=top bgcolor=white>
	<td ><FONT SIZE=2>Postal Address*</FONT></td>
	<td><FONT SIZE=2>Zipcode / Town*</FONT></td>
	<td><FONT SIZE=2>Area</FONT></td>
    </tr>
    <tr valign=top bgcolor=white>
	<td><input type=text name=address size=40 value="<!-- TMPL_VAR name="streetaddress" -->"></td>
	<td><input type=text name=zipcode size=20 value="<!-- TMPL_VAR name="zipcode" -->"> <br/><input type=text name=city size=20 value="<!-- TMPL_VAR name="city" -->"></td>
	<td>
      	<!-- TMPL_VAR name="CGIbranch" -->
	 </td>
    </tr>
    <tr><td>&nbsp;</TD></TR>

    <tr valign=top bgcolor="99cc33">
      <td COLSPAN=5 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif">
	  <B>CONTACT DETAILS</b>
      </td>
    </tr>

    <tr valign=top bgcolor=white>
	<td COLSPAN=3><FONT SIZE=2>Contact Name*</td>
    </tr>
    <tr valign=top bgcolor=white>
	<td COLSPAN=3><input type=text name=contactname size=40 value="<!-- TMPL_VAR name="contactname" -->"></td>
    </tr>


    <tr valign=top bgcolor=white>
	<td><FONT SIZE=2>Phone (day)</td>
	<td><FONT SIZE=2>Fax</td>
	<td><FONT SIZE=2>Email</td>
    </tr>
    <tr valign=top bgcolor=white>
	<td ><input type=text name=phoneday size=20 value="<!-- TMPL_VAR name="phoneday" -->"></td>
	<td><input type=text name=faxnumber size=20 value="<!-- TMPL_VAR name="faxnumber" -->"></td>
	<td ><input type=text name=emailaddress size=20 value="<!-- TMPL_VAR name="emailaddress" -->"></td>
    </tr>

    <tr><td>&nbsp;</TD></TR>

    <tr valign=top bgcolor=white>
	<td><FONT SIZE=2>Notes</font></td>
    </tr>
    <tr valign=top bgcolor=white>
	<td COLSPAN=4><textarea name=altnotes wrap=physical cols=70 rows=3><!-- TMPL_VAR name="altnotes" --></textarea></td>
    </tr>

    <tr><td>&nbsp;</TD></TR>

    <tr valign=top bgcolor="99cc33"  >
	<td  COLSPAN=5  background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif"><B>LIBRARY USE</B></td>
    </tr>

    <tr valign=top bgcolor=white>
	<td ><FONT SIZE=2>Notes</font></td>
    </tr>
    <tr valign=top >
	<td  COLSPAN=5><textarea name=borrowernotes wrap=physical cols=70 rows=3><!-- TMPL_VAR name="borrowernotes" --></textarea></td>
    </tr>

    <tr><td>&nbsp;</TD></TR>

    <tr valign=top bgcolor=white>
	<td  COLSPAN=5 align=right >
	  <input type=submit class="button" value="Save Changes" ALT="Add New Member" border=0 >
      </td>
    </tr>
  </TABLE>
</form>

</BLOCKQUOTE>

<br clear=all>
<p> &nbsp; </p>

<!-- TMPL_VAR NAME=endmenumember -->

</body>
</HTML>