1 <!-- TMPL_INCLUDE NAME="members-top.inc" -->
3 <!-- TMPL_IF NAME=addAction -->
14 <form action=/cgi-bin/koha/newmember.pl method=post>
15 <input type=hidden name=joining value="<!-- TMPL_VAR NAME=dateenrolled -->">
16 <input type=hidden name=expiry value="<!-- TMPL_VAR NAME=expiry -->">
17 <input type=hidden name=type value="borrowers">
18 <input type=hidden name=borrowernumber value="<!-- TMPL_VAR NAME=member -->">
19 <input type=hidden name=updtype value="<!-- TMPL_VAR NAME=updtype -->">
21 <table border=0 cellspacing=0 cellpadding=5 >
24 <td COLSPAN=2><input type=reset value="Clear all Fields"></td>
25 <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>
29 <td COLSPAN=3 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif"><B>MEMBER PERSONAL DETAILS</b></td>
30 <td COLSPAN=2 ALIGN=RIGHT background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif">*
31 <input type="radio" name="sex" value="F"<!-- TMPL_IF NAME=female --> checked<!-- /TMPL_IF -->>F
32 <input type="radio" name="sex" value="M"<!-- TMPL_UNLESS NAME=female --> checked<!-- /TMPL_UNLESS -->> M
33 <B>Date of Birth</B> (<!-- TMPL_VAR NAME=dateformat -->)
34 <input type=text name=dateofbirth size=10 value="<!-- TMPL_VAR NAME=dateofbirth -->">
38 <tr valign=top bgcolor=white>
39 <td><FONT SIZE=2>Title</FONT></td>
40 <td><FONT SIZE=2>Initials</FONT></td>
41 <td><FONT SIZE=2><b> Given Names*</b></FONT></td>
42 <td><FONT SIZE=2><b> Surname*</b></FONT></td>
43 <td><FONT SIZE=2> Prefered Name</FONT></td>
45 <tr valign=top bgcolor=white>
46 <td><!-- TMPL_VAR name="Mr" -->
48 <option <!-- TMPL_VAR name="title_selected_ " --> value=" ">No Title</option>
49 <option value="Miss" <!-- TMPL_VAR name="title_Miss" -->>Miss</option>
50 <option value="Mrs" <!-- TMPL_VAR name="title_Mrs" -->>Mrs</option>
51 <option value="Ms" <!-- TMPL_VAR name="title_Ms" -->>Ms</option>
52 <option <!-- TMPL_VAR name="title_Mr" --> value="Mr" >Mr</option>
53 <option value="Dr" <!-- TMPL_VAR name="title_Dr" -->>Dr</option>
54 <option value="Sir" <!-- TMPL_VAR name="title_Sir" -->>Sir</option>
57 <td><input type=text name=initials size=5 value="<!-- TMPL_VAR NAME=initials -->"></td>
58 <td><input type=text name=firstname size=20 value="<!-- TMPL_VAR NAME=firstname -->"></td>
59 <td><input type=text name=surname size=20 value="<!-- TMPL_VAR NAME=surname -->"></td>
60 <td><input type=text name=othernames size=20 value="<!-- TMPL_VAR NAME=othernames -->"></td>
64 <tr valign=top bgcolor=white>
65 <!-- TMPL_IF NAME=ethcatpopup --><!-- TMPL_VAR NAME=ethcatpopup -->
66 <td colspan=2><FONT SIZE=2>Ethnicity</FONT></td>
67 <td colspan=2><FONT SIZE=2>Ethnicity Notes</FONT></td>
69 <td colspan=2> </td><td colspan=2> </td>
71 <td><FONT SIZE=2><b>Membership Category*</b></FONT></td>
73 <tr valign=top bgcolor=white>
75 <!-- TMPL_IF name="ethcatpopup" -->
76 <select name="ethnicity" size=1>
77 <!-- TMPL_LOOP NAME=ethnicityloop -->
78 <option value=<!-- TMPL_VAR NAME=value --><!-- TMPL_VAR NAME=selected -->><!-- TMPL_VAR NAME=label -->
83 <!-- TMPL_IF NAME=ethcatpopup --><!-- TMPL_VAR NAME=ethcatpopup -->
84 <td colspan=2><input type=text name=ethnicnotes size=40 ></td>
86 <td colspan=2> </td>
88 <td><!-- TMPL_VAR NAME=catcodepopup --></td>
92 <tr valign=top bgcolor="99cc33" >
93 <td COLSPAN=5 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif"><B>MEMBER ADDRESS</b></td>
96 <tr valign=top bgcolor=white>
97 <td COLSPAN=3><FONT SIZE=2><b>Postal Address*</b></FONT></td>
98 <td><FONT SIZE=2><b>Zipcode / Town*</b></FONT></td>
99 <td><FONT SIZE=2>Joining Branch</FONT></td>
101 <tr valign=top bgcolor=white>
102 <td COLSPAN=3><input type=text name=address size=40 value="<!-- TMPL_VAR NAME=address -->"></td>
104 <input type=text name="zipcode" size=20 value="<!-- TMPL_VAR NAME="zipcode" -->"><br />
105 <input type=text name=city size=20 value="<!-- TMPL_VAR NAME=city -->">
108 <!-- TMPL_VAR name="CGIbranch" -->
113 <tr valign=top bgcolor=white>
114 <td COLSPAN=3><FONT SIZE=2>Street Address if different</FONT></td>
115 <td><FONT SIZE=2>Zipcode / Town</FONT></td>
117 <tr valign=top bgcolor=white>
118 <td COLSPAN=3><input type=text name=streetaddress size=40 value="<!-- TMPL_VAR NAME=streetaddress -->"></td>
120 <input type=text name="homezipcode" size=20 value="<!-- TMPL_VAR NAME="homezipcode" -->"></br/>
121 <input type=text name=streetcity size=20 value="<!-- TMPL_VAR NAME=streetcity -->"></td>
124 <tr valign=top bgcolor=white>
125 <td COLSPAN=2 ><FONT SIZE=2>Phone home</td>
126 <td><FONT SIZE=2>Fax</td>
127 <td><FONT SIZE=2>Email</td>
128 <td><FONT SIZE=2>Text Messaging</td>
130 <tr valign=top bgcolor=white>
131 <td COLSPAN=2><input type=text name=phone size=20 value="<!-- TMPL_VAR NAME=phone -->"></td>
132 <td><input type=text name=faxnumber size=20 value="<!-- TMPL_VAR NAME=faxnumber -->"></td>
133 <td><input type=text name=emailaddress size=20 value="<!-- TMPL_VAR NAME=emailaddress -->"></td>
134 <td><input type=text name=textmessaging size=20 value="<!-- TMPL_VAR NAME=textmessaging -->"></td>
138 <tr valign=top bgcolor=white>
139 <td COLSPAN=2 ><FONT SIZE=2>Phone daytime</td>
144 <tr valign=top bgcolor=white>
145 <td COLSPAN=2><input type=text name=phoneday size=20 value="<!-- TMPL_VAR NAME=phoneday -->"></td>
152 <tr valign=top bgcolor="99cc33">
153 <td COLSPAN=5 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif"><B>ALTERNATE CONTACT DETAILS</b></td>
156 <tr valign=top bgcolor=white>
157 <td COLSPAN=3 ><FONT SIZE=2><b> Surname*</b></td>
158 <td><FONT SIZE=2>Phone</td>
159 <td><FONT SIZE=2><b>Relationship*</b></td>
161 <tr valign=top bgcolor=white>
162 <td COLSPAN=3 ><input type=text name=contactname size=40 value="<!-- TMPL_VAR NAME=contactname -->"></td>
163 <td><input type=text name=altphone size=20 value="<!-- TMPL_VAR NAME=altphone -->"></td>
165 <select name=altrelationship size=1>
166 <!-- TMPL_LOOP NAME=relshiploop -->
167 <OPTION <!-- TMPL_VAR NAME=selected -->><!-- TMPL_VAR NAME=relationship -->
173 <tr valign=top bgcolor=white>
174 <td><FONT SIZE=2> Notes</font></td>
175 <td COLSPAN=4><textarea name=altnotes wrap=physical cols=70 rows=3><!-- TMPL_VAR NAME=altnotes --></textarea></td>
179 <tr valign=top bgcolor="99cc33">
180 <td COLSPAN=5 background="<!-- TMPL_VAR name="themelang" -->/images/background-mem.gif"><B>LIBRARY USE</B></td>
184 <td><FONT SIZE=2> Notes</font></td>
185 <td COLSPAN=4><textarea name=borrowernotes wrap=physical cols=70 rows=3><!-- TMPL_VAR NAME=borrowernotes --></textarea></td>
188 <!-- TMPL_IF NAME=modify -->
189 <tr><td COLSPAN=5><Font size=2>FLAGS</font></td></tr>
190 <!-- TMPL_LOOP NAME=flagloop -->
192 <td COLSPAN=2><!-- TMPL_VAR NAME=html --></td>
193 <td COLSPAN=3><input type=radio name="<!-- TMPL_VAR NAME=name -->" value="1" <!-- TMPL_VAR NAME=yes -->>Yes
194 <input type=radio name="<!-- TMPL_VAR NAME=name -->" value="0" <!-- TMPL_VAR NAME=no -->>No
204 <input type=hidden name=type value=<!-- TMPL_VAR NAME="type" -->>
205 <input type="submit" value="save" class="button">
211 <!-- TMPL_INCLUDE NAME="members-bottom.inc" -->