3 <TMPL_INCLUDE NAME="members-top.inc">
5 <FONT SIZE=6><em><TMPL_VAR NAME=header></em></FONT><br>
7 <form action=/cgi-bin/koha/newmember.pl method=post>
8 <input type=hidden name=joining value="<TMPL_VAR NAME=dateenrolled>">
9 <input type=hidden name=expiry value="<TMPL_VAR NAME=expiry>">
10 <input type=hidden name=type value="borrowers">
11 <input type=hidden name=borrowernumber value="<TMPL_VAR NAME=member>">
12 <input type=hidden name=updtype value="<TMPL_VAR NAME=updtype>">
14 <table border=0 cellspacing=0 cellpadding=5 >
17 <td COLSPAN=2><input type=reset value="Clear all Fields"></td>
18 <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>
22 <td COLSPAN=3 background="/images/background-mem.gif"><B>MEMBER PERSONAL DETAILS</b></td>
23 <td COLSPAN=2 ALIGN=RIGHT background="/images/background-mem.gif">*
24 <input type="radio" name="sex" value="F"<TMPL_IF NAME=female> checked</TMPL_IF>>F
25 <input type="radio" name="sex" value="M"<TMPL_UNLESS NAME=female> checked</TMPL_UNLESS>> M
26 <B>Date of Birth</B> (dd/mm/yy)
27 <input type=text name=dateofbirth size=10 value="<TMPL_VAR NAME=dateofbirth>">
31 <tr valign=top bgcolor=white>
33 <SELECT NAME="title" SIZE="1">
34 <OPTION value=" ">No Title
35 <TMPL_LOOP NAME=titleloop>
36 <OPTION value="<TMPL_VAR NAME=title>"<TMPL_VAR NAME=selected>><TMPL_VAR NAME=title>
40 <td><input type=text name=initials size=5 value="<TMPL_VAR NAME=initials>"></td>
41 <td><input type=text name=firstname size=20 value="<TMPL_VAR NAME=firstname>"></td>
42 <td><input type=text name=surname size=20 value="<TMPL_VAR NAME=surname>"></td>
43 <td><input type=text name=othernames size=20 value="<TMPL_VAR NAME=othernames>"></td>
46 <tr valign=top bgcolor=white>
47 <td><FONT SIZE=2>Title</FONT></td>
48 <td><FONT SIZE=2>Initials</FONT></td>
49 <td><FONT SIZE=2>Given Names*</FONT></td>
50 <td><FONT SIZE=2>Surname*</FONT></td>
51 <td><FONT SIZE=2>Prefered Name</FONT></td>
54 <tr><td> </TD></TR>
56 <tr valign=top bgcolor=white>
58 <select name="ethnicity" size=1>
59 <TMPL_LOOP NAME=ethnicityloop>
60 <option value=<TMPL_VAR NAME=value><TMPL_VAR NAME=selected>><TMPL_VAR NAME=label>
64 <TMPL_IF NAME=ethcatpopup><TMPL_VAR NAME=ethcatpopup>
65 <td colspan=2><input type=text name=ethnicnotes size=40 ></td>
67 <td colspan=2> </td>
69 <td><TMPL_VAR NAME=catcodepopup></td>
72 <tr valign=top bgcolor=white>
73 <TMPL_IF NAME=ethcatpopup><TMPL_VAR NAME=ethcatpopup>
74 <td colspan=2><FONT SIZE=2>Ethnicity</FONT></td>
75 <td colspan=2><FONT SIZE=2>Ethnicity Notes</FONT></td>
77 <td colspan=2> </td><td colspan=2> </td>
79 <td><FONT SIZE=2>Membership Category*</FONT></td>
82 <tr><td> </TD></TR>
84 <tr valign=top bgcolor="99cc33" >
85 <td COLSPAN=5 background="/images/background-mem.gif"><B>MEMBER ADDRESS</b></td>
88 <tr valign=top bgcolor=white>
89 <td COLSPAN=3><input type=text name=address size=40 value="<TMPL_VAR NAME=streetaddress>"></td>
90 <td><input type=text name=city size=20 value="<TMPL_VAR NAME=city>"></td>
92 <SELECT NAME="area" SIZE="1">
93 <TMPL_LOOP NAME=arealoop>
94 <OPTION value="<TMPL_VAR NAME=shortcut>"<TMPL_VAR NAME=selected>><TMPL_VAR NAME=shortcut> - <TMPL_VAR NAME=area>
100 <tr valign=top bgcolor=white>
101 <td COLSPAN=3><FONT SIZE=2>Postal Address*</FONT></td>
102 <td><FONT SIZE=2>Town*</FONT></td>
103 <td><FONT SIZE=2>Area</FONT></td>
106 <tr><td> </TD></TR>
108 <tr valign=top bgcolor=white>
109 <td COLSPAN=3><input type=text name=streetaddress size=40 value="<TMPL_VAR NAME=streetaddress>"></td>
110 <td><input type=text name=streetcity size=20 value="<TMPL_VAR NAME=streetcity>"></td>
113 <tr valign=top bgcolor=white>
114 <td COLSPAN=3><FONT SIZE=2>Street Address if different</FONT></td>
115 <td><FONT SIZE=2>Town</FONT></td>
118 <tr><td> </TD></TR>
120 <tr valign=top bgcolor="99cc33">
121 <td COLSPAN=5 background="/images/background-mem.gif"><B>MEMBER CONTACT DETAILS</b></td>
124 <tr valign=top bgcolor=white>
125 <td COLSPAN=2><input type=text name=phone size=20 value="<TMPL_VAR NAME=phone>"></td>
126 <td><input type=text name=phoneday size=20 value="<TMPL_VAR NAME=phoneday>"></td>
127 <td><input type=text name=faxnumber size=20 value="<TMPL_VAR NAME=faxnumber>"></td>
128 <td><input type=text name=emailaddress size=20 value="<TMPL_VAR NAME=emailaddress>"></td>
131 <tr valign=top bgcolor=white>
132 <td COLSPAN=2 ><FONT SIZE=2>Phone (Home)</td>
133 <td><FONT SIZE=2>Phone (day)</td>
134 <td><FONT SIZE=2>Fax</td>
135 <td><FONT SIZE=2>Email</td>
138 <tr><td> </TD></TR>
140 <tr valign=top bgcolor="99cc33">
141 <td COLSPAN=5 background="/images/background-mem.gif"><B>ALTERNATE CONTACT DETAILS</b></td>
144 <tr valign=top bgcolor=white>
145 <td COLSPAN=3 ><input type=text name=contactname size=40 value="<TMPL_VAR NAME=contactname>"></td>
146 <td><input type=text name=altphone size=20 value="<TMPL_VAR NAME=altphone>"></td>
148 <select name=altrelationship size=1>
149 <TMPL_LOOP NAME=relshiploop>
150 <OPTION <TMPL_VAR NAME=selected>><TMPL_VAR NAME=relationship>
156 <tr valign=top bgcolor=white>
157 <td COLSPAN=3 ><FONT SIZE=2>Name*</td>
158 <td><FONT SIZE=2>Phone</td>
159 <td><FONT SIZE=2>Relationship*</td>
162 <tr><td> </TD></TR>
164 <tr valign=top bgcolor=white>
165 <td><FONT SIZE=2>Notes</font></td>
166 <td COLSPAN=4><textarea name=altnotes wrap=physical cols=70 rows=3><TMPL_VAR NAME=altnotes></textarea></td>
169 <tr><td> </TD></TR>
171 <tr valign=top bgcolor="99cc33">
172 <td COLSPAN=5 background="/images/background-mem.gif"><B>LIBRARY USE</B></td>
176 <td><FONT SIZE=2>Notes</font></td>
177 <td COLSPAN=4><textarea name=borrowernotes wrap=physical cols=70 rows=3><TMPL_VAR NAME=borrowernotes></textarea></td>
180 <tr><td> </TD></TR>
182 <TMPL_IF NAME=modify>
183 <tr><td COLSPAN=5><Font size=2>FLAGS</font></td></tr>
184 <TMPL_LOOP NAME=flagloop>
186 <td COLSPAN=2><TMPL_VAR NAME=html></td>
187 <td COLSPAN=3><input type=radio name="<TMPL_VAR NAME=name>" value="1" <TMPL_VAR NAME=yes>>Yes
188 <input type=radio name="<TMPL_VAR NAME=name>" value="0" <TMPL_VAR NAME=no>>No
195 <TMPL_UNLESS NAME=modify><!-- Don't know what's this unless for -->
196 <td></td><td><input type=image src="/images/save-changes.gif" WIDTH=188 HEIGHT=44 ALT="Add New Member" border=0 ></td>
198 <td></td><td><input type=image src="/images/save-changes.gif" WIDTH=188 HEIGHT=44 ALT="Add New Member" border=0 ></td>
204 <TMPL_INCLUDE NAME="members-bottom.inc">