document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://78680.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana"><b>Anmeldung Newsletter des KFV Saarpfalz e.V.</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana" size="2"><i>mit * gekennzeichnete Felder müssen ausgefüllt werden</i></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Name *</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id3]" value="" size="38">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">E-Mail-Adresse *</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id4]" value="" size="38">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Feuerwehr *</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <select style=" font-family: Verdana;" name="user_input[id7]">');
document.write('          <option value="0">Bexbach');
document.write('</option>');
document.write('          <option value="1">Blieskastel');
document.write('</option>');
document.write('          <option value="2">Gersheim');
document.write('</option>');
document.write('          <option value="3">Homburg');
document.write('</option>');
document.write('          <option value="4">Kirkel');
document.write('</option>');
document.write('          <option value="5">Mandelbachtal');
document.write('</option>');
document.write('          <option value="6">St. Ingbert');
document.write('</option>');
document.write('          <option value="7">Sonstige</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Löschbezirk *</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id6]" value="" size="38">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
document.write('        <input type="hidden" name="mq" value="\'">');
document.write('        <input type="hidden" name="action" value="send_mail">');
document.write('        <input type="hidden" name="entry" value="78680">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
document.write('      </td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');