PHP-Code:
	
<div class="mod_catalognotify block" id="anmeldung">
    <form action="angebote-details/kategorie/freizeit/items/tanzkurs.html" method="post">
        <div class="formbody"> <input type="hidden" name="FORM_SUBMIT" value="tl_catalog_notify">
            <div class="notifyForm">
                 <label for="ctrl_vorname">Vorname</label>
                <input type="text" name="vorname" id="ctrl_vorname" class="text" value="" required="">
                <label for="ctrl_name">Name</label>
                <input type="text" name="name" id="ctrl_name" class="text" value="" required="">
                <label for="ctrl_telefon">Telefon</label>
                <input type="text" name="telefon" id="ctrl_telefon" class="text" value="" required="">
                <label for="ctrl_handy">Handy</label>
                <input type="text" name="handy" id="ctrl_handy" class="text" value="" required="">
                <label for="ctrl_geburtsdatum">Geburtsdatum</label>
                <input type="text" name="geburtsdatum" id="ctrl_geburtsdatum" class="text" value="" required="">
                <label for="ctrl_email">eMail</label>
                <input type="text" name="email" id="ctrl_email" class="text" value="" required="">
                <label for="ctrl_strasse">Straße</label>
                <input type="text" name="strasse" id="ctrl_strasse" class="text" value="" required="">
                <label for="ctrl_postleitzahl">Postleitzahl</label>
                <input type="text" name="postleitzahl" id="ctrl_postleitzahl" class="text" value="" required="">
                <label for="ctrl_ort">Ort</label>
                <input type="text" name="ort" id="ctrl_ort" class="text" value="" required="">
                <textarea name="message" id="ctrl_message" class="textarea" rows="12" cols="80" required=""></textarea>
                <input type="text" name="c2f9ed959a34209aaf9c2d43e8ed44532" id="ctrl_captcha" class="captcha mandatory" value="" maxlength="2" required="">
                <span class="captcha_text">Was ist die Summe aus 1 und 3?</span>
                <div class="submit_container">
                    <input type="submit" class="submit" value="Eine Benachrichtigung senden">
                </div>
            </div>
        </div>
    </form>
</div>