20 lines
514 B
HTML
20 lines
514 B
HTML
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<form action="%wakeup_link%&action=create" method="post">
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<table>
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<tr>
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<td align="right"> %date_text%: </td>
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<td><input type="text" name="Date" value="%date_value%"></td>
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</tr>
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<tr>
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<td align="right"> %place_text% </td>
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<td><input type="text" name="Ort" value=""></td>
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</tr>
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<tr>
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<td align="right"> %comment_text% </td>
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<td><textarea name="Bemerkung" rows="5" cols="40">
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%comment_value%
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</textarea></td>
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</tr>
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</table>
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<input type="submit" name="submit" value="%submit_text%" />
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</form>
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