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<p align="left"><font face="Arial"><b><u><span style="font-size:9pt;">!!!
WICHTIG nur vollständig ausgefüllte Anfragen werden beantwortet
!!!</span></u></b></font></p>
<p><span style="font-size:9pt;"><font face="Arial">"Sollten
Sie keine </font></span><font face="Arial"><span style="font-size:9pt;">Internetpräsenz</span></font><span style="font-size:9pt;"><font face="Arial"> haben
dann hängen Sie bitte die Referenzbilder von IHNEN mit an,</font><font face="Arial" color="black">
da</font><font face="Arial">mit ich mich von Ihrem können Überzeugen
kann. Dankeschön.</font></span></p>
<form action="http://www.omma.de/run/forma" method="post">
<font face="Arial"><span style="font-size:9pt;"><input type="hidden" name="_receiver" value="info@manu-ela.de">
<input type="hidden" name="_subject" value="Model Buchungs-Anfrage!">
<input type="hidden" name="_format" value="HTML">
<input type="hidden" name="_redirect" value="http://www.manu-ela.de/danke.htm"></span></font>
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<p align="left"><font face="Arial" size="2">Vor- und Nachname:</font></td> <td width="387" height="23"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Name" value=""></span></font></td>
<td width="45" height="23"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
</tr>
<tr> <td width="173">
<p align="left"><font size="2" face="Arial">Alter:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Alter" value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
</tr>
<tr> <td width="173">
<p align="left"><font face="Arial" size="2">PLZ & Wohnort:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Wohnort & PLZ" value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
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<p align="left"><font face="Arial" size="2">Strasse & Hausnr.:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Strasse & Hausnr." value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
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<tr> <td width="173">
<p align="left"><font face="Arial" size="2">E-Mail:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="E-Mail" value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
</tr>
<td width="173">
<p align="left"><font face="Arial" size="2">Telefon für evtl. Rückfragen:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Telefon" value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
</tr>
<font face="Arial"><span style="font-size:9pt;"> <tr> <td width="173">
<p align="left"><font face="Arial" size="2">Ihre Internetpräsenz:</font></td> <td width="387">
<p><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Homepage" value=""></span></font></p>
</td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
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<td align="right" width="173">
<p align="left"><font face="Arial,Helvetica" size="2">Referenzbild
1:</font></td>
<td width="387"><font face="Arial,Helvetica,Sanserif"><input type="file" name="Datei" size="20" accept="text/html"></font></td>
<td width="45"></td>
</tr>
<td align="right" width="173">
<p align="left"><font face="Arial,Helvetica" size="2">Referenzbild
2:</font></td>
<td width="387"><font face="Arial,Helvetica,Sanserif"><input type="file" name="Datei" size="20" accept="text/html"></font></td>
<td width="45"></td>
</tr>
<td align="right" width="173">
<p align="left"><font face="Arial,Helvetica" size="2">Referenzbild
3:</font></td>
<td width="387"><font face="Arial,Helvetica,Sanserif"><input type="file" name="Datei" size="20" accept="text/html"></font></td>
<td width="45"></td>
</tr>
<td align="right" width="173">
<p align="left"><font face="Arial,Helvetica" size="2">Referenzbild 4:</font></td>
<td width="387"><font face="Arial,Helvetica,Sanserif"><input type="file" name="Datei" size="20" accept="text/html"></font></td>
<td width="45"></td>
</tr>
<td align="right" width="173">
<p align="left"><font face="Arial,Helvetica" size="2">Referenzbild 5:</font></td>
<td width="387"><font face="Arial,Helvetica,Sanserif"><input type="file" name="Datei" size="20" accept="text/html"></font></td>
<td width="45"></td>
</tr>
<tr> <td width="173">
<p align="left"><font face="Arial" size="2">Sie sind Fotograf:</font></td> <td width="387">
<font face="Arial"><span style="font-size:9pt;"><input type="radio" name="Fotograf" value="Hobbyfotograf">Hobby
<input type="radio" name="Fotograf" value="Amateur">Amateur
<input type="radio" name="Fotograf" value="Profi">Profi
</span></font></td> <td width="45">
<font face="Arial"><span style="font-size:9pt;"> </span></font></td> </tr>
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<p align="left"><font face="Arial" size="2">Ort des Shootings:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Ort des Shootings" value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
</tr>
<tr> <td width="173">
<p align="left"><font face="Arial" size="2">Datum und Uhrzeit:</font></td> <td width="387"><font face="Arial"><span style="font-size:9pt;"><input type="text" name="Datum und Uhrzeit" value=""></span></font></td>
<td width="45"><font face="Arial"><span style="font-size:9pt;"> </span></font></td>
</tr>
<tr> <td width="173" valign="top">
<p align="left"><font face="Arial" size="2">Sonstiges:</font></td> <td width="387">
<font face="Arial"><span style="font-size:9pt;"><textarea name="Sonstiges" cols="52"
rows="4" wrap="virtual"></textarea>
</span></font></td>
<td width="45"></td>
</tr>
</table>
<font face="Arial"><span style="font-size:9pt;"><input type="submit" value="Absenden"></span></font>
</form>
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