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1 |
[% USE KohaDates %] |
2 |
[% SET userupdateview = 1 %] |
3 |
|
4 |
[% INCLUDE 'doc-head-open.inc' %] |
5 |
[% IF ( LibraryNameTitle ) %][% LibraryNameTitle %][% ELSE %]Koha online[% END %] catalog › Your fines and charges |
6 |
[% INCLUDE 'doc-head-close.inc' %] |
7 |
|
8 |
<script type="text/javascript"> |
9 |
$(document).ready(function() { |
10 |
$( "#borrower_dateofbirth" ).datepicker({ yearRange: "c-120:c" }); |
11 |
}); |
12 |
</script> |
13 |
</head> |
14 |
|
15 |
<body id="opac-account"> |
16 |
<div id="doc3" class="yui-t1"> |
17 |
<div id="bd"> |
18 |
[% INCLUDE 'masthead.inc' %] |
19 |
|
20 |
<div id="yui-main"> |
21 |
<div class="yui-b"> |
22 |
<div class="yui-g"> |
23 |
<div id="useraccount" class="container"> |
24 |
|
25 |
[% IF empty_mandatory_fields %] |
26 |
<div class="dialog alert">You have not filled out all required fields. Please fill in all missing fields and resubmit.</div> |
27 |
[% END %] |
28 |
|
29 |
[% IF failed_captcha %] |
30 |
<div class="dialog alert">You typed in the wrong characters in the box before submitting. Please try again.</div> |
31 |
[% END %] |
32 |
|
33 |
<form method="post"> |
34 |
|
35 |
[% UNLESS |
36 |
hidden.defined('branchcode') |
37 |
%] |
38 |
|
39 |
<fieldset class="rows" id="memberentry_library"> |
40 |
|
41 |
<legend id="library_legend">Library</legend> |
42 |
<ol> |
43 |
[% UNLESS hidden.defined('branchcode') %] |
44 |
<li> |
45 |
[% IF mandatory.defined('branchcode') %] |
46 |
<label for="borrower_branchcode" class="required"> |
47 |
[% ELSE %] |
48 |
<label for="borrower_branchcode"> |
49 |
[% END %] |
50 |
Home Library:</label> |
51 |
|
52 |
<select id="borrower_branchcode" name="borrower_branchcode"> |
53 |
[% FOREACH b IN branches %] |
54 |
[% IF b.value == borrower.branchcode %] |
55 |
<option value="[% b.value %]" selected="selected">[% b.branchname %]</option> |
56 |
[% ELSE %] |
57 |
<option value="[% b.value %]">[% b.branchname %]</option> |
58 |
[% END %] |
59 |
[% END %] |
60 |
</select> |
61 |
</li> |
62 |
[% END %] |
63 |
</ol> |
64 |
</fieldset> |
65 |
[% END %] |
66 |
|
67 |
[% UNLESS |
68 |
hidden.defined('title') && hidden.defined('surname') && hidden.defined('firstname') && |
69 |
hidden.defined('dateofbirth') && hidden.defined('initials') && hidden.defined('othernames') && |
70 |
hidden.defined('sex') |
71 |
%] |
72 |
<fieldset class="rows" id="memberentry_identity"> |
73 |
<legend id="identity_legend">Identity</legend> |
74 |
|
75 |
<ol> |
76 |
[% UNLESS hidden.defined('title') %] |
77 |
<li> |
78 |
[% IF mandatory.defined('title') %] |
79 |
<label for="borrower_title" class="required"> |
80 |
[% ELSE %] |
81 |
<label for="borrower_title"> |
82 |
[% END %] |
83 |
Salutation:</label> |
84 |
|
85 |
<select id="borrower_title" name="borrower_title"> |
86 |
<option value=""> </option> |
87 |
[% FOREACH mt IN member_titles %] |
88 |
[% IF mt == borrower.title %] |
89 |
<option value="[% mt %]" selected="selected">[% mt %]</option> |
90 |
[% ELSE %] |
91 |
<option value="[% mt %]">[% mt %]</option> |
92 |
[% END %] |
93 |
[% END %] |
94 |
</select> |
95 |
</li> |
96 |
[% END %] |
97 |
|
98 |
[% UNLESS hidden.defined('surname') %] |
99 |
<li> |
100 |
[% IF mandatory.defined('surname') %] |
101 |
<label for="borrower_surname" class="required"> |
102 |
[% ELSE %] |
103 |
<label for="borrower_surname"> |
104 |
[% END %] |
105 |
Surname:</label> |
106 |
|
107 |
<input type="text" id="borrower_surname" name="borrower_surname" value="[% borrower.surname %]" /> |
108 |
[% IF mandatory.defined('surname') %]<span class="required">Required</span>[% END %] |
109 |
</li> |
110 |
[% END %] |
111 |
|
112 |
[% UNLESS hidden.defined('firstname') %] |
113 |
<li> |
114 |
[% IF mandatory.defined('firstname') %] |
115 |
<label for="borrower_firstname" class="required"> |
116 |
[% ELSE %] |
117 |
<label for="borrower_firstname"> |
118 |
[% END %] |
119 |
First name:</label> |
120 |
|
121 |
<input type="text" id="borrower_firstname" name="borrower_firstname" value="[% borrower.firstname %]" /> |
122 |
[% IF mandatory.defined('firstname') %]<span class="required">Required</span>[% END %] |
123 |
</li> |
124 |
[% END %] |
125 |
|
126 |
[% UNLESS hidden.defined('dateofbirth') %] |
127 |
<li> |
128 |
[% IF mandatory.defined('dateofbirth') %] |
129 |
<label for="borrower_dateofbirth" class="required"> |
130 |
[% ELSE %] |
131 |
<label for="borrower_dateofbirth"> |
132 |
[% END %] |
133 |
Date of birth:</label> |
134 |
|
135 |
<input type="text" id="borrower_dateofbirth" name="borrower_dateofbirth" value="[% borrower.dateofbirth | $KohaDates %]" readonly="readonly" size="10" /> |
136 |
|
137 |
<a href="#" style="font-size:85%;text-decoration:none;" onclick="document.getElementById('borrower_dateofbirth').value='';return false;">Clear date</a><p></p> |
138 |
|
139 |
[% IF mandatory.defined('dateofbirth') %]<span class="required">Required</span>[% END %] |
140 |
</li> |
141 |
[% END %] |
142 |
|
143 |
[% UNLESS hidden.defined('initials') %] |
144 |
<li> |
145 |
[% IF mandatory.defined('initials') %] |
146 |
<label for="borrower_initials" class="required"> |
147 |
[% ELSE %] |
148 |
<label for="borrower_initials"> |
149 |
[% END %] |
150 |
Initials:</label> |
151 |
|
152 |
<input type="text" id="borrower_initials" name="borrower_initials" value="[% borrower.initials %]" /> |
153 |
[% IF mandatory.defined('initials') %]<span class="required">Required</span>[% END %] |
154 |
</li> |
155 |
[% END %] |
156 |
|
157 |
[% UNLESS hidden.defined('othernames') %] |
158 |
<li> |
159 |
[% IF mandatory.defined('othernames') %] |
160 |
<label for="borrower_othernames" class="required"> |
161 |
[% ELSE %] |
162 |
<label for="borrower_othernames"> |
163 |
[% END %] |
164 |
Other names:</label> |
165 |
|
166 |
<input type="text" id="borrower_othernames" name="borrower_othernames" value="[% borrower.othernames %]" /> |
167 |
[% IF mandatory.defined('othernames') %]<span class="required">Required</span>[% END %] |
168 |
</li> |
169 |
[% END %] |
170 |
|
171 |
[% UNLESS hidden.defined('sex') %] |
172 |
<li class="radio"> |
173 |
<label for="sex-female">Female:</label> |
174 |
[% IF borrower.sex == 'F' %] |
175 |
<input type="radio" name="borrower_sex" id="sex-female" value="F" checked="checked" /> |
176 |
[% ELSE %] |
177 |
<input type="radio" name="borrower_sex" id="sex-female" value="F" /> |
178 |
[% END %] |
179 |
|
180 |
<label for="sex-male">Male:</label> |
181 |
[% IF borrower.sex == 'M' %] |
182 |
<input type="radio" name="borrower_sex" id="sex-male" value="M" checked="checked" /> |
183 |
[% ELSE %] |
184 |
<input type="radio" name="borrower_sex" id="sex-male" value="M" /> |
185 |
[% END %] |
186 |
|
187 |
<label for="sex-none">N/A:</label> |
188 |
[% IF borrower.sex == '' %] |
189 |
<input type="radio" name="borrower_sex" id="sex-none" value="" checked="checked" /> |
190 |
[% ELSE %] |
191 |
<input type="radio" name="borrower_sex" id="sex-none" value="" /> |
192 |
[% END %] |
193 |
|
194 |
[% IF mandatory.defined('sex') %]<span class="required">Required</span>[% END %] |
195 |
</li> |
196 |
[% END %] |
197 |
</ol> |
198 |
</fieldset> |
199 |
[% END %] |
200 |
|
201 |
[% UNLESS |
202 |
hidden.defined('streetnumber') && hidden.defined('address') && hidden.defined('address2') && |
203 |
hidden.defined('city') && hidden.defined('state') && hidden.defined('zipcode') && |
204 |
hidden.defined('country') |
205 |
%] |
206 |
<fieldset class="rows" id="memberentry_mainaddress"> |
207 |
<legend id="mainaddress_legend">Main address</legend> |
208 |
|
209 |
<ol> |
210 |
[% UNLESS hidden.defined('streetnumber') %] |
211 |
<li> |
212 |
[% IF mandatory.defined('streetnumber') %] |
213 |
<label for="borrower_streetnumber" class="required"> |
214 |
[% ELSE %] |
215 |
<label for="borrower_streetnumber"> |
216 |
[% END %] |
217 |
Street number:</label> |
218 |
|
219 |
<input type="text" id="borrower_streetnumber" name="borrower_streetnumber" value="[% borrower.streetnumber %]" /> |
220 |
[% IF mandatory.defined('streetnumber') %]<span class="required">Required</span>[% END %] |
221 |
</li> |
222 |
[% END %] |
223 |
|
224 |
[% UNLESS hidden.defined('address') %] |
225 |
<li> |
226 |
[% IF mandatory.defined('address') %] |
227 |
<label for="borrower_address" class="required"> |
228 |
[% ELSE %] |
229 |
<label for="borrower_address"> |
230 |
[% END %] |
231 |
Address:</label> |
232 |
|
233 |
<input type="text" id="borrower_address" name="borrower_address" value="[% borrower.address %]" /> |
234 |
[% IF mandatory.defined('address') %]<span class="required">Required</span>[% END %] |
235 |
</li> |
236 |
[% END %] |
237 |
|
238 |
[% UNLESS hidden.defined('address2') %] |
239 |
<li> |
240 |
[% IF mandatory.defined('address2') %] |
241 |
<label for="borrower_address2" class="required"> |
242 |
[% ELSE %] |
243 |
<label for="borrower_address2"> |
244 |
[% END %] |
245 |
Address 2:</label> |
246 |
|
247 |
<input type="text" id="borrower_address2" name="borrower_address2" value="[% borrower.address2 %]" /> |
248 |
[% IF mandatory.defined('address2') %]<span class="required">Required</span>[% END %] |
249 |
</li> |
250 |
[% END %] |
251 |
|
252 |
[% UNLESS hidden.defined('city') %] |
253 |
<li> |
254 |
[% IF mandatory.defined('city') %] |
255 |
<label for="borrower_city" class="required"> |
256 |
[% ELSE %] |
257 |
<label for="borrower_city"> |
258 |
[% END %] |
259 |
City:</label> |
260 |
|
261 |
<input type="text" id="borrower_city" name="borrower_city" value="[% borrower.city %]" /> |
262 |
[% IF mandatory.defined('city') %]<span class="required">Required</span>[% END %] |
263 |
</li> |
264 |
[% END %] |
265 |
|
266 |
[% UNLESS hidden.defined('state') %] |
267 |
<li> |
268 |
[% IF mandatory.defined('state') %] |
269 |
<label for="borrower_state" class="required"> |
270 |
[% ELSE %] |
271 |
<label for="borrower_state"> |
272 |
[% END %] |
273 |
State:</label> |
274 |
|
275 |
<input type="text" id="borrower_state" name="borrower_state" value="[% borrower.state %]" /> |
276 |
[% IF mandatory.defined('state') %]<span class="required">Required</span>[% END %] |
277 |
</li> |
278 |
[% END %] |
279 |
|
280 |
[% UNLESS hidden.defined('zipcode') %] |
281 |
<li> |
282 |
[% IF mandatory.defined('zipcode') %] |
283 |
<label for="borrower_zipcode" class="required"> |
284 |
[% ELSE %] |
285 |
<label for="borrower_zipcode"> |
286 |
[% END %] |
287 |
Zip/Postal code:</label> |
288 |
|
289 |
<input type="text" id="borrower_zipcode" name="borrower_zipcode" value="[% borrower.zipcode %]" /> |
290 |
[% IF mandatory.defined('zipcode') %]<span class="required">Required</span>[% END %] |
291 |
</li> |
292 |
[% END %] |
293 |
|
294 |
[% UNLESS hidden.defined('country') %] |
295 |
<li> |
296 |
[% IF mandatory.defined('country') %] |
297 |
<label for="borrower_country" class="required"> |
298 |
[% ELSE %] |
299 |
<label for="borrower_country"> |
300 |
[% END %] |
301 |
Country:</label> |
302 |
|
303 |
<input type="text" id="borrower_country" name="borrower_country" value="[% borrower.country %]" /> |
304 |
[% IF mandatory.defined('country') %]<span class="required">Required</span>[% END %] |
305 |
</li> |
306 |
[% END %] |
307 |
|
308 |
</ol> |
309 |
</fieldset> |
310 |
[% END %] |
311 |
|
312 |
[% UNLESS |
313 |
hidden.defined('phone') && hidden.defined('phonepro') && hidden.defined('mobile') && |
314 |
hidden.defined('email') && hidden.defined('emailpro') && hidden.defined('fax') |
315 |
%] |
316 |
<fieldset class="rows" id="memberentry_contact"> |
317 |
<legend id="contact_legend">Contact information</legend> |
318 |
|
319 |
<ol> |
320 |
[% UNLESS hidden.defined('phone') %] |
321 |
<li> |
322 |
[% IF mandatory.defined('phone') %] |
323 |
<label for="borrower_phone" class="required"> |
324 |
[% ELSE %] |
325 |
<label for="borrower_phone"> |
326 |
[% END %] |
327 |
Primary phone:</label> |
328 |
|
329 |
<input type="text" id="borrower_phone" name="borrower_phone" value="[% borrower.phone %]" /> |
330 |
[% IF mandatory.defined('phone') %]<span class="required">Required</span>[% END %] |
331 |
</li> |
332 |
[% END %] |
333 |
|
334 |
[% UNLESS hidden.defined('phonepro') %] |
335 |
<li> |
336 |
[% IF mandatory.defined('phonepro') %] |
337 |
<label for="borrower_phonepro" class="required"> |
338 |
[% ELSE %] |
339 |
<label for="borrower_phonepro"> |
340 |
[% END %] |
341 |
Secondary phone:</label> |
342 |
|
343 |
<input type="text" id="borrower_phonepro" name="borrower_phonepro" value="[% borrower.phonepro %]" /> |
344 |
[% IF mandatory.defined('phonepro') %]<span class="required">Required</span>[% END %] |
345 |
</li> |
346 |
[% END %] |
347 |
|
348 |
[% UNLESS hidden.defined('mobile') %] |
349 |
<li> |
350 |
[% IF mandatory.defined('mobile') %] |
351 |
<label for="borrower_mobile" class="required"> |
352 |
[% ELSE %] |
353 |
<label for="borrower_mobile"> |
354 |
[% END %] |
355 |
Mobile phone:</label> |
356 |
|
357 |
<input type="text" id="borrower_mobile" name="borrower_mobile" value="[% borrower.mobile %]" /> |
358 |
[% IF mandatory.defined('mobile') %]<span class="required">Required</span>[% END %] |
359 |
</li> |
360 |
[% END %] |
361 |
|
362 |
[% UNLESS hidden.defined('email') %] |
363 |
<li> |
364 |
[% IF mandatory.defined('email') %] |
365 |
<label for="borrower_email" class="required"> |
366 |
[% ELSE %] |
367 |
<label for="borrower_email"> |
368 |
[% END %] |
369 |
Primary email:</label> |
370 |
|
371 |
<input type="text" id="borrower_email" name="borrower_email" value="[% borrower.email %]" /> |
372 |
[% IF mandatory.defined('email') %]<span class="required">Required</span>[% END %] |
373 |
</li> |
374 |
[% END %] |
375 |
|
376 |
[% UNLESS hidden.defined('emailpro') %] |
377 |
<li> |
378 |
[% IF mandatory.defined('emailpro') %] |
379 |
<label for="borrower_emailpro" class="required"> |
380 |
[% ELSE %] |
381 |
<label for="borrower_emailpro"> |
382 |
[% END %] |
383 |
Secondary email:</label> |
384 |
|
385 |
<input type="text" id="borrower_emailpro" name="borrower_emailpro" value="[% borrower.emailpro %]" /> |
386 |
[% IF mandatory.defined('emailpro') %]<span class="required">Required</span>[% END %] |
387 |
</li> |
388 |
[% END %] |
389 |
|
390 |
[% UNLESS hidden.defined('fax') %] |
391 |
<li> |
392 |
[% IF mandatory.defined('fax') %] |
393 |
<label for="borrower_fax" class="required"> |
394 |
[% ELSE %] |
395 |
<label for="borrower_fax"> |
396 |
[% END %] |
397 |
Fax:</label> |
398 |
|
399 |
<input type="text" id="borrower_fax" name="borrower_fax" value="[% borrower.fax %]" /> |
400 |
[% IF mandatory.defined('fax') %]<span class="required">Required</span>[% END %] |
401 |
</li> |
402 |
[% END %] |
403 |
</ol> |
404 |
</fieldset> |
405 |
[% END %] |
406 |
|
407 |
[% UNLESS |
408 |
hidden.defined('B_address') && hidden.defined('B_address2') && hidden.defined('B_city') && |
409 |
hidden.defined('B_state') && hidden.defined('B_zipcode') && hidden.defined('B_county') && |
410 |
hidden.defined('B_phone') && hidden.defined('B_email') && hidden.defined('contactnote') |
411 |
%] |
412 |
<fieldset class="rows" id="memberentry_alternateaddress"> |
413 |
<legend id="alternateaddress_legend">Alternate address</legend> |
414 |
|
415 |
<ol> |
416 |
[% UNLESS hidden.defined('B_address') %] |
417 |
<li> |
418 |
[% IF mandatory.defined('B_address') %] |
419 |
<label for="borrower_B_address" class="required"> |
420 |
[% ELSE %] |
421 |
<label for="borrower_B_address"> |
422 |
[% END %] |
423 |
Address:</label> |
424 |
|
425 |
<input type="text" id="borrower_B_address" name="borrower_B_address" value="[% borrower.B_address %]" /> |
426 |
[% IF mandatory.defined('B_address') %]<span class="required">Required</span>[% END %] |
427 |
</li> |
428 |
[% END %] |
429 |
|
430 |
[% UNLESS hidden.defined('B_address2') %] |
431 |
<li> |
432 |
[% IF mandatory.defined('B_address2') %] |
433 |
<label for="borrower_B_address2" class="required"> |
434 |
[% ELSE %] |
435 |
<label for="borrower_B_address2"> |
436 |
[% END %] |
437 |
Address 2:</label> |
438 |
|
439 |
<input type="text" id="borrower_B_address2" name="borrower_B_address2" value="[% borrower.B_address2 %]" /> |
440 |
[% IF mandatory.defined('B_address2') %]<span class="required">Required</span>[% END %] |
441 |
</li> |
442 |
[% END %] |
443 |
|
444 |
[% UNLESS hidden.defined('B_city') %] |
445 |
<li> |
446 |
[% IF mandatory.defined('B_city') %] |
447 |
<label for="borrower_B_city" class="required"> |
448 |
[% ELSE %] |
449 |
<label for="borrower_B_city"> |
450 |
[% END %] |
451 |
City:</label> |
452 |
|
453 |
<input type="text" id="borrower_B_city" name="borrower_B_city" value="[% borrower.B_city %]" /> |
454 |
[% IF mandatory.defined('B_city') %]<span class="required">Required</span>[% END %] |
455 |
</li> |
456 |
[% END %] |
457 |
|
458 |
[% UNLESS hidden.defined('B_state') %] |
459 |
<li> |
460 |
[% IF mandatory.defined('B_state') %] |
461 |
<label for="borrower_B_state" class="required"> |
462 |
[% ELSE %] |
463 |
<label for="borrower_B_state"> |
464 |
[% END %] |
465 |
State:</label> |
466 |
|
467 |
<input type="text" id="borrower_B_state" name="borrower_B_state" value="[% borrower.B_state %]" /> |
468 |
[% IF mandatory.defined('B_state') %]<span class="required">Required</span>[% END %] |
469 |
</li> |
470 |
[% END %] |
471 |
|
472 |
[% UNLESS hidden.defined('B_zipcode') %] |
473 |
<li> |
474 |
[% IF mandatory.defined('B_zipcode') %] |
475 |
<label for="borrower_B_zipcode" class="required"> |
476 |
[% ELSE %] |
477 |
<label for="borrower_B_zipcode"> |
478 |
[% END %] |
479 |
Zip/Postal code:</label> |
480 |
|
481 |
<input type="text" id="borrower_B_zipcode" name="borrower_B_zipcode" value="[% borrower.B_zipcode %]" /> |
482 |
[% IF mandatory.defined('B_zipcode') %]<span class="required">Required</span>[% END %] |
483 |
</li> |
484 |
[% END %] |
485 |
|
486 |
[% UNLESS hidden.defined('B_country') %] |
487 |
<li> |
488 |
[% IF mandatory.defined('B_country') %] |
489 |
<label for="borrower_B_country" class="required"> |
490 |
[% ELSE %] |
491 |
<label for="borrower_B_country"> |
492 |
[% END %] |
493 |
Country:</label> |
494 |
|
495 |
<input type="text" id="borrower_B_country" name="borrower_B_country" value="[% borrower.B_country %]" /> |
496 |
[% IF mandatory.defined('B_country') %]<span class="required">Required</span>[% END %] |
497 |
</li> |
498 |
[% END %] |
499 |
|
500 |
[% UNLESS hidden.defined('B_phone') %] |
501 |
<li> |
502 |
[% IF mandatory.defined('B_phone') %] |
503 |
<label for="borrower_B_phone" class="required"> |
504 |
[% ELSE %] |
505 |
<label for="borrower_B_phone"> |
506 |
[% END %] |
507 |
Phone:</label> |
508 |
|
509 |
<input type="text" id="borrower_B_phone" name="borrower_B_phone" value="[% borrower.B_phone %]" /> |
510 |
[% IF mandatory.defined('B_phone') %]<span class="required">Required</span>[% END %] |
511 |
</li> |
512 |
[% END %] |
513 |
|
514 |
[% UNLESS hidden.defined('B_email') %] |
515 |
<li> |
516 |
[% IF mandatory.defined('B_email') %] |
517 |
<label for="borrower_B_email" class="required"> |
518 |
[% ELSE %] |
519 |
<label for="borrower_B_email"> |
520 |
[% END %] |
521 |
Email:</label> |
522 |
|
523 |
<input type="text" id="borrower_B_email" name="borrower_B_email" value="[% borrower.B_email %]" /> |
524 |
[% IF mandatory.defined('B_email') %]<span class="required">Required</span>[% END %] |
525 |
</li> |
526 |
[% END %] |
527 |
|
528 |
[% UNLESS hidden.defined('contactnote') %] |
529 |
<li> |
530 |
[% IF mandatory.defined('contactnote') %] |
531 |
<label for="borrower_contactnote" class="required"> |
532 |
[% ELSE %] |
533 |
<label for="borrower_contactnote"> |
534 |
[% END %] |
535 |
Contact Note:</label> |
536 |
|
537 |
<textarea id="borrower_contactnote" name="borrower_contactnote" cols="40" rows="2">[% borrower.contactnote %]</textarea> |
538 |
[% IF mandatory.defined('contactnote') %]<span class="required">Required</span>[% END %] |
539 |
</li> |
540 |
[% END %] |
541 |
|
542 |
</ol> |
543 |
</fieldset> |
544 |
[% END %] |
545 |
|
546 |
[% UNLESS |
547 |
hidden.defined('altcontactsurname') && hidden.defined('altcontactfirstname') && hidden.defined('altcontactaddress1') && |
548 |
hidden.defined('altcontactaddress2') && hidden.defined('altcontactaddress3') && hidden.defined('altcontactstate') && |
549 |
hidden.defined('altcontactzipcode') && hidden.defined('altcontactcountry') && hidden.defined('altcontactphone') |
550 |
%] |
551 |
<fieldset class="rows" id="memberentry_alternatecontact"> |
552 |
<legend id="alternatecontact_legend">Alternate contact</legend> |
553 |
|
554 |
<ol> |
555 |
[% UNLESS hidden.defined('altcontactsurname') %] |
556 |
<li> |
557 |
[% IF mandatory.defined('altcontactsurname') %] |
558 |
<label for="borrower_altcontactsurname" class="required"> |
559 |
[% ELSE %] |
560 |
<label for="borrower_altcontactsurname"> |
561 |
[% END %] |
562 |
Surname:</label> |
563 |
|
564 |
<input type="text" id="borrower_altcontactsurname" name="borrower_altcontactsurname" value="[% borrower.altcontactsurname %]" /> |
565 |
[% IF mandatory.defined('altcontactsurname') %]<span class="required">Required</span>[% END %] |
566 |
</li> |
567 |
[% END %] |
568 |
|
569 |
[% UNLESS hidden.defined('altcontactfirstname') %] |
570 |
<li> |
571 |
[% IF mandatory.defined('altcontactfirstname') %] |
572 |
<label for="borrower_altcontactfirstname" class="required"> |
573 |
[% ELSE %] |
574 |
<label for="borrower_altcontactfirstname"> |
575 |
[% END %] |
576 |
First name:</label> |
577 |
|
578 |
<input type="text" id="borrower_altcontactfirstname" name="borrower_altcontactfirstname" value="[% borrower.altcontactfirstname %]" /> |
579 |
[% IF mandatory.defined('altcontactfirstname') %]<span class="required">Required</span>[% END %] |
580 |
</li> |
581 |
[% END %] |
582 |
|
583 |
[% UNLESS hidden.defined('altcontactaddress1') %] |
584 |
<li> |
585 |
[% IF mandatory.defined('altcontactaddress1') %] |
586 |
<label for="borrower_altcontactaddress1" class="required"> |
587 |
[% ELSE %] |
588 |
<label for="borrower_altcontactaddress1"> |
589 |
[% END %] |
590 |
Address:</label> |
591 |
|
592 |
<input type="text" id="borrower_altcontactaddress1" name="borrower_altcontactaddress1" value="[% borrower.altcontactaddress1 %]" /> |
593 |
[% IF mandatory.defined('altcontactaddress1') %]<span class="required">Required</span>[% END %] |
594 |
</li> |
595 |
[% END %] |
596 |
|
597 |
[% UNLESS hidden.defined('altcontactaddress2') %] |
598 |
<li> |
599 |
[% IF mandatory.defined('altcontactaddress2') %] |
600 |
<label for="borrower_altcontactaddress2" class="required"> |
601 |
[% ELSE %] |
602 |
<label for="borrower_altcontactaddress2"> |
603 |
[% END %] |
604 |
Address 2:</label> |
605 |
|
606 |
<input type="text" id="borrower_altcontactaddress2" name="borrower_altcontactaddress2" value="[% borrower.altcontactaddress2 %]" /> |
607 |
[% IF mandatory.defined('altcontactaddress2') %]<span class="required">Required</span>[% END %] |
608 |
</li> |
609 |
[% END %] |
610 |
|
611 |
[% UNLESS hidden.defined('altcontactaddress3') %] |
612 |
<li> |
613 |
[% IF mandatory.defined('altcontactaddress3') %] |
614 |
<label for="borrower_altcontactaddress3" class="required"> |
615 |
[% ELSE %] |
616 |
<label for="borrower_altcontactaddress3"> |
617 |
[% END %] |
618 |
City:</label> |
619 |
|
620 |
<input type="text" id="borrower_altcontactaddress3" name="borrower_altcontactaddress3" value="[% borrower.altcontactaddress3 %]" /> |
621 |
[% IF mandatory.defined('altcontactaddress3') %]<span class="required">Required</span>[% END %] |
622 |
</li> |
623 |
[% END %] |
624 |
|
625 |
[% UNLESS hidden.defined('altcontactstate') %] |
626 |
<li> |
627 |
[% IF mandatory.defined('altcontactstate') %] |
628 |
<label for="borrower_altcontactstate" class="required"> |
629 |
[% ELSE %] |
630 |
<label for="borrower_altcontactstate"> |
631 |
[% END %] |
632 |
State:</label> |
633 |
|
634 |
<input type="text" id="borrower_altcontactstate" name="borrower_altcontactstate" value="[% borrower.altcontactstate %]" /> |
635 |
[% IF mandatory.defined('altcontactstate') %]<span class="required">Required</span>[% END %] |
636 |
</li> |
637 |
[% END %] |
638 |
|
639 |
[% UNLESS hidden.defined('altcontactzipcode') %] |
640 |
<li> |
641 |
[% IF mandatory.defined('altcontactzipcode') %] |
642 |
<label for="borrower_altcontactzipcode" class="required"> |
643 |
[% ELSE %] |
644 |
<label for="borrower_altcontactzipcode"> |
645 |
[% END %] |
646 |
Zip/Postal code:</label> |
647 |
|
648 |
<input type="text" id="borrower_altcontactzipcode" name="borrower_altcontactzipcode" value="[% borrower.altcontactzipcode %]" /> |
649 |
[% IF mandatory.defined('altcontactzipcode') %]<span class="required">Required</span>[% END %] |
650 |
</li> |
651 |
[% END %] |
652 |
|
653 |
[% UNLESS hidden.defined('altcontactcountry') %] |
654 |
<li> |
655 |
[% IF mandatory.defined('altcontactcountry') %] |
656 |
<label for="borrower_altcontactcountry" class="required"> |
657 |
[% ELSE %] |
658 |
<label for="borrower_altcontactcountry"> |
659 |
[% END %] |
660 |
Country:</label> |
661 |
|
662 |
<input type="text" id="borrower_altcontactcountry" name="borrower_altcontactcountry" value="[% borrower.altcontactcountry %]" /> |
663 |
[% IF mandatory.defined('altcontactcountry') %]<span class="required">Required</span>[% END %] |
664 |
</li> |
665 |
[% END %] |
666 |
|
667 |
[% UNLESS hidden.defined('altcontactphone') %] |
668 |
<li> |
669 |
[% IF mandatory.defined('altcontactphone') %] |
670 |
<label for="borrower_altcontactphone" class="required"> |
671 |
[% ELSE %] |
672 |
<label for="borrower_altcontactphone"> |
673 |
[% END %] |
674 |
Phone:</label> |
675 |
|
676 |
<input type="text" id="borrower_altcontactphone" name="borrower_altcontactphone" value="[% borrower.altcontactphone %]" /> |
677 |
[% IF mandatory.defined('altcontactphone') %]<span class="required">Required</span>[% END %] |
678 |
</li> |
679 |
[% END %] |
680 |
</ol> |
681 |
</fieldset> |
682 |
[% END %] |
683 |
|
684 |
[% UNLESS action == 'edit' %] |
685 |
<p>Please type this following characters into the box below : [% captcha %]</p> |
686 |
<p> |
687 |
<input type="text" name="captcha" id="captcha" /> |
688 |
<input type="hidden" name="captcha_digest" value="[% captcha_digest %]" /> |
689 |
</p> |
690 |
[% END %] |
691 |
|
692 |
[% IF action == 'edit' %] |
693 |
<input type="hidden" name="action" value="update" /> |
694 |
<input type="submit" value="Submit Update Request" /> |
695 |
[% ELSE %] |
696 |
<input type="hidden" name="action" value="create" /> |
697 |
<input type="submit" value="Submit" /> |
698 |
[% END %] |
699 |
|
700 |
</form> |
701 |
|
702 |
</div><!--/div id="useraccount" --> |
703 |
</div> |
704 |
</div> |
705 |
</div> |
706 |
|
707 |
<div class="yui-b"> |
708 |
<div id="leftmenus" class="container"> |
709 |
[% INCLUDE 'navigation.inc' IsPatronPage=1 %] |
710 |
</div> |
711 |
</div> |
712 |
</div> |
713 |
[% INCLUDE 'opac-bottom.inc' %] |