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<h1>Registrierung</h1>
<br><br>


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			<span class="text-fett">Lieferanschrift:</span>
			
			
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				<td colspan=2 class="text-color" align=right>Kunden-Art &nbsp;&nbsp;</TD>
			
				
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			  	  <input name="kind" type="radio" class="input" value="K"> Krankenhaus / Klinik &nbsp; <br>
				  <input name="kind" type="radio" class="input" value="P"> Arztpraxis, die per Post versendet &nbsp; <br>
				  <input name="kind" type="radio" class="input" value="B"> Arztpraxis, die per Kurier versendet &nbsp; <br>
				  <input name="kind" type="radio" class="input" value="D"> Dermatologie &nbsp;					  			  
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			<span class="text-fett">Pers&ouml;nliche Daten:</span>
			
			
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				<td colspan=2 class="text-color" align=right>Anrede &nbsp;&nbsp;</TD>
			
				
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				  <input name="gender" type="radio" class="input" value="Herr"> Herr &nbsp;&nbsp;&nbsp;
				  <input name="gender" type="radio" class="input" value="Frau"> Frau	
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			Titel &nbsp;&nbsp;</TD>
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				Mit diesen Daten melden Sie sich in Zukunft bei uns an:	<td><td></td></tr>		
		
		
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			Die farblich gekennzeichneten Felder d&uuml;rfen nicht leer bleiben			
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