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<form class=“layout_form cr_form cr_font“ action=“https://mailings.kirschbaum.de/f/268908-174026/wcs/“ method=“post“ target=“_blank“>
<div class=“cr_body cr_page cr_font formbox“>
<div class=“non_sortable“ style=“text-align:left;“>
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<div id=“4038914″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable musthave“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038914″ class=“itemname“>Teilnehmer Name, Vorname, Akad. Grad*</label>
        <input id=“cr_form-input–text4038914″ class=“cr_form-input“ type=“text“ name=“358257″ placeholder=““ style=“width:100%;“>
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</div>
<div id=“4038929″ rel=“mce_text“ class=“cr_ipe_item ui-sortable“>
    <div class=“mce_text“><p><br></p><p><span style=“font-size: medium;“ mce_style=“font-size: medium;“><b>Teilnehmeradresse</b></span></p></div>
    </div><div id=“4038932″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable musthave“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038932″ class=“itemname“>Straße Nr.*</label>
        <input id=“cr_form-input–text4038932″ class=“cr_form-input“ type=“text“ name=“358258″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038933″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable musthave“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038933″ class=“itemname“>PLZ/Ort/Land*</label>
        <input id=“cr_form-input–text4038933″ class=“cr_form-input“ type=“text“ name=“358259″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038934″ rel=“email“ class=“cr_form-component cr_form-component–email cr_ipe_item ui-sortable musthave“ style=“margin-bottom:15px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typeemail“>
        <label for=“text4038934″>E-Mail*</label>
        <input class=“cr_form-input“ type=“email“ id=“text4038934″ name=“email“ value=““ placeholder=“name@example.com“ style=“width:100%;“>
    </div>
</div><div id=“4038935″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038935″ class=“itemname“>EFN</label>
        <input id=“cr_form-input–text4038935″ class=“cr_form-input“ type=“text“ name=“358260″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038936″ rel=“mce_text“ class=“cr_ipe_item ui-sortable“>
    <div class=“mce_text“><p><br></p><p><span style=“font-size: medium;“ mce_style=“font-size: medium;“><b>Rechnungsadresse </b>(falls abweichend von Teilnehmeradresse)</span></p></div>
    </div><div id=“4038937″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038937″ class=“itemname“>Firma/Institution</label>
        <input id=“cr_form-input–text4038937″ class=“cr_form-input“ type=“text“ name=“358261″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038938″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038938″ class=“itemname“>UID Nummer (zwingend anzugeben für Firmen auch aus Deutschland)</label>
        <input id=“cr_form-input–text4038938″ class=“cr_form-input“ type=“text“ name=“358262″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038939″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038939″ class=“itemname“>Abteilung</label>
        <input id=“cr_form-input–text4038939″ class=“cr_form-input“ type=“text“ name=“358263″ placeholder=““ style=“width:100%;“>
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</div>
<div id=“4038940″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038940″ class=“itemname“>Straße Nr. </label>
        <input id=“cr_form-input–text4038940″ class=“cr_form-input“ type=“text“ name=“358264″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038941″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038941″ class=“itemname“>PLZ/Ort</label>
        <input id=“cr_form-input–text4038941″ class=“cr_form-input“ type=“text“ name=“358265″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038942″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038942″ class=“itemname“>Telefonnummer</label>
        <input id=“cr_form-input–text4038942″ class=“cr_form-input“ type=“text“ name=“358266″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038943″ rel=“text“ class=“cr_form-component cr_form-component–text cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <div class=“cr_form-inputgroup cr_form-inputgroup–typetext“>
        <label for=“cr_form-input–text4038943″ class=“itemname“>E-Mail Adresse Rechnungsempfänger</label>
        <input id=“cr_form-input–text4038943″ class=“cr_form-input“ type=“text“ name=“358267″ placeholder=““ style=“width:100%;“>
    </div>
</div>
<div id=“4038944″ rel=“hr“ class=“cr_ipe_item ui-sortable cr_noedit“ style=““>
    <hr class=“cr_hr“ />
</div><div id=“4038945″ rel=“radio“ class=“cr_form-component cr_form-component–group cr_form-component–radio cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <span class=“label cr_form-component–header“>Kongressgebühren</span>
    <div class=“cr_form-component–group“>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“Mitglieder der DGVM oder DGVP 365,- Euro (zzgl. MwSt.)4038945″ class=“cr_form-radio“ name=“358268″ type=“radio“ value=“Mitglieder der DGVM oder DGVP 365,- Euro (zzgl. MwSt.)“ >
            <label class=“no-label“ for=“Mitglieder der DGVM oder DGVP 365,- Euro (zzgl. MwSt.)4038945″>Mitglieder der DGVM oder DGVP 365,- Euro (zzgl. MwSt.)</label>
        </span><br>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“Normalpreis 410,- Euro (zzgl. MwSt.)4038945″ class=“cr_form-radio“ name=“358268″ type=“radio“ value=“Normalpreis 410,- Euro (zzgl. MwSt.)“ >
            <label class=“no-label“ for=“Normalpreis 410,- Euro (zzgl. MwSt.)4038945″>Normalpreis 410,- Euro (zzgl. MwSt.)</label>
        </span><br>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“Behördenpreis 365,- Euro (zzgl. MwSt.)4038945″ class=“cr_form-radio“ name=“358268″ type=“radio“ value=“Behördenpreis 365,- Euro (zzgl. MwSt.)“ selected checked>
            <label class=“no-label“ for=“Behördenpreis 365,- Euro (zzgl. MwSt.)4038945″>Behördenpreis 365,- Euro (zzgl. MwSt.)</label>
        </span><br>
    </div>
</div>
<div id=“4038946″ rel=“radio“ class=“cr_form-component cr_form-component–group cr_form-component–radio cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <span class=“label cr_form-component–header“>Workshops am 27.9.2024</span>
    <div class=“cr_form-component–group“>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“39,- Euro (zzgl. MwSt.) WS 1 „GIDAS – Unfalldatenerhebung und Verletzungsdokumentation“ (8.30 – 10.00 Uhr) 4038946″ class=“cr_form-radio“ name=“358269″ type=“radio“ value=“39,- Euro (zzgl. MwSt.) WS 1 „GIDAS – Unfalldatenerhebung und Verletzungsdokumentation“ (8.30 – 10.00 Uhr) “ >
            <label class=“no-label“ for=“39,- Euro (zzgl. MwSt.) WS 1 „GIDAS – Unfalldatenerhebung und Verletzungsdokumentation“ (8.30 – 10.00 Uhr) 4038946″>39,- Euro (zzgl. MwSt.) WS 1 „GIDAS – Unfalldatenerhebung und Verletzungsdokumentation“ (8.30 – 10.00 Uhr) </label>
        </span><br>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“39,- Euro (zzgl. MwSt.) WS 2 „Unfallursachen – Einschlafen versus Bewusstseinsstörungen“ (8.30 – 10.00 Uhr)4038946″ class=“cr_form-radio“ name=“358269″ type=“radio“ value=“39,- Euro (zzgl. MwSt.) WS 2 „Unfallursachen – Einschlafen versus Bewusstseinsstörungen“ (8.30 – 10.00 Uhr)“ >
            <label class=“no-label“ for=“39,- Euro (zzgl. MwSt.) WS 2 „Unfallursachen – Einschlafen versus Bewusstseinsstörungen“ (8.30 – 10.00 Uhr)4038946″>39,- Euro (zzgl. MwSt.) WS 2 „Unfallursachen – Einschlafen versus Bewusstseinsstörungen“ (8.30 – 10.00 Uhr)</label>
        </span><br>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“39,- Euro (zzgl. MwSt.) WS 3 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil I, psychoaktive Substanzen“ (8.30 – 10.00 Uhr)4038946″ class=“cr_form-radio“ name=“358269″ type=“radio“ value=“39,- Euro (zzgl. MwSt.) WS 3 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil I, psychoaktive Substanzen“ (8.30 – 10.00 Uhr)“ >
            <label class=“no-label“ for=“39,- Euro (zzgl. MwSt.) WS 3 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil I, psychoaktive Substanzen“ (8.30 – 10.00 Uhr)4038946″>39,- Euro (zzgl. MwSt.) WS 3 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil I, psychoaktive Substanzen“ (8.30 – 10.00 Uhr)</label>
        </span><br>
    </div>
</div>
<div id=“4038947″ rel=“radio“ class=“cr_form-component cr_form-component–group cr_form-component–radio cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <span class=“label cr_form-component–header“>Workshops am 28.9.2024</span>
    <div class=“cr_form-component–group“>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“39,- Euro (zzgl. MwSt.) WS 4 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil II, straf- und ordnungsrechtl.iche Vergehen“ (8.30 – 10.00 Uhr)4038947″ class=“cr_form-radio“ name=“358270″ type=“radio“ value=“39,- Euro (zzgl. MwSt.) WS 4 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil II, straf- und ordnungsrechtl.iche Vergehen“ (8.30 – 10.00 Uhr)“ >
            <label class=“no-label“ for=“39,- Euro (zzgl. MwSt.) WS 4 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil II, straf- und ordnungsrechtl.iche Vergehen“ (8.30 – 10.00 Uhr)4038947″>39,- Euro (zzgl. MwSt.) WS 4 „Fahreigungsbegutachtung aus psychologischer Sicht – Fallbesprechungen Teil II, straf- und ordnungsrechtl.iche Vergehen“ (8.30 – 10.00 Uhr)</label>
        </span><br>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typeradio“>
            <input id=“39,- Euro (zzgl. MwSt.) WS 5  „Toxikologie – Plausibilität in der polizeilichen Praxis und in der Fahreignungsbegutachtung“ (8.30 – 10.00 Uhr)4038947″ class=“cr_form-radio“ name=“358270″ type=“radio“ value=“39,- Euro (zzgl. MwSt.) WS 5  „Toxikologie – Plausibilität in der polizeilichen Praxis und in der Fahreignungsbegutachtung“ (8.30 – 10.00 Uhr)“ >
            <label class=“no-label“ for=“39,- Euro (zzgl. MwSt.) WS 5  „Toxikologie – Plausibilität in der polizeilichen Praxis und in der Fahreignungsbegutachtung“ (8.30 – 10.00 Uhr)4038947″>39,- Euro (zzgl. MwSt.) WS 5  „Toxikologie – Plausibilität in der polizeilichen Praxis und in der Fahreignungsbegutachtung“ (8.30 – 10.00 Uhr)</label>
        </span><br>
    </div>
</div>
<div id=“4038948″ rel=“checkbox“ class=“cr_form-component cr_form-component–group cr_form-component–checkbox cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <span class=“label cr_form-component–header“>Vorabendveranstaltung am 26.9.2024 (lockeres Get-together mit kleinem Imbiss)</span>
    <div class=“cr_form-component–group“>
        <!– FIXME: Nebeneinander, nicht untereinander –>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typecheckbox“>
            <input id=“25,- Euro (zzgl. MwSt.) Teilnahme an der Vorabendveranstaltung (begrenzte Teilnehmerzahl)4038948″ class=“cr_form-checkbox cr_ipe_checkbox“ type=“checkbox“ name=“358271[]“ value=“25,- Euro (zzgl. MwSt.) Teilnahme an der Vorabendveranstaltung (begrenzte Teilnehmerzahl)“ >
            <label class=“no-label“ for=“25,- Euro (zzgl. MwSt.) Teilnahme an der Vorabendveranstaltung (begrenzte Teilnehmerzahl)4038948″>25,- Euro (zzgl. MwSt.) Teilnahme an der Vorabendveranstaltung (begrenzte Teilnehmerzahl)</label>
        </span>&nbsp;
    </div>
</div>
<div id=“4038949″ rel=“checkbox“ class=“cr_form-component cr_form-component–group cr_form-component–checkbox cr_ipe_item ui-sortable“ style=“ margin-bottom:0px;“>
    <span class=“label cr_form-component–header“>Abendveranstaltung am 27.9.2024</span>
    <div class=“cr_form-component–group“>
        <!– FIXME: Nebeneinander, nicht untereinander –>
        <span class=“cr_form-inputgroup cr_form-inputgroup–typecheckbox“>
            <input id=“59,- Euro (zzgl. MwSt.) Teilnahme an der Abendveranstaltung4038949″ class=“cr_form-checkbox cr_ipe_checkbox“ type=“checkbox“ name=“358272[]“ value=“59,- Euro (zzgl. MwSt.) Teilnahme an der Abendveranstaltung“ >
            <label class=“no-label“ for=“59,- Euro (zzgl. MwSt.) Teilnahme an der Abendveranstaltung4038949″>59,- Euro (zzgl. MwSt.) Teilnahme an der Abendveranstaltung</label>
        </span>&nbsp;
    </div>
</div>
<div id=“4038950″ rel=“button“ class=“cr_form-component cr_form-component–submit cr_ipe_item ui-sortable  submit_container“>
    <button type=“submit“ class=“cr_form-block cr_button“>kostenpflichtig anmelden</button>
</div>
        </div>
    </div>
</form>