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- <div id="form-gewinnspiel">
- <div class="form-instructions">
- <p>Mach mit und gewinne einen E-Roller! Einfach das Formular ausfüllen und die Zukunft von E-Mobility selber ausprobieren.</p>
- </div>
- <div class="panel">
- <div class="acl-contest-response-window alert" style="display: none;">
- <div class="alert--content"></div>
- </div>
- <form method="post" action="{url controller=aclcontest action=addnewentry}" class="acl-contest-form">
- <div class="panel--body is--wide form-gewinn">
- <div class="namefields">
- <div class="form-gewinn-firstname">
- Vorname:*<br>
- <input type="text" name="firstname" required /><br>
- </div>
- <div class="form-gewinn-lastname">
- Nachname:*<br>
- <input type="text" name="lastname" required /><br>
- </div>
- </div>
- <div class="streetfields">
- <div class="form-gewinn-street">
- Straße:*<br>
- <input type="text" name="street" required /><br>
- </div>
- <div class="form-gewinn-plz">
- PLZ*<br>
- <input type="text" name="zipcode" required /><br>
- </div>
- </div>
- <div class="areafields">
- <div class="form-gewinn-city">
- Ort*<br>
- <input type="text" name="city" required /><br>
- </div>
- <div class="form-gewinn-email">
- E-mail*<br>
- <input type="email" name="email" required /><br>
- </div>
- </div>
- <div class="contactfields">
- <div class="form-gewinn-phone">
- Telefonnummer<br>
- <input type="text" name="phone"><br>
- </div>
- <div class="form-gewinn-birthday">
- Geburtsdatum* (e.g. 28.10.2001)<br>
- <input type="text" name="birthdate" required><br>
- </div>
- </div>
- <div class="form-gewinn-datenshutz">
- <input type="checkbox" required name="agreement">
- Ich akzeptiere die <a href="https://shop.wienenergie.at/datenschutz" target="_blank">Datenschutzerklärung.</a><br>
- <input type="checkbox" required name="conditions">
- Ich akzeptiere die <a href="https://shop.wienenergie.at/media/pdf/84/e3/1d/05092018_Teilnahmebedingungen_Gewinnspiel.pdf" target="_blank">Teilnahmebedingungen.</a><br><br>
- </div>
- <button type="submit" class="btn btn-info button-gewinn-submit">Jetzt gewinnen</button>
- <div class="tickets-image-gewinn">
- <img src="https://shop.wienenergie.at/media/image/f7/14/8f/180917_WEN_Stadt-Wien_Websitebild_510x510_E-Roller5b9fbd28626e7.png" alt="ticket">
- <a href="https://shop.wienenergie.at/media/pdf/a8/cd/08/NIU_N1S_C1-C3_N1S-EU4_GER.pdf" target="_blank">Zur Produktbeschreibung</a><br>
- </div>
- </div>
- </div>
- </form>
- </div>
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