WFFM Formular: Bonusformular

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<form action="/form/Index?wffm.FormItemId=f66196be-f6fd-43c8-9b39-101d01ab534c&amp;wffm.Id=f324d78d-4440-4bba-b41d-05dc046bdfcf" class="text-left" data-wffm="{F66196BE-F6FD-43C8-9B39-101D01AB534C}" data-wffm-ajax="True" enctype="multipart/form-data" id="wffmf324d78d44404bbab41d05dc046bdfcf"
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    <input name="__RequestVerificationToken" type="hidden" value="Dd5693fL4f-WW0_zfkzeQzBA09S4dXId8RMSO8pkJvcOp9wYA1VAAz1Av5VyJjetrxM6An577Kc5EFbD5CpdMk86wPGuCoPlo33Z8JP51KE1"><input id="wffmf324d78d44404bbab41d05dc046bdfcf_Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Id"
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    <div class="page-header">
        <h2>
            Gleich ausfüllen und mehr Infos bekommen
        </h2>
    </div>

    <div class="has-error has-feedback">
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            <ul class="list-group">
                <li style="display:none">
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    <div class="required-field form-group">
        <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_0__Fields_0__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[0].Fields[0].Id" type="hidden" value="{AD5E1A15-DA82-4801-8CFB-D4396C37299F}"><label class="control-label" for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_0__Fields_0__Value">Ich m&#246;chte</label>
        <div class="checkbox">
            <label><input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_0__Fields_0__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[0].Fields[0].Value" type="checkbox" value="Ja, ich m&#246;chte Mitglied der Krankenkasse hkk werden."> Ja, ich m&#246;chte Mitglied der Krankenkasse hkk werden.</label>
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        <div class="checkbox">
            <label><input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_0__Fields_0__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[0].Fields[0].Value" type="checkbox" value="Ja, ich m&#246;chte mehr &#252;ber die Krankenkasse hkk wissen. Senden Sie mir bitte Infomaterial zu."> Ja, ich m&#246;chte mehr &#252;ber die Krankenkasse hkk wissen. Senden Sie mir bitte Infomaterial zu.</label>
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        <span class="field-validation-valid help-block" data-valmsg-for="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[0].Fields[0].Value" data-valmsg-replace="true"></span>
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    <div class="required-field form-group">
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            <option value="Arbeitnehmer oder Auszubildender">
                Arbeitnehmer oder Auszubildender
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            <option value="Selbstständig oder Sonstiges">
                Selbstst&#228;ndig oder Sonstiges
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            <option value="Rentner">
                Rentner
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            <option value="Familienangehöriger">
                Familienangeh&#246;riger
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            <option value="Studierender">
                Studierender
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    <fieldset class="scfSectionBorder">
        <legend>Persönliche Informationen</legend>
        <div class="row">
            <div class="col-md-12">
                <div class="required-field halfAvailableWidth form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_0__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[0].Id" type="hidden" value="{BC2F6CA5-4FC9-438D-90C7-92E10E963000}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_0__Value">Vorname</label><input class=" form-control text-box single-line" data-val="true" data-val-length="Das Feld Vorname muss zwischen 0 und 256 Zeichen aufweisen." data-val-length-max="256"
                        data-val-required="Das Feld Vorname ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_0__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[0].Value"
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                <div class="required-field halfAvailableWidth form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_1__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[1].Id" type="hidden" value="{0F29839D-1060-4F7D-B3CD-E7C6131390FA}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_1__Value">Nachname</label><input class=" form-control text-box single-line" data-val="true" data-val-length="Das Feld Nachname muss zwischen 0 und 256 Zeichen aufweisen."
                        data-val-length-max="256" data-val-required="Das Feld Nachname ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_1__Value"
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                <div class="required-field scfDatePickerBorder form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_2__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[2].Id" type="hidden" value="{C61EE769-6070-4A75-A9EE-A7C9D7C1D67C}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_2__Value">Geburtsdatum</label>
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                        window.WffmFieldsData.wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_2__Value = {
                            defaultDate: new Date("18-05-18"),
                            dateFormat: "y-mm-dd",
                            minDate: new Date("2000", "0", "1"),
                            maxDate: new Date("2019", "4", "18")
                        }
                    </script><input class="form-control datepicker text-box single-line" data-val="true" data-val-required="Das Feld Geburtsdatum ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}"
                        id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_2__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[2].Value" type="text" value="18-05-18"><span class="field-validation-valid help-block" data-valmsg-for="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[2].Value"
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                <div class="required-field form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_3__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[3].Id" type="hidden" value="{A5025794-8419-450B-96F4-F0C8F78090DF}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_3__Value">Stra&#223;e, Nr.</label><input class=" form-control text-box single-line" data-val="true" data-val-length="Das Feld Straße, Nr. muss zwischen 0 und 256 Zeichen aufweisen."
                        data-val-length-max="256" data-val-required="Das Feld Straße, Nr. ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_3__Value"
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                <div class="required-field halfAvailableWidth form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_4__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[4].Id" type="hidden" value="{B0BF0FF6-BD6A-495F-B287-74C982574AD1}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_4__Value">PLZ</label><input class=" form-control text-box single-line" data-val="true" data-val-range="Geben Sie für das Feld PLZ einen gültigen Wert ein." data-val-range-max="2147483647"
                        data-val-range-min="0" data-val-range-tracking="{844BBD40-91F6-42CE-8823-5EA4D089ECA2}" data-val-regex="Geben Sie für das Feld PLZ einen gültigen Wert ein." data-val-regex-pattern="^[-,+]{0,1}\d*\.{0,1}\d+$" data-val-regex-tracking="{844BBD40-91F6-42CE-8823-5EA4D089ECA2}"
                        data-val-required="Das Feld PLZ ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_4__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[4].Value"
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                <div class="required-field halfAvailableWidth form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_5__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[5].Id" type="hidden" value="{DA6C2DF3-1A08-4B48-9DB3-3BAF3134A7D1}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_5__Value">Ort</label><input class=" form-control text-box single-line" data-val="true" data-val-length="Das Feld Ort muss zwischen 0 und 256 Zeichen aufweisen." data-val-length-max="256"
                        data-val-required="Das Feld Ort ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_5__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[5].Value"
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                <div class="required-field halfAvailableWidth form-group">
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                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_6__Value">E-Mail-Adresse</label><input class=" form-control text-box single-line" data-val="true" data-val-length="Das Feld E-Mail-Adresse muss zwischen 0 und 256 Zeichen aufweisen."
                        data-val-length-max="256" data-val-regex="Geben Sie für das Feld E-Mail-Adresse eine gültige E-Mail-Adresse ein." data-val-regex-pattern="^[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,17}$" data-val-required="Das Feld E-Mail-Adresse ist erforderlich. Geben Sie einen Wert ein."
                        data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_6__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[6].Value" placeholder="" style=""
                        type="email" value=""><span class="field-validation-valid help-block" data-valmsg-for="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[6].Value" data-valmsg-replace="true"></span>
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                <div class="required-field halfAvailableWidth form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_7__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[7].Id" type="hidden" value="{38A6E812-6EB2-4CB0-8AAB-00A273AF28A7}"><label class="control-label"
                        for="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_7__Value">Telefonnummer</label><input class=" form-control text-box single-line" data-val="true" data-val-length="Das Feld Telefonnummer muss zwischen 0 und 256 Zeichen aufweisen."
                        data-val-length-max="256" data-val-required="Das Feld Telefonnummer ist erforderlich. Geben Sie einen Wert ein." data-val-required-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_7__Value"
                        name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[7].Value" placeholder="" style="" type="text" value=""><span class="field-validation-valid help-block" data-valmsg-for="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[7].Value"
                        data-valmsg-replace="true"></span>
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                <div class="required-field form-group">
                    <input id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_8__Id" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[8].Id" type="hidden" value="{6C61DE41-CE65-4378-94D2-C0B6B3D7233C}">
                    <div class="checkbox">
                        <label><input data-val="true" data-val-ischecked="Das Feld Ich akzeptiere die Datenschutzerklärungen** ist erforderlich. Geben Sie einen Wert ein." data-val-ischecked-tracking="{7E86B2F5-ACEC-4C60-8922-4EB5AE5D9874}" data-val-required="Das Feld &quot;Value&quot; ist erforderlich." id="wffmf324d78d44404bbab41d05dc046bdfcf_Sections_1__Fields_8__Value" name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[8].Value" type="checkbox" value="true"><input name="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[8].Value" type="hidden" value="false"> Ich akzeptiere die Datenschutzerklärungen**</label>
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                    <span class="field-validation-valid help-block" data-valmsg-for="wffmf324d78d44404bbab41d05dc046bdfcf.Sections[1].Fields[8].Value" data-valmsg-replace="true"></span>
                </div>
            </div>
        </div>
    </fieldset>

    <p>
        ** Datenschutztext mit <a href="http://google.de">Link</a>
    </p>

    <div class="form-submit-border">
        <input class="btn btn-default" type="submit" value="Absenden">
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