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+<form action="http://c3voc.de/feedback/" target="_blank" method="post" role="form" class="form-horizontal row">
+ <div class="col-sm-4 col">
+ <div class="form-group">
+ <label for="net">Network Connection</label>
+ <select class="form-control" name="net" id="net">
+ <option></option>
+ <option>EDGE</option>
+ <option>3G</option>
+ <option>LTE</option>
+ <option>DSL &lt;2000</option>
+ <option>DSL 2000-6000</option>
+ <option>DSL &gt;6000</option>
+ <option>VDSL</option>
+ <option>Public Hotspot</option>
+ <option>WLAN Inside the CCH</option>
+ <option>Ethernet Inside the CCH</option>
+ <option>Something else</option>
+ </select>
+ </div>
+
+ <div class="form-group">
+ <label for="os">Operating System</label>
+ <select class="form-control" name="os" id="os">
+ <option></option>
+ <option>Unixoid</option>
+ <option>OS/X</option>
+ <option>Windows</option>
+ <option>Something else</option>
+ </select>
+ </div>
+
+ <div class="form-group">
+ <label for="player">Player</label>
+ <select class="form-control" name="player" id="player">
+ <option></option>
+ <option>Firefox</option>
+ <option>Chrome/Chromium</option>
+ <option>Anderer Browser</option>
+ <option>VLC</option>
+ <option>MPlayer</option>
+ <option>Totem</option>
+ <option>ffplay</option>
+ <option>Something else</option>
+ </select>
+ </div>
+
+ <div class="form-group">
+ <label for="stream">Stream</label>
+ <select class="form-control" name="stream" id="stream">
+ <option></option>
+ <? foreach(array('saal1', 'saal2', 'saalg', 'saal6', 'sendezentrum') as $roomIter): ?>
+ <? foreach($GLOBALS['CONFIG']['FORMATS'] as $formatIter => $formatDislay): ?>
+ <option
+ <? if($roomIter == $room && $formatIter == $format): ?>selected<? endif ?>
+ value="<?=h("$roomIter-$formatIter")?>"><?=h($GLOBALS['CONFIG']['ROOMS'][$roomIter])?> – <?=h($formatDislay)?></option>
+ <? endforeach ?>
+ <? endforeach ?>
+
+ <? foreach(array('lounge', 'ambient') as $roomIter): ?>
+ <option value="<?=h("$roomIter")?>"><?=h($GLOBALS['CONFIG']['ROOMS'][$roomIter])?></option>
+ <? endforeach ?>
+ </select>
+ </div>
+ </div>
+
+ <div class="col-sm-4 col">
+ <div class="form-group">
+ <label>IP-Connectivity</label>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="v4" name="ipproto" checked /> IPv4
+ </label>
+ </div>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="v6" name="ipproto" /> IPv6
+ </label>
+ </div>
+ </div>
+
+ <div class="form-group">
+ <label for="datetime" class="text">Date/Time</label>
+ <input type="text" value="<?=h(strftime('%d.%m.%Y %H:%I'))?>" name="datetime" id="datetime" class="form-control" />
+ </div>
+
+ <div class="form-group">
+ <label for="provider" class="text">Provider</label>
+ <input type="text" value="" name="provider" id="provider" class="form-control" />
+ </div>
+ </div>
+
+ <div class="col-sm-4 col">
+ <div class="form-group">
+ <label>Did you have Issues?</label>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="Dropouts" name="issues[]"/> Dropouts
+ </label>
+ </div>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="Hickups/Jerking" name="issues[]"/> Hickups/Jerking
+ </label>
+ </div>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="Loops" name="issues[]"/> Loops
+ </label>
+ </div>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="Image" name="issues[]"/> No Image
+ </label>
+ </div>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="Audio" name="issues[]"/> No Audio
+ </label>
+ </div>
+ <div class="checkbox">
+ <label>
+ <input type="checkbox" value="Artifacts" name="issues[]"/> Artifacts
+ </label>
+ </div>
+ </div>
+
+ <div class="form-group">
+ <input type="submit" value="Submit" />
+ </div>
+ </div>
+
+</form>