[text* field_731051_sei class:box100] [text* field_731051_mei class:box100]
[text* field_731060_sei class:box100] [text* field_731060_mei class:box100]
[text* field_731052 class:box250]
[text* field_731056_1 /3 class:box50] [text* field_731056_2 /3 class:box50] [text* field_731056_3 /3 class:box50]
[textarea field_731066 50x10]
[textarea field_731067 50x10]