\documentclass[parskip=half]{scrreprt}

\usepackage[utf8]{inputenc}
\usepackage[T1]{fontenc}
\usepackage[ngerman]{babel}
\usepackage{lmodern}
\usepackage[margin=2cm]{geometry}
\usepackage{eurosym}
\usepackage[shortlabels]{enumitem}
\usepackage{csquotes}

% ToDo-Notes: Parameter "disable" versteckt alle Notizen.
\usepackage[colorinlistoftodos]{todonotes}
\newcommand{\litnote}[1]{\todo[inline,color=blue!40]{#1}}
\newcommand{\refnote}[1]{\todo[color=blue!40]{#1}}
\newcommand{\note}[1]{\todo[inline,color=green!40]{#1}}


\usepackage[pdftex,colorlinks=true,linkcolor=black,citecolor=black,urlcolor=black]{hyperref}
\def\LayoutTextField#1#2{#2}
\def\tf#1#2{\TextField[name=#1,width=#2,bordercolor={},backgroundcolor={}]{\null}}

\def\LayoutCheckField#1#2{#2}
\def\cb#1{\CheckBox[name=#1,height=0.5cm,width=0.5cm,bordercolor=black]{\null}}

\usepackage{tabularx}

\def\n39logo{
	  %% Inline Logo
	  \begin{tikzpicture}[
	      y=0.8pt,
	      x=0.8pt,
	      yscale=-1,
	      inner sep=0pt,
	      outer sep=0pt,
	      scale=0.2
	  ]
	  \begin{scope}[shift={(-448.05262,-67.70133)}]
	    \path[color=black,fill=black,even odd rule,line width=16.000pt]
	      (534.1205,161.8816) -- (534.1205,172.2877) -- (581.3732,172.2877) .. controls
	      (571.8452,181.8308) and (562.3036,191.3603) .. (552.7463,200.8741) --
	      (565.3389,200.8741) .. controls (585.4511,200.8741) and (601.7400,217.2036) ..
	      (601.7400,237.3158) .. controls (601.7400,257.4280) and (585.4511,273.7170) ..
	      (565.3389,273.7170) .. controls (545.2267,273.7170) and (528.8972,257.4280) ..
	      (528.8972,237.3158) -- (518.4911,237.3158) .. controls (518.4911,263.1743) and
	      (539.4804,284.1231) .. (565.3389,284.1231) .. controls (591.1974,284.1231) and
	      (612.1462,263.1743) .. (612.1462,237.3158) .. controls (612.1462,215.3233) and
	      (596.9939,196.8355) .. (576.5548,191.8042) -- (606.5180,161.8816) -- cycle;
	    \begin{scope}[cm={{-1.0,0.0,0.0,-1.0,(1130.6373,475.18252)}}]
	      \path[color=black,fill=black,even odd rule,line width=16.000pt]
		(565.3389,208.6889) .. controls (549.5365,208.6889) and (536.7120,221.5134) ..
		(536.7120,237.3158) .. controls (536.7120,249.4467) and (544.2722,259.8031) ..
		(554.9328,263.9587) -- (554.9328,252.2164) .. controls (550.2090,248.9346) and
		(547.1181,243.5056) .. (547.1181,237.3158) .. controls (547.1181,227.2597) and
		(555.2828,219.0950) .. (565.3389,219.0950) .. controls (575.3950,219.0950) and
		(583.5192,227.2597) .. (583.5192,237.3158) .. controls (583.5192,243.4955) and
		(580.4441,248.9328) .. (575.7450,252.2164) -- (575.7450,263.9587) .. controls
		(586.3945,259.8031) and (593.9253,249.4467) .. (593.9253,237.3158) .. controls
		(593.9253,221.5134) and (581.1413,208.6889) .. (565.3389,208.6889) -- cycle;
	      \path[color=black,fill=black,even odd rule,line width=16.000pt]
		(565.3389,232.0925) .. controls (562.4657,232.0925) and (560.1156,234.4426) ..
		(560.1156,237.3158) -- (560.1156,268.4937) -- (570.5217,268.4937) --
		(570.5217,237.3158) .. controls (570.5217,234.4426) and (568.2121,232.0925) ..
		(565.3389,232.0925) -- cycle;
	    \end{scope}
	    \path[fill=black] (630.8529,149.4914) .. controls (625.1306,149.5458) and
	      (620.4890,150.3447) .. (619.3535,151.0301) .. controls (617.0825,152.4009) and
	      (616.5461,155.6877) .. (617.2480,156.4558) .. controls (617.9500,157.2237) and
	      (628.6785,164.1143) .. (633.3633,166.3761) .. controls (645.9778,172.4665) and
	      (632.0756,195.7720) .. (621.2161,191.6018) .. controls (613.5199,188.6464) and
	      (604.7892,179.8446) .. (603.3192,179.7785) .. controls (601.8492,179.7137) and
	      (599.9557,180.7048) .. (599.4726,183.2607) .. controls (598.9895,185.8166) and
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	      (638.1817,206.5491) .. (638.1817,217.0704) --
	      (638.1817,265.9427)arc(179.961:0.039:13.018) -- (664.2172,203.5060) --
	      (664.2172,188.9294) .. controls (664.2172,183.4623) and (670.9201,161.5406) ..
	      (648.7498,152.3663) .. controls (643.3754,150.1424) and (636.5752,149.4370) ..
	      (630.8529,149.4914) -- cycle;
	  \end{scope}
	  \path[color=black,fill=black,even odd rule,line width=8.333pt]
	    (150.0000,23.1213) .. controls (79.9291,23.1213) and (23.1213,79.9291) ..
	    (23.1213,150.0000) .. controls (23.1213,220.0708) and (79.9291,276.8787) ..
	    (150.0000,276.8787) .. controls (220.0708,276.8787) and (276.8787,220.0708) ..
	    (276.8787,150.0000) .. controls (276.8787,79.9291) and (220.0708,23.1213) ..
	    (150.0000,23.1213) -- cycle(150.0000,40.5068) .. controls (210.4603,40.5068)
	    and (259.4540,89.5397) .. (259.4540,150.0000) .. controls (259.4540,210.4603)
	    and (210.4603,259.4540) .. (150.0000,259.4540) .. controls (89.5278,259.8428)
	    and (41.3547,203.5210) .. (40.5068,150.0000) .. controls (40.5068,89.5397) and
	    (89.5397,40.5068) .. (150.0001,40.5068) -- cycle;
	  \end{tikzpicture}
	  %% Logo End
}

\usepackage[headsepline, footsepline]{scrlayer-scrpage}
\renewcommand{\headfont}{\sffamily}
\renewcommand{\footfont}{\sffamily \small}
\setlength{\headheight}{58pt} % logo height
\setlength{\footheight}{58pt} % logo height
\clearpairofpagestyles
\ihead{%
\unitlength1mm
\begin{picture}(0,0)
      \put(0, 7){\parbox{180mm}{\n39logo}}
      \put(17,6){\parbox{180mm}{ \sffamily \huge Netz39 e.V.}}
\end{picture}
}
\setlength{\footheight}{9em} % logo height
\ifoot{
\begin{tabular}{rl}
    Vorsitzende   &  Stefan Haun\\
                  &  Rick Hollinski\\
    Kassenwart    &  David Kilias%
\end{tabular}%
}
\cfoot{
\begin{tabular}{rl}
    IBAN&  DE64\ 4306\ 0967\ 4120\ 8043\ 00\\
    BIC&   GENODEM1GLS\\
    &     GLS Gemeinschaftsbank%
\end{tabular}%
}
\ofoot{
\begin{tabular}{l}
    Amtsgericht Stendal\\
    VR\ 3169\\
    \ %
\end{tabular}%
}


%\pagenumbering{gobble}

\begin{document}
\section*{Aufnahmeantrag\\ zur aktiven Mitgliedschaft im Netz39\ e.V.}

\begin{Form}
Hiermit beantrage ich die aktive Mitgliedschaft als natürliche Person im Netz39 e.V.

\begin{center}
\begin{tabularx}{\textwidth}{| p{5cm} | X |}
\hline
Nachname & \tf{nachname}{10cm}\\
\hline
Vorname & \tf{vorname}{10cm}\\
\hline
\end{tabularx}
\end{center}

\begin{center}
\begin{tabularx}{\textwidth}{| p{5cm} | X |}
\hline
Straße& \tf{strasse}{10cm}\\
\hline
PLZ, Wohnort & \tf{plzort}{10cm}\\
\hline
\end{tabularx}
\end{center}

\begin{center}
\begin{tabularx}{\textwidth}{| p{5cm} | X |}
\hline
E-Mail-Adresse & \tf{email}{10cm}\\
\hline
\end{tabularx}
\end{center}

Die Mitgliedsbeiträge richten sich nach der jeweils gültigen Beschlussfassung der Mitgliederversammlung. Mit meiner Unterschrift erkenne ich die Satzung des Netz e.V. an und verpflichte mich, die satzungsgemäßen Ziele des Netz39\ e.V. nach Kräften zu unterstützen.

\vspace{2cm}
\begin{tabular}{p{7cm}p{.5cm}p{7cm}}
\tf{datum}{7cm} & & \\
\dotfill & & \dotfill \\
Ort, Datum & & Unterschrift \\
\end{tabular}%

\end{Form}
\end{document}