JSFiddle - React, Tailwind, and code Playground

HTML

<table id="myTable">
    <thead>
        <tr>
            <th>Name</th>
            <th>Date</th>
            <th>Place</th>
            <th>Price</th>
            <th>Hours</th>
            <th>Book</th>
        </tr>
    </thead>
    <tbody>
        <tr>
            <td class="name"><a href="#" title="title1">Camp1</a>

            </td>//send to form this value
            <td class="date">10.09 - 15.09.2014 r.</td>//send to form this value
            <td>Brighton</td>
            <td>555 EURO</td>
            <td>20</td>
            <td class="book">
                <button>Book</button>
            </td>//when user click on this button</tr>
        <tr>
            <td class="name"><a href="#" title="title1">Camp2</a>

            </td>
            <td class="date">02.09 - 22.09.2014 r.</td>
            <td>Brighton</td>
            <td>432 EURO</td>
            <td>20</td>
            <td class="book">
                <button>Book</button>
            </td>
        </tr>
        <tr>
            <td class="name"><a href="#" title="title1">Camp3</a>

            </td>
            <td class="date">23.09 - 27.09.2014 r.</td>
            <td>Brighton</td>
            <td>123 EURO</td>
            <td>20</td>
            <td class="book">
                <button>Book</button>
            </td>
        </tr>
    </tbody>
</table>
<form>
    <fieldset id="contact_form">
        <div id="result"></div>
        <label for="name"><span>Name</span>

        </label>
        <input type="text" name="name" id="name" placeholder="Enter Your Name" />
        <label for="email"><span>Email Address</span>

        </label>
        <input type="email" name="email" id="email" placeholder="Enter Your Email" />
        <label for="date"><span>Date</span>

            <input type="text" name="date" id="date" placeholder "Enter date"/>
        </label>
        <button class="submit_btn" id="submit_btn">Submit</button>
    </fieldset>
</form>

JavaScript

$("button").click(function () {
    var _this = $(this);
    var text = _this.parent().siblings('.name').text();
    console.debug(text);
    $("#name").val(text);
    var date = _this.parent().siblings('.date').text();
    console.debug(date);
    $("#date").val(date);
});