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Dec 16th, 2018
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  1. <div id="insc">
  2. <form method='post' action="traitement.php" size="50">
  3. <span class="form_col">
  4. <input type="text" name="nom" placeholder="Nom" size="30"/>
  5. <span name="aideNom"></span>
  6. </span>
  7. <br />
  8. <span class="form_col">
  9. <input type="text" id="prenom" placeholder="Prénom" size="30"/>
  10. <span name="aidePrénom"></span>
  11. </span>
  12. <br />
  13. <span class="form_col">
  14. <input type="date" name="date" size="30"/>
  15. </span>
  16. <br />
  17. <span class="form_col">
  18. <input type="tel" name="tel" placeholder="0123456789" size="30" required/>
  19. <span name="aideTel"></span>
  20. </span>
  21. <br />
  22. <span class="form_col">
  23. <input type="email" name="mail" placeholder="Ex : truc@machin.fr" size="30" required/>
  24. </span>
  25. <br />
  26. <span class="form_col">
  27. <input type="password" id="mdp" placeholder="Mot de passe" size="30" required/>
  28. <span name="aideMdp"></span>
  29. </span>
  30. <br />
  31. <span class="form_col">
  32. <input type="password" name="verifmdp" placeholder="Confirmer Mot de passe" size="30" required/>
  33. </span>
  34. <br />
  35. <span class="form_col">
  36. <input type="tel" name="numcb" placeholder="Numéro de carte bleue" size="30" required/>
  37. </span>
  38. <br />
  39. <span class="form_col">
  40. <input type="text" name="adresse" placeholder="Ex : 56 avenue des bois" size="30" required/>
  41. </span>
  42. <br />
  43. <span class="form_col">
  44. <input type="text" name="ville" placeholder="Ville" size="30" required/>
  45. </span>
  46. <br />
  47. <span class="form_col">
  48. <input type="tel" name="codep" placeholder="Code Postal" size="30" required/>
  49. <span name="aideCodepostal"></span>
  50. </span>
  51. <br />
  52. <div class="form_col">
  53. <input type="submit" name="valider" value="S'inscrire"/>
  54. <input type="reset" value="Réinitialiser le formulaire"/>
  55. </div>
  56. </form>
  57. </div>
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