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- <div id="insc">
- <form method='post' action="traitement.php" size="50">
- <span class="form_col">
- <input type="text" name="nom" placeholder="Nom" size="30"/>
- <span name="aideNom"></span>
- </span>
- <br />
- <span class="form_col">
- <input type="text" id="prenom" placeholder="Prénom" size="30"/>
- <span name="aidePrénom"></span>
- </span>
- <br />
- <span class="form_col">
- <input type="date" name="date" size="30"/>
- </span>
- <br />
- <span class="form_col">
- <input type="tel" name="tel" placeholder="0123456789" size="30" required/>
- <span name="aideTel"></span>
- </span>
- <br />
- <span class="form_col">
- <input type="email" name="mail" placeholder="Ex : truc@machin.fr" size="30" required/>
- </span>
- <br />
- <span class="form_col">
- <input type="password" id="mdp" placeholder="Mot de passe" size="30" required/>
- <span name="aideMdp"></span>
- </span>
- <br />
- <span class="form_col">
- <input type="password" name="verifmdp" placeholder="Confirmer Mot de passe" size="30" required/>
- </span>
- <br />
- <span class="form_col">
- <input type="tel" name="numcb" placeholder="Numéro de carte bleue" size="30" required/>
- </span>
- <br />
- <span class="form_col">
- <input type="text" name="adresse" placeholder="Ex : 56 avenue des bois" size="30" required/>
- </span>
- <br />
- <span class="form_col">
- <input type="text" name="ville" placeholder="Ville" size="30" required/>
- </span>
- <br />
- <span class="form_col">
- <input type="tel" name="codep" placeholder="Code Postal" size="30" required/>
- <span name="aideCodepostal"></span>
- </span>
- <br />
- <div class="form_col">
- <input type="submit" name="valider" value="S'inscrire"/>
- <input type="reset" value="Réinitialiser le formulaire"/>
- </div>
- </form>
- </div>
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