Artois
/
microfolie


			
				
					
						
						
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							<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
	pageEncoding="ISO-8859-1"%>

<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Inscription</title>
  <script src="js/index.js" type="text/javascript"></script>
    <script src="js/index.js" type="number/javascript"></script>
  <link rel="stylesheet" type="text/css" href="css/style.css">
  <link rel="stylesheet" href="css/style1.css" type="text/css"  /> 
  <link rel="stylesheet" href="css/style.css" type="bootstrap/css/bootstrap.min.css"  />
  <script src="https://ajax.googleapis.com/ajax/libs/jquery/2.1.1/jquery.min.js"></script>
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</head>

<body>

<div id="principal">
    <div class="header">
        <div class="navbar">
            <ul>
                <li><a href="index.html">Accueil</a></li>
                <li><a href="abonnes.html">nos Abonnés</a></li>
                
            </ul>
        </div>
    </div><!-- end of header -->
    <div class="main">

    
        <div class="content">
    

     

    </div><!-- end of main div -->
    <br>
  	<h1>Inscription à l'espace microfolies</h1>
  
<br>

  <form>
  <div class="form-group row">
  <label  class="col-2 col-form-label">Nom* </label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row">
  <label  class="col-2 col-form-label">Prénom*</label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row">
  <label  class="col-2 col-form-label">Genre*</label>
  <div class="col-3">
<select class="form-control"  required>
  	<option>Homme</option>
    <option>Femmme</option>
    <option>Autre</option>
</select>  
</div>
</div>
<div class="form-group row">
  <label  class="col-2 col-form-label">Date de naissance*</label>
  <div class="col-10">
    <input class="form-control" type="date" required>
  </div>
</div>
<div class="form-group row">
  <label  class="col-2 col-form-label">Ville*</label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row">
  <label  class="col-2 col-form-label">Situation*</label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row">
  <label class="col-2 col-form-label">Email*</label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row">
  <label class="col-2 col-form-label" >Téléphone *</label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row">
  <label  class="col-2 col-form-label" >Contact d'urgence* </label>
  <div class="col-10">
    <input class="form-control" type="text" required>
  </div>
</div>
<div class="form-group row" type="text">
  <label  class="col-2 col-form-label" >Pièce jointe</label>
  <div class="col-10">
    <input class="form-control" type="file" required>
  </div>
</div>
  <button type="submit" class="btn btn-primary">Submit</button>
</form>
</body>
</body>
  <div class="clear"></div>
    <div class="footer"></div>
    </div>
</html>