Artois
/
microfolie


			
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							<html>
<head>
<title>Inscription</title>
<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 type="text/javascript" src="js/verif_inscription.js"></script>
</head>
<body>
  <div id="principal">
      <div class="header">
          <div class="navbar">
          </div><!-- end navbar -->
      </div><!-- end of header -->
<fieldset>
  <legend><h2>Inscription</h2></legend>
<form name="fo" method="post"  action="Ins.php"  onsubmit="return verif();" >

    <table>
        <tr>
            <td>
                <label for="nom">Nom : </label>
            </td>
            <td>
                <input type="text" name="nom" id="nom" />
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="prenom">Prenom : </label>
            </td>
            <td>
                <input type="text" name="prenom" id="prenom" />
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="sexe">Sexe : </label>
            </td>
            <td>
                <input type="radio" name="sexe" id = "sm" value="M" /> H
                <input type="radio" name="sexe" id = "sf" value="F" /> F
                </br>
                <span>Autre </span>
                </br>
                <input type="text" name="sexe" id = "si" value="" />
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="date_naissance">Date de naissance : </label>
            </td>
            <td>
                <input type="date" name="date_naissance" id="date_naissance" value=""/>
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="ville">Ville : </label>
            </td>
            <td>
                <input type="text" name="ville" id="ville"/>
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="email">Mail : </label>
            </td>
            <td>
                <input type="text" name="email" id="email" value="...@..."/>
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="tel">Téléphone : </label>
            </td>
            <td>
                <input type="text" name="tel" id="tel" />
                <br />
            </td>
        </tr>
        <tr>
            <td>
                <label for="contact">Personne à contacter en cas d'urgence : </label>
            </td>
            <td>
                <input type="text" name="contact" id="contact" />
                <br />
            </td>
        </tr>


    </table>

                <input type="submit" value="Valider">

                <input type="reset" value="Annuler">


    <div class="clear"></div>
    <div class="footer"></div><!-- end footer div -->
</form>
</fieldset>
</body>
</html>