k o D
Elite
Google est ton ami:
Voici ici un tuto pour créer des formulaires
http://lewebe.free.fr/formulaires_html.htm
Voilà
Voici ici un tuto pour créer des formulaires
http://lewebe.free.fr/formulaires_html.htm
Voilà
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
"http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<title>Document sans nom</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<input type="hidden" name="to" value="ventilo@swing.be">
<input type="hidden" name="next" value="http://users.skynet.be/ventilo/siteweb/index.htm">
<form method="post" action="http://users.skynet.be/cgi-bin/formd.cgi">
<input type="checkbox" name="checkbox">oui<br>
<input type="checkbox" checked name="checkbox">Non
<form>
</form>
<form method="post" action="http://users.skynet.be/cgi-bin/formd.cgi">
<input type="submit"><br><br>
<input type="submit" value="Envoyer"> BlaBla.
</form>
</head>
<body>
</body>
</html>
<style type="text/css">
<!--
.Style2 {
font-size: 18px;
font-weight: bold;
font-family: Verdana, Arial, Helvetica, sans-serif;
}
.Style3 {font-family: Arial, Helvetica, sans-serif}
-->
</style>
<body><form method="post" action="http://users.skynet.be/cgi-bin/form.cgi">
<input type="hidden" name="to" value="votremail@domaine.be">
<input type="hidden" name="next" value="http://votrepageafficheeapres">
<input type="hidden" name="subject" value="inscription au club">
<table width="100%" height="100%" border="0" cellpadding="0" cellspacing="0">
<tr>
<td align="center" valign="middle"><table width="700" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td align="left"><span class="Style2">Identit&eacute;</span></td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="right"><table width="600" border="0" cellspacing="0" cellpadding="0">
<tr>
<td align="left"><span class="Style3">Nom, pr&eacute;nom</span></td>
<td align="right">
<input name="txtNom" type="text" class="input" id="txtNom">
</td>
</tr>
<tr>
<td align="left" valign="top" class="Style3">Adresse</td>
<td align="right"><textarea name="txtAdresse" id="txtAdresse"></textarea></td>
</tr>
<tr>
<td align="left" class="Style3">Localit&eacute;</td>
<td align="right"><input name="txtLocalite" type="text" class="input" id="txtNom3"></td>
</tr>
<tr>
<td align="left" class="Style3">T&eacute;l&eacute;phone</td>
<td align="right"><input name="txtTelephone" type="text" class="input" id="txtNom4"></td>
</tr>
<tr>
<td align="left" class="Style3">Date de naissance </td>
<td align="right"><input name="txtNee" type="text" class="input" id="txtNom5"></td>
</tr>
<tr>
<td align="left" class="Style3">N&deg; de carte d'identit&eacute; </td>
<td align="right"><input name="txtNumCarte" type="text" class="input" id="txtNom6"></td>
</tr>
<tr>
<td align="left" class="Style3">Taille maillot </td>
<td align="right"><select name="select" class="input">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select></td>
</tr>
</table></td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="left" class="Style2">Cotisations</td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="right"><table width="600" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="300" align="left" class="Style3">R&eacute;inscription</td>
<td align="right" class="Style3"><input type="radio" name="chkCotisations" value="R&eacute;inscriptions">
18 €</td>
</tr>
<tr>
<td width="300" align="left" class="Style3">Nouvelle inscription + maillot </td>
<td align="right" class="Style3"><input type="radio" name="chkCotisations" value="Nouvelle inscription + maillot">
60 €</td>
</tr>
<tr>
<td width="300" align="left" class="Style3">Nouvelle inscription (- 18 ans ) + maillot </td>
<td align="right" class="Style3"><input type="radio" name="chkCotisations" value="Nouvelle inscription (-18 ans) + maillot)">
45 €</td>
</tr>
<tr>
<td width="300" align="left" class="Style3">Enfants (de 8 &agrave; 12 ans) </td>
<td align="right" class="Style3"><input type="radio" name="chkCotisations" value="Enfants (de 8 &agrave; 12 ans)">
10 €</td>
</tr>
<tr>
<td width="300" align="left" class="Style3">Maillot suppl&eacute;mentaire </td>
<td align="right" class="Style3"><input name="chkMaillot" type="checkbox" id="chkMaillot" value="Maillot suppl&eacute;mentaire">
42 &euro; </td>
</tr>
</table></td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="left" class="Style2">Assurance</td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="right"><table width="600" border="0" cellspacing="0" cellpadding="0">
<tr>
<td align="left" class="Style3"><div align="left">La cotisation donne automatiquement droit &agrave; une assurance pour d&eacute;gats corporels uniquements (frais m&eacute;dicaux rembours&eacute;s &agrave; concurrence de 100% des tarifs INAMI). Cette assurance n'est valable que dans le cadre des organisations du club.<br>
<br>
Je d&eacute;sire recevoir une copie du contrat </div></td>
</tr>
<tr>
<td align="center" class="Style3"> <input type="radio" name="chkAssurance" value="Oui">
Oui
<input type="radio" name="chkAssurance" value="Non">
Non</td>
</tr>
</table> </td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="left" class="Style2">Groupes</td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="right"><table width="600" border="0" cellspacing="0" cellpadding="0">
<tr class="Style3">
<td align="left">Allure libre </td>
<td align="left">En veillant &agrave; l'esprit d'unit&eacute;</td>
<td align="right"><p>
<label>
<input type="radio" name="chkGroupes" value="Groupe 1">
Groupe 1</label>
</p></td>
</tr>
<tr align="left" class="Style3">
<td>Cyclos</td>
<td>Vitesse d'environ 26 km/h</td>
<td align="right"><label>
<input type="radio" name="chkGroupes" value="Groupe 2">
Groupe 2</label></td>
</tr>
<tr align="left" class="Style3">
<td>Touristes</td>
<td>vitesse d'environ 22 km/h </td>
<td align="right"><label>
<input type="radio" name="chkGroupes" value="Groupe 3">
Groupe 3</label></td>
</tr>
<tr align="left" class="Style3">
<td>Randonneurs</td>
<td>Vitesse d'environ 16 km/h </td>
<td align="right"><label>
<input type="radio" name="chkGroupes" value="Groupe 4">
Groupe 4</label></td>
</tr>
<tr align="left" class="Style3">
<td>Enfants (8 - 12 ans) </td>
<td>Allure promenade </td>
<td align="right"><label>
<input type="radio" name="chkGroupes" value="Groupe 5">
Groupe 5</label></td>
</tr>
</table></td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="left" class="Style2">Suggestions</td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="right"><textarea name="txtSuggestions" class="input" id="txtSuggestions"></textarea></td>
</tr>
<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td align="center"><input type="submit" name="Submit" value="Envoyer"></td>
</tr>
</table></td>
</tr>
</table></form>
</body>