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| <form method="get" action="ajetab2.asp">
<tr>
<td><a href="../../../popup.html#secteur" target="wclose"
onclick="window.open('../../../popup.html#secteur','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Secteur:</a></td>
<td><select name="secteur">
<option value="1">Enfant</option>
<option value="2">Adulte</option>
<option value="3">Personne âgée</option>
<option value="4">Sanitaire</option>
</td>
</tr>
<tr>
<td><a href="../../../popup.html#nom" target="wclose"
onclick="window.open('../../../popup.html#nom','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Nom de l'établissement:</a></td>
<td><input type="text" name="nom" size="40"></td>
</tr>
<td><a href="../../../popup.html#adresse" target="wclose"
onclick="window.open('../../../popup.html#adresse','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Adresse:</a></td>
<td><input type="text" name="adresse" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#cp" target="wclose"
onclick="window.open('../../../popup.html#cp','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Code postal:</a></td>
<td><input type="text" name="cp" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#ville" target="wclose"
onclick="window.open('../../../popup.html#ville','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Ville:</a></td>
<td><input type="text" name="ville" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#tel" target="wclose"
onclick="window.open('../../../popup.html#tel','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Téléphone:</a></td>
<td><input type="text" name="tel" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#fax" target="wclose"
onclick="window.open('../../../popup.html#fax','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Fax:</a></td>
<td><input type="text" name="fax" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#mail" target="wclose"
onclick="window.open('../../../popup.html#mail','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Mail:</a></td>
<td><input type="text" name="mail" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#directeur" target="wclose"
onclick="window.open('../../../popup.html#directeur','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Nom du directeur:</a></td>
<td><input type="text" name="directeur" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#lits" target="wclose"
onclick="window.open('../../../popup.html#lits','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Nombre de lits:</a></td>
<td><input type="text" name="lits" size="40"></td>
</tr>
<tr>
<td><a href="../../../popup.html#description" target="wclose"
onclick="window.open('../../../popup.html#description','wclose',
'width=380,height=350,toolbar=no,status=no,left=20,top=30')">Description:</a></td>
<td><textarea name="description" rows=10 cols=50></textarea></td>
</tr>
<tr>
<td></td>
<td><INPUT type="submit" value="Ajouter" class="bouton"></td>
</tr>
</form> |