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<FORM METHOD=POST ACTION="http://users.skynet.be/cgi-bin/formd.cgi" onsubmit="return formemail_Validator(this)" name="formemail">
<body bgcolor="#181C20">
<INPUT TYPE=hidden NAME="to" value ="XXXXXXXXXXXXXX">
<INPUT TYPE=hidden NAME="subject" VALUE="XXXXXXXXXXXXXX">
<INPUT TYPE=hidden NAME="next" value="XXXXXXXXXXXXX">
<table border="1" width="493" height="133" style="border-width: 0px">
<tr>
<td height="29" width="483" colspan="5" bgcolor="#181C20" style="border-style: none; border-width: medium">
<p align="center">
<font face="Verdana" style="font-weight:700" color="#FFFF00" size="4">Vous</font></td>
</tr>
<tr>
<td height="33" width="72" style="border-style: none; border-width: medium">
<p align="center">
<select name="genre">
<option>Mlle</option>
<option>Mme</option>
<option>Mr</option>
</select></td>
<td height="33" width="33" style="border-style: none; border-width: medium"><span style="font-size: 9pt">
<font color="#FFFFFF" face="Verdana">Nom:</font></span></td>
<td height="33" width="153" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="nom" size="15" style="float: left"></span></font></td>
<td height="33" width="63" style="border-style: none; border-width: medium">
<font color="#FFFFFF" face="Verdana" style="font-size: 9pt">Prénom:</font></td>
<td height="33" width="139" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="prenom" size="15" style="float: left"></span></font></td>
</tr>
<tr>
<td height="29" width="71" style="border-style: none; border-width: medium">
<p align="right">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">E-Mail:</font></td>
<td height="29" width="33" style="border-style: none; border-width: medium"> </td>
<td height="29" width="367" colspan="3" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="e-mail" size="24" style="float: left"></span></font></td>
</tr>
<tr>
<td height="30" width="71" style="border-style: none; border-width: medium">
<p align="right"><font face="Verdana" color="#FFFFFF"><span style="font-size: 9pt">
Téléphone:</span></font></td>
<td height="30" width="33" style="border-style: none; border-width: medium"> </td>
<td height="30" width="367" colspan="3" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="Telephone" size="24" style="float: left"></span></font></td>
</tr>
</table>
<table border="1" width="14" height="29" style="border-width: 0px">
<tr>
<td height="23" width="14" style="border-style: none; border-width: medium"> </td>
</tr>
</table>
<table border="1" width="493" height="154" style="border-width: 0px">
<tr>
<td height="30" width="493" colspan="5" bgcolor="#181C20" style="border-style: none; border-width: medium">
<p align="center">
<font face="Verdana" style="font-weight:700" size="4" color="#FFFF00">Votre
évènement</font></td>
</tr>
<tr>
<td height="28" width="79" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">
Organisateur:</font></td>
<td height="28" width="398" colspan="4" style="border-style: none; border-width: medium">
<select name="Organisateur">
<option>Particulier</option>
<option>Restaurant/Café</option>
<option>École</option>
<option>Association</option>
<option>Autre</option>
</select></td>
</tr>
<tr>
<td height="27" width="79" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">
Évènement:</font></td>
<td height="27" width="129" style="border-style: none; border-width: medium">
<select name="Evenement">
<option>Anniversaire</option>
<option>Communion</option>
<option>Baptème</option>
<option>Mariage</option>
<option>Soirée rhéto</option>
<option>Soirée privée</option>
<option>Autre</option>
</select></td>
<td height="27" width="43" style="border-style: none; border-width: medium">
</td>
<td height="27" width="103" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">Nbr personnes:</font></td>
<td height="27" width="96" style="border-style: none; border-width: medium">
<select name="Nbr-Personnes">
<option>- de 50</option>
<option>50 à 100</option>
<option>100 à 150</option>
<option>150 à 200</option>
<option>+ de 200</option>
</select></td>
</tr>
<tr>
<td height="27" width="79" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">
Lieu:</font></td>
<td height="27" width="398" colspan="4" style="border-style: none; border-width: medium">
<select name="Lieu">
<option>Salle de réception</option>
<option>Restaurant/Café</option>
<option>École</option>
<option>Particulier</option>
<option>Plein air</option>
<option>Autre</option>
</select></td>
</tr>
<tr>
<td height="28" width="79" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">
Ville:</font></td>
<td height="28" width="129" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="Ville" size="16" style="float: left"></span></font></td>
<td height="28" width="43" style="border-style: none; border-width: medium">
</td>
<td height="28" width="103" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">Code postal:</font></td>
<td height="28" width="96" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="Code-Postal" size="6" style="float: left"></span></font></td>
</tr>
</table>
<table border="1" width="492" height="32" style="border-width: 0px">
<tr>
<td height="26" width="128" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">
Date (jj/mm/aaaa):</font></td>
<td height="26" width="157" style="border-style: none; border-width: medium">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT name="Date" size="16" style="float: left"></span></font></td>
<td height="26" width="59" style="border-style: none; border-width: medium">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">Horaire:</font></td>
<td height="26" width="40" style="border-style: none; border-width: medium">
<select name="Heure-debut">
<option>0</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
</select></td>
<td height="26" width="11" style="border-style: none; border-width: medium">
<p align="center"><font face="Verdana" style="font-size: 9pt">
à</font></td>
<td height="26" width="57" style="border-style: none; border-width: medium">
<select name="Heure-fin">
<option>0</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
</select></td>
</tr>
</table>
<table border="1" width="493" height="55" style="border-width: 0px">
<tr>
<td height="55" width="109" style="border-style: none; border-width: medium">
<font face="Verdana" color="#FFFFFF">
<span style="font-size: 9pt">Votre message:</span></font></td>
<td height="55" width="368" style="border-style: none; border-width: medium"><font face="Verdana"><span style="font-size: 9pt">
<TEXTAREA name="Message" cols="43" rows="4"></TEXTAREA></span></font></td>
</tr>
</table>
<table border="1" width="8" height="25" style="border-width: 0px">
<tr>
<td height="19" width="8" style="border-style: none; border-width: medium"></td>
</tr>
</table>
<table border="1" width="494" height="48" style="border-width: 0px">
<tr>
<td height="30" width="334" style="border-style: none; border-width: medium">
<p align="center">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">
Comment avez-vous découvert Démoniak Sono ?</font></td>
<td height="30" width="144" style="border-style: none; border-width: medium">
<select name="Cmt-connu-site?">
<option>Ami/Proche</option>
<option>Annonce Ebay</option>
<option>Vu en soirée</option>
<option>Publicité</option>
<option>Sur Véhicule</option>
<option>Autre</option>
</select></td>
</tr>
<tr>
<td height="2" width="478" colspan="2" style="border-style: none; border-width: medium"> <p align="center">
<font face="Verdana" style="font-size: 9pt" color="#FFFFFF">Merci de vérifier votre
adresse E-Mail et téléphone avant de cliquer <i><br>
une seule fois</i> sur "Valider"<br>
</font></td>
</tr>
</table>
<table border="1" width="494" height="48" style="border-width: 0px">
<tr>
<td width="229" height="57" align="center" bordercolorlight="#000000" bordercolordark="#000000" style="border-style: none; border-width: medium">
<p align="center">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT type="submit" name="nom2" value="Envoyer" style="float: right"> </span>
</font> </td>
<td width="249" height="57" align="center" bordercolorlight="#000000" bordercolordark="#000000" style="border-style: none; border-width: medium">
<p align="center">
<font face="Verdana"><span style="font-size: 9pt">
<INPUT type="reset" name="nom1" value="Effacer le formulaire" style="float: left"></span></font><p align="center"> |
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