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| <body>
<table width="863" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td height="152" colspan="6"><img src="mes%20images/haut.jpg" width="750" height="93">
<table width="862" height="57" border="1">
<tr bgcolor="#003366">
<td width="852" class="gras Style6"><div align="center" class="Style2">
<h1><span class="Style4">Formulaire d'inscription</span>: </h1>
</div></td>
</tr>
</table></td>
</tr>
<tr>
<td width="157" bordercolor="#003366" bgcolor="#003366"> </td>
<td colspan="4" rowspan="14" bgcolor="#FFFFFF">
<form action="ajout_loc.php" method="post" name="form1" >
<table width="450" border="0" align="center" cellpadding="0" cellspacing="0" >
<tr>
<td width="151" height="29" bgcolor="#FFFFFF"><div align="left" class="Style3">
<p class="Style9">Nom</p>
</div></td>
<td colspan="3"><label> </label>
<div align="left">
<input name="Nom" type="text" maxlength="30" />
</div></td>
</tr>
<tr>
<td><div align="left" class="Style9">Prenom</div></td>
<td colspan="3"><label> </label>
<div align="left">
<input name="Prenom" type="text" id="Prenom" maxlength="30" />
</div></td>
</tr>
<tr>
<td><div align="left" class="Style9">Age</div></td>
<td colspan="3"><label>
<input name="Age" type="text" class="Style3" id="Age" size="2" maxlength="2" />
</label>
<span class="Style9">
ans</span></td>
</tr>
<tr>
<td><div align="left" class="Style9">Telephone</div></td>
<td colspan="3"><label> </label>
<div align="left">
<input name="Telephone" type="text" id="Telephone" maxlength="15" />
</div></td>
</tr>
<td><div align="left" class="Style9">E_mail</div></td>
<td colspan="3"><label> </label>
<div align="left">
<input name="E_mail" type="text" id="E_mail" maxlength="40" />
</div></td>
<tr>
<td><div align="left" class="Style9">Pseudo</div></td>
<td width="98"><label> </label><input type="text" name="Pseudo" /></div></td>
</tr>
<tr>
<td><div align="left" class="Style9">Veuillez choisir un mot de passe</div></td>
<td colspan="3"><label> </label>
<div align="left">
<input name="mot_de_passe" type="password" id="mot_de_passe" maxlength="15" />
</div></td>
</tr>
<tr>
<td><div align="left" class="Style9">Veuillez confirmer votre mot de passe</div></td>
<td colspan="3"><label> </label>
<div align="left">
<input name="mot_de_passe1" type="password" id="mot_de_passe1" maxlength="15" />
</div></td>
</tr>
<tr>
<td><div align="left" class="Style9">Adresse</div></td>
<td colspan="3"><label>
<input name="Adresse" type="text" id="Adresse" maxlength="45" />
</label> </td>
</tr>
<tr>
<td><div align="left" class="Style9">Ville</div></td>
<td colspan="3"><label>
<input name="Ville" type="text" id="Ville" maxlength="20" />
</label> </td>
</tr>
<tr>
<td><div align="left" class="Style9">Code postal</div></td>
<td colspan="3"><label>
<input name="Code_postal" type="text" id="Code_postal" size="5" maxlength="5" />
</label> </td>
</tr>
<tr>
<td><div align="left" class="Style9">Pays</div></td>
<td colspan="3"><label>
<input name="Pays" type="text" id="Pays" maxlength="20" />
</label> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td width="96"> </td>
<td width="105"> </td>
</tr>
<tr>
<td><label>
<div align="center">
<input name="Submit" type="submit" class="Style9" value="Envoyer" onClick=" return validate_form();" />
</label> </td>
<td colspan="3"><label>
<input name="Submit2" type="reset" class="Style9" value="Réinitialiser" />
</label> </td>
</tr>
</table>
</form> </td>
<td width="168" bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366">
</td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"></td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr>
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td bgcolor="#003366"> </td>
</tr>
<tr bgcolor="#000099">
<td bordercolor="#003366" bgcolor="#003366"> </td>
<td width="4" bgcolor="#003366"> </td>
<td width="161" bgcolor="#003366"> </td>
<td width="161" bgcolor="#003366"> </td>
<td width="212" bgcolor="#003366"><a href="index.html" class="gras1 Style7">Retour à la page d'accueil</a></td>
<td bgcolor="#003366"> </td>
</tr>
</table> |
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