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| <!doctype html>
<head>
<title>Ma page de test DVP</title>
<meta charset="UTF-8" />
<script type="text/javascript" src="./main/js/jquery-ui/jquery-1.6.2.min.js"></script>
<script type="text/javascript" src="./main/js/jquery-ui/jquery-ui-1.8.16.custom.min.js"></script>
<link href="style.css" rel="stylesheet" type="text/css" />
<style type="text/css">
#label{
background:#D8F8A1;
}
#info label{
display:inline-block;
width:5em;
text-align:right;
}
#info input{
margin-right:60px;
}
#town label{
display:inline-block;
}
#town input{
background:#D8F8A1;
margin-right:18px;
}
input[type=radio]{
color:#D8F8A1;
}
#nvx input{
background:#D8F8A1;
}
</style>
<script type='text/javascript'>
</script>
</head>
<body>
<header>
</header>
<article>
<form action="/HDWForm2Mail/Form2Mail.php" method="post" id="form1" onsubmit="return validate(this)" accept-charset="iso-8859-1">
<p id="nvx">
<label for="Nom"><span class="text9">Nom / prénom :</span></label>
<input name="Nom" type="text" value="" width="260px"/>
</p>
<p id="town">
<label for="Adresse"><span class="text9">Adresse :</span></label>
<input name="Adresse" type="text" value="" />
<label for="Code"><span class="text9">Code postal :</span></label>
<input name="Code" type="text" value="" width="80" />
<label for="Ville"><span class="text9">Ville :</span></label>
<input name="Ville" type="text" value="" />
</p>
<p id="nvx">
<label for="Email"><span class="text9">Email :</span></label>
<input name="Email" type="email" value="" width="260px" />
</p>
<p>
<label><span class="text9">La séance est pour un:</span></label>
</p>
<p id="info"><center>
<label for="Adulte" class="text9">Adulte</label>
<input name="Genre" type="radio" value="Adulte" />
<label for="Adolescent" class="text9"> Adolescent</label>
<input name="Genre" type="radio" value="Adolescent" />
<label for="Enfant" class="text9"> Enfant</label>
<input name="Genre" type="radio" value="Enfant" /></center>
</p>
<p>
<label for="Sujet"><span class="text9">Veuillez décrire en quelques lignes votre problème</span></label>
</p>
<p>
<textarea name="Problème" class="textarea"></textarea>
</p>
<p>
<label for="calendrier"><span class="text9">Choisissez une date de rendez-vous </span></label>
</p>
<div style="z-index:1000;">
<div id="cal2Container" align="right"></div>
<br />
<div style="text-align:right;">
<div style="margin-left:auto;margin-right:auto;width:210px">
<input name="selDaycal2" type="hidden" id="selDaycal2" />
<input name="selMonthcal2" type="hidden" id="selMonthcal2" />
<input name="selYearcal2" type="hidden" id="selYearcal2" />
<input name="selHourcal2" type="hidden" id="selHourcal2" />
<input name="selMinutecal2" type="hidden" id="selMinutecal2" />
</div>
</div>
<p>
<center> <input type="submit" value="Envoyer" name="submit" class="text19"/></center>
</p>
<input type="hidden" name="hdwemail" id="hdwemail" value="hypnosepithiviers+yahoo.fr" />
<input type="hidden" name="hdwok" id="hdwok" value="merci.html" />
<input type="hidden" name="hdwnook" id="hdwnook" value="erreur.html" />
</div>
</form>
</article>
<footer>
</footer>
</body>
</html> |
