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| <form method="get" action="resrecherche.php">
Sexe (Obligatoire):
<INPUT type="checkbox" name="Sexe[]" value="Homme"> Homme
<INPUT type="checkbox" name="Sexe[]" value="Femme"> Femme<br><br>
Origine (Obligatoire): <br><br>
<div class="taborigine">
<INPUT type="checkbox" name="origines[]" value="toto"> 1
<INPUT type="checkbox" name="origines[]" value="titi"> 2
<INPUT type="checkbox" name="origines[]" value="tutu"> 3<br><br>
<INPUT type="checkbox" name="origines[]" value="lolloo"> 4
</div>
<br><br>
Email <input type="text" name="email" /><br><br>
Tel <input type="text" name="tel" /><br><br>
Départements séparés par / (rien si toute la France)<input type="text" name="departement" /><br><br>
age entre <input type="text" name="agemin" /> et <input type="text" name="agemax" /><br><br>
Date entree <input type="text" name="DateEnt" /><br><br>
Date fraicheur<input type="text" name="DateFrai" /><br><br>
Client payant?? <br>
<INPUT type="checkbox" name="ClientPWap" value="ClientPWap"> Client Payant Wap
<INPUT type="checkbox" name="ClientPNet" value="ClientPTel"> Client Payant tel
<INPUT type="checkbox" name="ClientPWeb" value="ClientPWeb"> Client Payant Web<br><br>
Abonné a quelle news?? <br>
<INPUT type="checkbox" name="abonnenewent" value="abonnenewent"> abonné à notre newsletter
<INPUT type="checkbox" name="abonnenewpart" value="abonnenewpart"> abonné à la newsletter partenaire<br><br>
<input type="submit" value="valider">
</form> |