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| <HTML>
<HEAD>
<TITLE>Formulaire de disponibilité journalière</TITLE>
</HEAD>
<BODY BACKGROUND="PAPER.gif">
<FORM method="post" action="hugues.dupont2@sfr.fr" enctype="text/plain">
Remplissez tous les champs du formulaire.
<br>
<br>
<FORM>
Matricule <INPUT type="text" name="matricule" size="15">
</FORM>
<br>
Format de la date: jj/mm/aaaa (01/01/2010)
<FORM>
Date <INPUT type="date" name="date" size="15">
</FORM>
<HR align=center size=8 width="50%">
<br>
<FORM>
<INPUT type="checkbox" name="choix1" value="1"> 00h00-05h30
<br>
<INPUT type="checkbox" name="choix2" value="2"> 05h30-07h30
<br>
<INPUT type="checkbox" name="choix3" value="3"> 07h30-09h30
<br>
<INPUT type="checkbox" name="choix4" value="4"> 09h30-11h30
<br>
<INPUT type="checkbox" name="choix5" value="5"> 11h30-13h30
<br>
<INPUT type="checkbox" name="choix6" value="6"> 13h30-15h30
<br>
<INPUT type="checkbox" name="choix7" value="7"> 15h30-17h30
<br>
<INPUT type="checkbox" name="choix8" value="8"> 17h30-19h30
<br>
<INPUT type="checkbox" name="choix9" value="9"> 19h30-21h30
<br>
<INPUT type="checkbox" name="choix10" value="10"> 21h30-24h00
</FORM>
<FORM>
Code <INPUT type="text" name="code" size="15">
</FORM>
<br>
<FORM>
<INPUT TYPE="submit" NAME="nom" VALUE=" Envoyer ">
</FORM>
</FORM>
</BODY>
</HTML> |