54 lines
2.4 KiB
HTML
54 lines
2.4 KiB
HTML
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<!DOCTYPE html>
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<htlm lang="fr">
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<head>
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Site Internet
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</head>
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<body>
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<p>
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<form method="post" action="https://dwarves.iut-fbleau.fr/requete.php">
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<div>
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<label for="name"> Nom </label><input type="text" id="name" name="UserName"required><br>
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</div>
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<div>
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<label for="prenom"> Prénom </label><input type="text" id="prenom" name="UserSurame"required><br>
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</div>
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<div>
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<label for="naissance"> Date de naissance </label><input type="date" id="naissance" name="UserDateNaissance"required><br>
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</div>
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<div>
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<label for="mail"> Email </label><input type="email" id="mail" name="UserEmail"required><br>
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</div>
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<div>
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<label for="cpostal"> Code postal </label><input type="number" id="cpostal" pattern="[0-9]{5}" name="UserCodePostal"required><br>
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</div>
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<div>
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<label for="tel"> Téléphone portable </label><input type="text" id="tel" pattern="^(?:0|\(?\+33\)?\s?|0033\s?)[1-79](?:[\.\-\s]?\d\d){4}$" name="UserTelephone"equired><br>
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</div>
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<div>
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<input type="radio" id="sexe" value="Homme"name="UserSexe">
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<label for="sexe">Homme</label>
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<input type="radio" id="sexe" value="Femme"name="UserSexe">
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<label for="sexe">Femme</label>
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</div>
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<div>
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<label for="semestre"> Semestre </label>
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<select name="UserSemestre"id="semestre">
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<option value="semestre2" >Semestre 2</option>
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<option value="semestre1">Semestre 1</option>
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<option value="semestre3">Semestre 3</option>
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<option value="semestre4">Semestre 4</option>
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</select><br>
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</div>
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<div>
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<label for="niv"> Niveau en html </label><input type="range" id="niv" min="0" max="10" step="1" name="UserLevel" required><br>
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</div>
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<div>
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<label for="msg"> Message </label><textarea id="msg" name="user_message" ></textarea>
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</div>
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<input type="submit" name="soumission" value="Submit" /> <input type="reset" name="reset" value="Reset" />
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</form>
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<p>
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</body>
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