33 lines
1.6 KiB
HTML
33 lines
1.6 KiB
HTML
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<!DOCTYPE html>
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<html lang="FR-fr">
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<head>
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<title>Formulaire</title>
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</head>
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<body>
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<h1>Formulaire</h1>
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<form method="post" action="https://dwarves.iut-fbleau.fr/requete.php">
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<label>Nom: <input type=text name="Nom" placeholder="Dupond"></label><br>
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<label>Prénom: <input type="text" name="Prénom" placeholder="Jean"></label><br>
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<label>Date de naissance : <input type="date" name="Date de naissance"></label><br>
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<label>Adresse E-Mail: <input type="email" name="Email" placeholder="toto.exemple@u-pec.fr"></label><br>
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<label>Code Postale: <input type="number" name="Code Postal" placeholder="77300"></label><br>
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<label>Téléphone Portable: <input type="tel" name="Téléphone portable"
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placeholder="01 23 45 67 89"
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maxlength="14"
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pattern="[0 6-7]{2} [0-9]{2} [0-9]{2} [0-9]{2} [0-9]{2}"></label><br>
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<label>Sexe: </label>
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<label><input type="radio" name="Sexe" value="male">Homme</label>
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<label><input type="radio" name="Sexe" value="female">Femme</label>
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<label><input type="radio" name="Sexe" value="other">Autre</label><br>
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<label>Semestre: <select name="Semestre">
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<option value="S1">Semestre 1</option>
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<option value="S2" selected>Semestre 2</option>
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<option value="S3">Semestre 3</option>
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<option value="S4">Semestre 4</option>
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</select></label><br>
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<label>Niveau en html: <input type="range" name="Niveau en html" value="5" min="0" max="10" step="1"/></label><br>
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<label>Message: <textarea name="Message" rows="20" cols="50"></textarea></label><br><br>
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<input type="reset" value="Remise à zéro"><input type="submit" value="Envoyer le formulaire">
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</form>
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</body>
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</html>
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