31 lines
1.6 KiB
HTML
31 lines
1.6 KiB
HTML
<!DOCTYPE html>
|
|
<html lang="FR-fr">
|
|
<head>
|
|
<title>Formulaire</title>
|
|
</head>
|
|
<body>
|
|
<h1>Formulaire</h1>
|
|
<form method="post" action="https://dwarves.iut-fbleau.fr/requete.php">
|
|
<label>Nom: <input type=text name="Nom" placeholder="Dupond"></label><br>
|
|
<label>Prénom: <input type="text" name="Prénom" placeholder="Jean"></label><br>
|
|
<label>Date de naissance : <input type="date" name="Date de naissance"></label><br>
|
|
<label>Adresse E-Mail: <input type="email" name="Email" placeholder="toto.exemple@u-pec.fr"></label><br>
|
|
<label>Code Postale: <input type="number" name="Code Postal" placeholder="77300"></label><br>
|
|
<label>Téléphone Portable: <input type="text" name="Téléphone portable" placeholder="0123456789" maxlength="10"></label><br>
|
|
<label>Sexe: </label>
|
|
<label><input type="radio" name="Sexe" value="male">Homme</label>
|
|
<label><input type="radio" name="Sexe" value="female">Femme</label>
|
|
<label><input type="radio" name="Sexe" value="other">Autre</label><br>
|
|
<label>Semestre: <select name="Semestre">
|
|
<option value="">Veuillez sélectionnez un semestre</option>
|
|
<option value="S1">Semestre 1</option>
|
|
<option value="S2">Semestre 2</option>
|
|
<option value="S3">Semestre 3</option>
|
|
<option value="S4">Semestre 4</option>
|
|
</select></label><br>
|
|
<label>Niveau en html: <input type="range" name="Niveau en html" value="5" min="0" max="10" step="1"/></label><br>
|
|
<label>Message: <textarea name="Message" rows="20" cols="50"></textarea></label><br><br>
|
|
<input type="reset" value="Remise à zéro"><input type="submit" value="Envoyer le formulaire">
|
|
</form>
|
|
</body>
|
|
</html> |