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66 lines
2.4 KiB
66 lines
2.4 KiB
<!doctype html>
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<html lang="fr">
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<head>
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<meta charset="utf-8">
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<title>Pikes Peak</title>
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<link rel="stylesheet" type="text/css" href="CSS/Style.css">
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<link rel="stylesheet" type="text/css" href="CSS/PageFormulaire.css">
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</head>
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<body>
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<header>
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<nav>
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<a href="pageActualites.html">actus</a>
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<a href="pageTableaux.html">taleaux</a>
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<a href="PageAcceuil.html" class="PPIHC"><img src="Medias/Images/PPIHC.png" id="PPIHC"></a>
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<a href="PageImages.html">Images</a>
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<a href="PageVideo.html">vidéos</a>
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</nav>
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</header>
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<form method="post" action="PageFormulaire.php">
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<div id="Nom">
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<input type="text" name="Nom" placeholder="Nom" minlength="3" required/>
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<input type="text" name="Prenom" placeholder="Prenom"/>
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</div>
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<input type="email" name="email" placeholder="email" required/>
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<div id="date">
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<label for="date">Date de votre demande :</label>
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<input type="date" name="date" value="2022-08-08"/>
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</div>
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<div id="Sexe">
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<label for="sexe">Sexe :</label>
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<input type="radio" name="sexe" value="homme"/>Homme
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<input type="radio" name="sexe" value="femme"/>Femme
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<input type="radio" name="sexe" value="autre"/>Autres
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</div>
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<div id="Raison">
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<label for="raison">Raison de votre demande :</label>
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<select name="raison" id="raison">
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<optgroup label="Problème technique">
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<option value="Pbt">Problème d'images</option>
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<option value="Pbt">Problème de texte</option>
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<option value="Pbt">Problème de forme</option>
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<option value="Pbt">Données éronnées</option>
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</optgroup>
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<optgroup label="Autres">
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<option value="Autres">Demande d'information</option>
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<option value="Autres">Suggestions</option>
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</optgroup>
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</select>
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</div>
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<textarea name="message" placeholder="message" rows="10" cols="50"></textarea>
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<div id="Conditions">
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<input type="checkbox" name="conditions" placeholder="conditions d'utilisations"/>
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<label for="conditions"><a title="Hello" href="PageConditions.html">Conditions d'utilisations</a></label>
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<input type="submit" name="submittp7" value="Envoyer" />
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</div>
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</form>
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<footer>
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<div id="contact">
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<p>© 2004-2022</p>
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<p>AntoinePEREDERII corp.</p>
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<p><a href="PageFormulaire.html">Contact</a></p>
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</div>
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</footer>
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</body>
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</html> |