6 novembre 2017

Votre projet

[insert_php]
if(isset($_GET['v'])){
$txt = ($_GET['v'] == '0')? "Le formulaire est invalide.":"Le formulaire a bien été envoyé !";
echo "

";
}
[/insert_php]

<form method="post" action="/nouvelelan/emprunt/" enctype="multipart/form-data"> <div class="mdl-grid"> <div class="mdl-textfield mdl-cell mdl-cell--6-col mdl-js-textfield mdl-textfield--floating-label col s12 m6"> <input class="mdl-textfield__input" name="prenom" pattern="^[^0-9<>&;']+$" type="text"> <label class="mdl-textfield__label">Prénom*</label> <span class="mdl-textfield__error">Votre prénom n'est pas valide !</span> </div> <div class="mdl-textfield mdl-cell mdl-cell--6-col mdl-js-textfield mdl-textfield--floating-label col s12 m6"> <input class="mdl-textfield__input" name="nom" pattern="^[^0-9<>&;']+$" type="text"> <label class="mdl-textfield__label">Nom*</label> <span class="mdl-textfield__error">Votre nom n'est pas valide !</span> </div> <div class="mdl-textfield mdl-cell mdl-cell--12-col mdl-js-textfield mdl-textfield--floating-label col s12"> <input class="mdl-textfield__input" name="nom_naissance" pattern="^[^0-9<>&;']+$" type="text"> <label class="mdl-textfield__label">Nom de naissance</label> <span class="mdl-textfield__error">Votre nom de naissance n'est pas valide !</span> </div> <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label col mdl-cell mdl-cell--12-col mdl-cell--6-col-tablet"> <input class="mdl-textfield__input" name="birth" maxlength="10" pattern="^([0-2][0-9]|3[01])/(0[1-9]|1[0-2])/(1[89][0-9]{2}|20[01][0-9])$" type="text"> <label class="mdl-textfield__label">Date de naissance*</label> </div> <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label mdl-cell mdl-cell--12-col"> <select id="sexe" name="sexe" class="mdl-textfield__input"> <option value=""></option> <option value="feminin">Féminin</option> <option value="masculin">Masculin</option> </select> <label class="mdl-textfield__label" for="sexe">Genre*</label> </div> <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label mdl-cell mdl-cell--12-col mdl-cell--6-col-tablet"> <input class="mdl-textfield__input" name="mail" type="email"> <label class="mdl-textfield__label">Adresse mail*</label> </div> <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label mdl-cell mdl-cell--12-col mdl-cell--6-col-tablet"> <input class="mdl-textfield__input" name="tel" maxlength="10" pattern="^0[0-9]{9}$" type="tel"> <label class="mdl-textfield__label">Téléphone*</label> </div> <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label mdl-cell mdl-cell--12-col"> <select id="location" name="location" class="mdl-textfield__input"> <option value=""></option> <option value="Baincthun">62360 - Baincthun</option> <option value="Boulogne-sur-mer">62200 - Boulogne-sur-mer</option> <option value="Condette">62360 - Condette</option> <option value="Conteville-Les-Boulogne">62126 - Conteville-Les-Boulogne</option> <option value="Equihen-Plage">62224 - Equihen-Plage</option> <option value="Hesdin l'Abbe">62360 - Hesdin l'Abbé</option> <option value="Isques">62360 - Isques</option> <option value="La Capelle-Les-Boulognes">62360 - La Capelle-Les-Boulognes</option> <option value="Le Portel">62480 - Le Portel</option> <option value="Neufchatel-Hardelot">62152 - Neufchâtel-Hardelot</option> <option value="Outreau">62230 - Outreau</option> <option value="Saint-Etienne-au-Mont">62360 - Saint-Étienne-au-Mont</option> <option value="Saint-Leonard">62360 - Saint-Léonard</option> <option value="Saint-Martin-Boulogne">62280 - Saint-Martin-Boulogne</option> <option value="Wimereux">62930 - Wimereux</option> <option value="Wimille">62126 - Wimille</option> </select> <label class="mdl-textfield__label" for="location">Lieu de résidence*</label> </div> <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label mdl-cell mdl-cell--12-col"> <textarea name="project" class="mdl-textfield__input"></textarea> <label class="mdl-textfield__label">Votre projet</label> </div> <input name="post_id" value="500" type="hidden"> <button class="mdl-button mdl-js-button mdl-button--raised mdl-button--colored" type="submit" name="send" value="true">Envoyer</button> </div> </form>