[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>