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| <form name="coordonnees" id="coordonnees" method="post" action="engagements.php">
<center>
<p class="titre">
<fieldset id="coordonnees">
<legend>Vos coordonnées</legend>
<label for="nom_prenom"><strong>Nom-Prenom* : </strong></label>
<!--<input id="nom" type="text" name="nom" /><br /></p>-->
<select name="nom" id="nom" size="1" maxlength="55" required>
<option value=""> </option>
</select>
<p>
<!--<input type="text" name="nom" size="20" value="nom" maxlength="35"><br>-->
<label for="phone"><strong>Telephone* (portable) : </strong></label><input type="tel" name="phone" size="10" value="" maxlength="10" required required pattern="[0]{1}[6-7]{1}[0-9]{8}" title="telephone portable 06, 07 (10chiffres)"/><br>
<br><label><strong>Adresse courriel** : </strong></label><input type="email" name="email" size="35" value="" maxlength="40" required><br>
<br><label for="fede"><strong> federation*: </strong></label>
<select name="fede" id="fede"size="1" maxlength="6" required>
<option value="">  </option>
<option value="xx">FFC</option>
<option value="yyy">FFCT</option>
<option value="zzzT">FSGT</option>
<option value="vvv">FFTri</option>
<option value="www">UFOLEP</option>
<option value="autre">Autre</option>
</select></br>
<br><label for="numlicence"><strong>Num.Licence* : </strong></label><input type="text" name="numlicence" size="6" value="" maxlength="6" required required pattern="[5-6-7-8]{1}[0-9]{5}" title="licence 6 chiffres obligatoires"/></br><br>
<SCRIPT language="JavaScript">
<!--
function Choix(form)
{
i = form.Rando.selectedIndex;
if (i == 0)
{
for (i=0;i<4;i++)
{
form.Dist.options[i].text="";
}
return;
for (i=0;i<4;i++)
{
form.DateR.options[i].text="";
}
return;
for (i=0;i<4;i++)
{
form.prix.options[i].text="";
}
return;
}
switch (i)
{
//case 1 : var txt = new Array ('2006-03-13'); break;
case 1 : var txt = new Array ('2016-03-20'); break;
case 2 : var txt = new Array ('2016-04-30'); break;
case 3 : var txt =new Array ( '2016-04-09'); break;
case 4 : var txt = new Array ('2016-05-21'); break;
case 5 : var txt = new Array ('2016-06-11'); break;
}
form.DateR.options[1].text="- Date Rando-";
for (i=0;i<3;i++) {
form.DateR.options[i+1].text=txt[i];
}
form.DateR.selectedIndex = 1;
i = form.Rando.selectedIndex;
if (i == 0)
{
for (i=0;i<4;i++)
{
form.Dist.options[i].text="";
}
return;
for (i=0;i<4;i++)
{
form.DateR.options[i].text="";
}
return;
}
switch (i)
{
//case 1 : var txt = new Array ('51','73','100','-'); break;
case 1 : var txt = new Array ('30','60','90','115'); break;
case 2 : var txt = new Array ('150','200','-','-'); break;
case 3 : var txt =new Array ( '130'); break;
case 4 : var txt = new Array ('135','215','-','-'); break;
case 5 : var txt = new Array ('150','200','-','-'); break;
}
form.Dist.options[0].text="-Choisissez une Distance-";
for (i=0;i<4;i++) {
form.Dist.options[i+1].text=txt[i];
}
form.Dist.selectedIndex = 0;
}
// -->
</SCRIPT>
<br>
<TABLE>
<TR>
<TH>Randonnees* :</TH>
<th>Date de la rando* </th>
<TH>Distances* :</TH>
<TH>Prix :</TH>
</TR>
<TR>
<TD><SELECT NAME="Rando" onChange='Choix(this.form)' required>
<OPTION value="">  </OPTION>
<OPTION value="xxx">F Print.</OPTION>
<option value="yyyyy">R aux</option>
<option value="zzzz">La ine</option>
<option value="vvvvv">Vux</option>
<option value="wwwww">Lclo</option>
</SELECT></TD>
<TD><SELECT NAME="DateR" required>
<OPTION value="">-Date rando-</OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
</SELECT></TD>
<TD><SELECT NAME="Dist" required>
<OPTION value="">-Choix Distance-</OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
</SELECT></TD>
<TD><SELECT NAME="prix" disabled >
<OPTION value="">-Cout rando-</OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
<OPTION></OPTION>
</SELECT></TD>
</TR>
</TABLE>
<!--<input type="text" name="titre" size="40" value="titre du site" maxlength="40"><br>
<input type="text" name="url" size="50" value="url du site" maxlength="50"><br>-->
<input type="submit" value="Envoyer" name="envoyer">
<p class="nota">
Les champs notés * sont obligatoires ! Le champ Prix est désactivé</br>** Cette adresse courriel est strictement confidentielle et ne sera utilisée que
dans le cadre de nos activités.
</center></p>
</fieldset>
</form> |
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