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<html>
<head>
<title>Inscription</title>
</head>
<body>
<h2 align="center">Formulaire d'inscription</h2>
<form name="forml" method="post" action="executerInscription.php" enctype="multipart/form-data">
<table width="53%" border="0" align="center" cellpadding="5" cellspacing="0">
<tr>
<td width="49%">Nom</td>
<td colspan="2">
<div align="left">
<input type="text" name="nom" size="25" maxlength="25">
</div>
</td>
</tr>
<tr>
<td width="49%"></td>
<td height="2" colspan="2"></td>
</tr>
<tr>
<td width="49%" height="57">Adresse</td>
<td height="57" colspan="2">
<textarea name="address" cols="25" rows="4"> </textarea>
</td>
</tr>
<tr>
<td width="49%"></td>
<td height="2" colspan="2"></td>
</tr>
<tr>
<td width="49%"> Date de Naissance</td>
<td height="2" colspan="2">
<select name=mois_naissance>
<option selected value=1>Janvier
<option value=2> Fevrier
<option value=3>Mars
<option value=4>Avril
<option value=5>Mai
<option value=6>Juin
<option value=7>Juillet
<option value=8>Août
<option value=9>Septembre
<option value=10>Octobre
<option value=11>Novembre
<option value=12>Decembre
</select>
<select name=jour_naissance>
<option selected value=1>01
<option value=2>02
<option value=3>03
<option value=4>04
<option value=5>05
<option value=6>06
<option value=7>07
<option value=8>08
<option value=9>09
<option value=10>10
<option value=11>11
<option value=12>12
<option value=13>13
<option value=14>14
<option value=15>15
<option value=16>16
<option value=17>17
<option value=18>18
<option value=19>19
<option value=20>20
<option value=21>21
<option value=22>22
<option value=23>23
<option value=24>24
<option value=25>25
<option value=26>26
<option value=27>27
<option value=28>28
<option value=29>29
<option value=30>30
<option value=31>31</option>
</select>
<input maxlength=4 name=annee_naissance size=4>
(Year)</td>
</tr>
<tr>
<td width="49%" height="2"></td>
<td height="2" width="17%"></td>
<td height="2" width="34%"></td>
</tr>
<tr>
<td width="49%">Sexe</td>
<td height="2" width="17%"><input type="radio" name="gender" value="M">Male </td>
<td height="2" width="34%"><input type="radio" name="gender" value="F">Female </td>
</tr>
<tr>
<td width="49%" height="5"></td>
<td height="5" colspan="2"></td>
</tr>
<tr>
<td width="49%">Loisirs </td>
<td height="2" colspan="2">
<table width="100%" border="0">
<tr>
<td>
<input type="checkbox" name="sport" value="1">
Sport </td>
<td>
<input type="checkbox" name="lecture" value="1">
Lecture </td>
</tr>
<tr>
<td>
<input type="checkbox" name="surf" value="1">
Surf </td>
<td>
<input type="checkbox" name="cinema" value="1">
Cinema </td>
</tr>
<tr>
<td>
<input type="checkbox" name="musique" value="1">
Musique </td>
<td></td>
</tr>
</table>
</td>
</tr>
<tr>
<td width="49%" height="2"></td>
<td colspan="2" height="2"></td>
</tr>
<tr>
<td colspan="3">
<div align="center">
<input type="submit" name="Submit" value="Envoyer">
</div>
</td>
</tr>
</table>
</form>
</body>
</html>
<!-- executerInscription.php
<html>
<head>
<title>Confirmation</title>
</head>
<body>
<h2> Chèr(e)
<?php
if ($gender=='M') {
echo "Mr.";
} elseif ($gender=='F') {
echo "Ms.";
}
echo " ", $nom;
?> ! You have entered the following information: </h2>
<table border="1">
<tr>
<td>Adresse </td>
<td>
<?php echo $address; ?>
</td>
</tr>
<tr>
<td>Date de Naissance </td>
<td>
<?php echo $mois_naissance, " ", $jour_naissance, " ", $annee_naissance; ?>
</td>
</tr>
<tr>
<td colspan=2>Vos Loisirs:
<?php
if (!(empty($sport))) {
if ($sport==1){
echo " Sport ";
}
}
if (!(empty($surf))) {
if ($surf==1) {
echo " Surf ";
}
}
if (!(empty($lecture))) {
if ($lecture==1){
echo " Lecture ";
}
}
if (!(empty($musique))) {
if ($musique==1) {
echo " Musique ";
}
}
if (!(empty($cinema))) {
if ($cinema==1){
echo " Cinema ";
}
}
?>
</td>
</tr>
</table>
</body>
</html>
-->