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<!DOCTYPE html> <html lang="fr"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>Document</title> </head> <body bgcolor="#20b2aa"> <marquee direction="up"> <table width="70%" align="center"> <tr align="center"> <td> <img src="image/fond-d-ecran-3.jpg" height="150" title="THEOPHANE"> </td> <td> <img src="image/Bahamas_Hotel_hd_wallpaper.jpg" height="150" > </td> <td> <img src="image/Bentley_Continental_GTC,_2007.jpg" height="150"> </td> </tr> </table> </marquee> <form> <h1 align="center"><u><font face="Franklin Gothic">FICHE D'INSCRIPTION</font></u></h1> <fieldset ><h2 align="center"> <font face="elephant" color="#00ffff">ESPACE ETUDIANT</font></h2></fieldset> <table border="2" align="center" width="70%" bordercolor="purple"> <tr align="center"> <marquee direction="right"><img src="image/JESUS.jpg" height="120" align="left"></marquee> <marquee direction="left"><img src="image/Heunder stand stop.jpg" height="140" align="left"></marquee><td> <label>NOM DE FAMILLE</label> <input type="text" placeholder="ENTREZ VOTRE NOM" required> <br><br> <label>PRENOM</label> <input type="text" placeholder="ENTREZ VOTRE PRENOM" required><br><br> <label>SEXE:</label> <label>F</label> <input type="radio" name="SEXE"> <label>M</label> <input type="radio" name="SEXE"><br><br> <label>DOCUMENT D'IDENTITÉ</label> <input type="text" placeholder="DOCUMENT D'IDENTITÉ" required><br><br> <label>N˚DOCUMENT D'IDENTITÉ </label> <input type="number" placeholder="numero" required> <br><br> NIVEAU D'ETUDES: <label>SANS BAC</label> <input type="radio" name="NIVEAU D'ETUDES" required> <label>BAC</label> <input type="radio" name="NIVEAU D'ETUDES" required> <label>LICENCE</label> <input type="radio" name="NIVEAU D'ETUDES" required> <label>AUTRES(preciser)</label> <input type="radio" name="NIVEAU D'ETUDES" required> <input type="text"> <br> <br> <label>LIEN</label> <input type="url" required> <br><br> NOMBRE: <label>1</label> <input type="range" required> <label>2</label> <input type="range" required> <br><br> HORAIRE PRÉFÉRÉ: <table align="center"> <tr> <td> <label>9h-11h15</label> <input type="checkbox" required> </td> <td> <label>11h15-13h30</label> <input type="checkbox" required> </td> <td> <label>13h30-15h45</label> <input type="checkbox" required> </td> <td> <label>15h45-18h</label> <input type="checkbox" required> </td> </tr> </table> </td> <td width="50%"> <label>DATE DE NAISSANCE</label> <input type="date" required> <br><br> <label>LIEU DE NAISSANCE</label> <input type="text" placeholder="ENTREZ VOTRE LIEU DE NAISSANCE" required><br><br> <label>ADRESSE</label> <input type="text" placeholder="ENTREZ VOTRE ADRESSE" required><br><br> VILLE: <select> <option>ABIDJAN</option> <option>ADZOPE</option> <option>MAN</option> <option>KORHOGO</option> <option>BOUAKÉ</option> </select> <br><br> <label>TELEPHONE</label> <input type="tel" required placeholder="ENTREZ VOTRE NUMERO DE TELEPHONE"><br><br> <label>E-MAIL</label> <input type="email" placeholder="ENTREZ VOTRE E-MAIL" required> <br><br> <label>MOT DE PASSE</label> <input type="password" placeholder="ENTREZ VOTRE MOT DE PASSE" required><br><br> <label >couleur</label> <input type="color"><br><br> <label>HEURE</label> <input type="time" required><br> <br> </td> </tr> </table> <fieldset><h2 align="center"><font color="orange" face="elephant">ESPACE </font><font color="white" face="elephant">PARENT</font></h2></fieldset> <table border="1" bordercolor="#6a5acd" align="center" width="70%" > <tr align="center"> <td> <label>PATRONYME</label><br><br> <label>PRENOM</label><br><br> <label>ADRESSE</label><br><br> <label>E-MAIL</label><br><br> <label>MOT DE PASSE</label><br><br> <label>CELLULAIRE</label><br><br> <label>DATE ET HEURE DE NAISSANCE</label><br><br> <label>PROFESSION</label><br><br> </td> <td> <input type="text" placeholder="ENTREZ VOTRE NOM" required><br><br> <input type="text" required placeholder="ENTREZ VOTRE PRENOM"><br><br> <input type="text" required placeholder="ENTREZ VOTRE ADRESSE"><br><br> <input type="email" required placeholder="ENTREZ VOTRE E-MAIL"><br><br> <input type="password" required placeholder="ENTREZ VOTRE MOT DE PASSE"><br><br> <input type="tel" required placeholder="ENTREZ VOTRE NUMERO DE TELEPHONE"><br><br> <input type="datetime-local" required ><br><br> <input type="search" required placeholder="ENTREZ VOTRE PROFESSION"><br><br> </td> </tr> <tr align="center"> <td width="20%"> <label>ÂGE(ANS)</label> <input type="number" required> </td> <td width="20%"> <h3>VOUS-ÊTES LE PARENTS BIOLOGIQUES? </h3> <label>OUI</label> <input type="button" required name="VOUS-ÊTES LE PARENTS BIOLOGIQUES?"> <label>NON</label> <input type="button" required name="VOUS-ÊTES LE PARENTS BIOLOGIQUES?"> </td> </tr> </table> <h1 align="center"> <input type="submit" required> <input type="reset" required> </h1> <marquee direction="up"> <table align="center" width="60%"> <tr align="center"> <td width="50%" ><img src="image/Monde_imaginaire.jpg" height="150"></td> <td width="50%"><img src="image/Balance_widescreen_wallpaper.jpg" height="150" ></td> <td width="50%"><img src="image/BMW Z4.jpg" height="150"></td> </tr> </table> </marquee> </form> </body> </html>
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