ÿþ<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html> <head> <script> function check() { if (document.F.condition.checked) { return true; } alert('Terms and conditions is obligatory field'); return false; } </script> <script language=JavaScript src="http://www.alberobelloholidays.com/js/biblio-js.js"></script> <link rel="stylesheet" type="text/css" media="all" href="../form.css" /> <link rel="stylesheet" type="text/css" media="all" href="../style.css" /> <title>BOOKING FORM </title> </head> <body text="#000000" bgcolor="#FFFFFF" TOPMARGIN="0" MARGINHEIGHT="0" LEFTMARGIN="0" MARGINWIDTH="0" alink="red" bgcolor="FFFFFF" text="000000" link="0000FF" vlink="FF0000"> <table width="100%" cellpadding="0" cellspacing="0" border="0"> <tr bgcolor="#797E54" width="100%" height="50"> <td align="left" width="30%"><a href="http://www.alberobelloholidays.com/index.php" border="0"><img src="http://www.alberobelloholidays.com/images/title.gif"/ border="0"></a> </td> <td bgcolor="#797E54" align="left" width="70%"> <span class="headertitle" style="FONT-SIZE: 18px;COLOR : #ffffff!important;FONT-FAMILY: Arial, Helvetica, sans-serif; ">Formulaire d inscription</span> </td> <tr> </table> <div class="obligatoryfield">* Champs obligatoires </div> <form NAME="F" action ="trait-book-form.php" onSubmit="return check()" method="post" > <div class="tbforms1"> <table class="tbforms1" border="0"> <tr> <td colspan="2"> <div class="subhead3"></div> </td> </tr> <!-- Question 1 --> <tr> <td class="qblock" id="qblock1"> <div class="qtitle">Titre<span class="redstar">* </span> </div> </td> <td class="qblock" id="qblock1_1"> <div class="qform"> <INPUT Type="Radio" Value="Mrs" Name="title">M <INPUT Type="Radio" Value="Ms" Name="title">Mme <INPUT Type="Radio" Value="Mr" Name="title">Melle </div> </td> </tr> <!-- Question 2 --> <tr> <td class="qblock" id="qblock2"> <div class="qtitle">Nom<span class="redstar">* </span> </div> </td> <td class="qblock" id="qblock2_1"> <div class="qform"> <input type="text" name="Surname"> </div> </td> </tr> <tr> <td class="qblock" id="qblock8"> <div class="qtitle">Prénom<span class="redstar">*</span> </div> </td> <td class="qblock" id="qblock8_1"> <div class="qform"> <input type="text" name="Surname1"> </div> </td> </tr> <!-- Question 10 --> <tr> <td class="qblock" id="qblock10"> <div class="qtitle">Adresse </div> </td> <td class="qblock" id="qblock10_1"> <div class="qform"> <input type="Text" name="Address1" > </div> </td> </tr> <!-- Question 11 --> <tr> <td class="qblock" id="qblock11"> <div class="qtitle">Adresse secondaire</div> </td> <td class="qblock" id="qblock11_1"> <div class="qform"> <input type="Text" name="Address2"> </div> </td> </tr> <!-- Question 13 --> <tr> <td class="qblock" id="qblock13"> <div class="qtitle">Code postal </div> </td> <td class="qblock" id="qblock13_1"> <div class="qform"> <input type="Text" name="postcode"> </div> </td> </tr> <!-- Question 14 --> <tr> <td class="qblock" id="qblock14"> <div class="qtitle">Pays </div> </td> <td class="qblock" id="qblock13_1"> <div class="qform"> <input type="Text" name="country"> </div> </td> </tr> <!-- Question 15 --> <tr> <td class="qblock" id="qblock15"> <div class="qtitle">E-mail <span class="redstar">* </span> </div> </td> <td class="qblock" Id="qblock15_1"> <div class="qform"> <input type="Text" name="email"> </div> </td> </tr> <!-- Question 16 --> <tr> <td class="qblock" id="qblock16"> <div class="qtitle">Numéro de téléphone </div> </td> <td class="qblock" id="qblock16_1"> <div class="qform"> <input type="Text" name="phone"> </div> </td> </tr> <!-- Question 16 --> <tr> <td class="qblock" id="qblock16"> <div class="qtitle">Date de naissance </div> </td> <td class="qblock" id="qblock16_1"> <div class="qform"> <input type="Text" name="birthdate"> </div> </td> </tr> <tr> <td class="qblock" id="qblock12" colspan="2"> <div class="qtext"> <div class="qtitle">Dates préférées de cours <br /><span class="description">(Mentionnez vos autres préférences sous « commentaires »):</span> </div> <div class="fieldlabel"></div> </div> <div class="qform"> <INPUT Type="radio" Value="painting" Name="date">16-23 mai 2009 (la peinture, en anglais) <br /> <INPUT Type="radio" Value="cooking" Name="date">24-30 mai 2009 (la cuisine) <br /> <INPUT Type="radio" Value="both" Name="date">les deux semaines<br /> </div> </td> </tr> </table> </div> <div class="tbforms"> <table class="tbforms" border="0"> <!-- Question 2 --> <!-- Question 12 --> <tr> <td class="qblock" id="qblock2" colspan="2"> <div class="qtext"> <div class="qtitle">Accompagnant(es) : </div> <div class="fieldlabel"></div> </div> <div class="qform"> <INPUT type="text" Name="Adulte"> Adultes<br /> <INPUT type="text" Name="children"> Enfants<br /> </div> </td> </tr> <!-- Question 12 --> <tr> <td class="qblock" id="qblock2" colspan="2"> <div class="qtext"> <div class="qtitle">Types de logement (voir sous « Où nous sommes ») : </div> <div class="fieldlabel"></div> </div> <div class="qform"> <INPUT Type="Checkbox" Value="Double (single occupancy)" Name="room">Double (personne seule)<br /> <INPUT Type="Checkbox" Value="Double_shared" Name="room1">Double (2 personnes)<br /> <INPUT Type="Checkbox" Value="Triple" Name="room2">Triple<br /> <INPUT Type="Checkbox" Value="For_four" Name="room3">A quatre<br /> <INPUT Type="Checkbox" Value="For_five" Name="room4">A cinq<br /> <INPUT Type="Checkbox" Value="Trullo_8_people" Name="room5">Trullo (8 personnes)<br /> </div> </td> </tr> <!-- Question 1 --> <tr> <td class="qblock" id="qblock1" colspan="2"> <div class="qtext"> <div class="qtitle">Commentaires : </div> <div class="fieldlabel"></div> </div> <div class="qform"> <textarea name="message" cols=40 rows=4></textarea> </div> </td> </tr> <!-- Question 4 --> <tr> <td class="qblock" id="qblock2" colspan="2"> <div class="qtext"> </div> <div class="qform"> <INPUT Type="Checkbox" Value="yes" Name="condition">J accepte<a href="../doc/Terms_and_Conditions-fr.pdf" class="url"> les termes et conditions </a> (pdf) <span class="redstar">* </span><br /> </div> </td> </tr> <td colspan="2"> &nbsp; </td> </tr> <!-- Submit button --> <TR> <TD Class="buttonsubmit"> <DIV Class="buttonsubmit"> <input type = "submit" value = "Envoyer"> </DIV> </TD> </TR> </TABLE> </div> <br /> </DIV><br /> </form> <br clear="all" /> <hr > <div class="copyright">© 2007 Alberobello e più holidays </div> </body> </html>