Page 1030 - IT2
P. 1030

<body>


               <pre> <font size="6">  <u> Formulaire d'inscription </u>


                   <b>Les Informations Client</b>
                      </font>  </pre>
               <table>




               <form name="f" align=center>



               <tr>

               <td>Nom Client :</td>
               <td><input type="text" name="nom" value=""/></td>

               <td id="id1"><font color=red size=5>*</font></td>
               </tr>


               <tr>
               <td>Prenom :</td>

               <td><input type="text" name="prenom" value=""/></td>
               <td id="id2"><font color=red size=5>*</font></td>

               </tr>


               <tr>
               <td>Sexe :</td>

               <td><input type="radio" name="radio" value=""/> Femme <input
               type="radio" name="radio" value=""/> Homme</td>
               </tr>



               <tr>
               <td>Email :</td>
               <td><input type="text" name="email" value=""

               placeholder="Exemple@hotmail.com"/></td>
               <td id="id3"><font color=red size=5>*</font></td>

               </tr>




               Filière                Epreuve                  Session               Page 12 sur 14
               TDM                    Synthèse V1              Juillet 2015
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