Page 1037 - IT2

<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>

<tr>
<td>Age :</td>
<td><input type="text" name="age" value=""/></td>
<td id="id5"><font color=red size=5>*</font></td>
</tr>
<td>Ville :
</td>
<td>
<SELECT name="ville" size="1" width="30%">
<OPTION> Rabat
<OPTION> Méknes
<OPTION> Fés
<OPTION> Tanger
</SELECT>
</td></tr>
<tr>
<td>Num Chambre :</td>
<td><input type="text" name="cham" value=""/></td>
<td id="id4" rowspan=2><font color=red size=5>*</font></td>
</tr>
<tr>

</tr>
<tr>
<td>Type Chambre :</td>
<td><input type="text" name="cham" value=""/></td>
<td id="id4" rowspan=2><font color=red size=5>*</font></td>

Filière Epreuve Session Page 5 sur 6
TDM Synthèse V2 Juillet 2015