Bonjour à toutes et tous ! J'espère sur votre aide !
Voilà 3 jours que je galère sur un formulaire de sondage et je n'y arrive pas !
Je suis au 36ème nivaux en sous sol en PHP et à peine moins bas en html ... pourtant, je tente de comprendre :?
Voilà ma page intégrale, elle est constituée d'un modèle trouvé sur le web adapté à mon besoin !
mais ... galère !
Je m'occupe de formations photo et je souhaite faire un sondage de besoins et attentes ...
1/ Aucun n'est champs obligatoire.
2/ Je souhaite uniquement une vérification sur la syntaxe de l'adresse mail, mais aucune obligation pour le visiteur de la rentrer ( c'est une option en cas de demande de réponse ).
3/ Récupération : des cases à cocher validées et non validées, adresse mail visiteur et message envoyés sont mon adresse personnelle ...
Merci d'avance de votre aide ! Cordialement de Belgique :D
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[php]<?php
/*
CONFIGURATION
*/
// destinataire est votre adresse mail. Pour envoyer à plusieurs à la fois, séparez-les par une virgule
$destinataire = 'MON
[email protected]';
// copie ? (envoie une copie au visiteur)
//$copie = 'non'; // 'oui' ou 'non'
// Messages de confirmation du mail
//$message_envoye = "Votre message nous est bien parvenu !";
//$message_non_envoye = "L'envoi du mail a échoué, veuillez réessayer SVP.";
// Messages d'erreur du formulaire
//$message_erreur_formulaire = "Vous devez d'abord <a href=\"contact.html\">envoyer le formulaire</a>.";
//$message_formulaire_invalide = "Vérifiez que tous les champs soient bien remplis et que l'email soit sans erreur.";
/*
FIN DE LA CONFIGURATION
*/
// formulaire non envoyé
//echo '<p>'.$message_erreur_formulaire.'</p>'."\n";
//}
//else
//{
/*
* cette fonction sert à nettoyer et enregistrer un texte
*/
function Rec($text)
{
$text = htmlspecialchars(trim($text), ENT_QUOTES);
if (1 === get_magic_quotes_gpc())
{
$text = stripslashes($text);
}
$text = nl2br($text);
return $text;
};
/*
* Cette fonction sert à vérifier la syntaxe d'un email
*/
function IsEmail($email)
{
$value = preg_match('/^(?:[\w\!\#\$\%\&\'\*\+\-\/\=\?\^\`\{\|\}\~]+\.)*[\w\!\#\$\%\&\'\*\+\-\/\=\?\^\`\{\|\}\~]+@(?:(?:(?:[a-zA-Z0-9_](?:[a-zA-Z0-9_\-](?!\.)){0,61}[a-zA-Z0-9_-]?\.)+[a-zA-Z0-9_](?:[a-zA-Z0-9_\-](?!$)){0,61}[a-zA-Z0-9_]?)|(?:\[(?:(?:[01]?\d{1,2}|2[0-4]\d|25[0-5])\.){3}(?:[01]?\d{1,2}|2[0-4]\d|25[0-5])\]))$/', $email);
return (($value === 0) || ($value === false)) ? false : true;
}
// formulaire envoyé, on récupère tous les champs.
// qui êtes vous //
$f_1 = (isset($_POST['$f_1'])) ? Rec($_POST['$f_1']) : '';
$f_2 = (isset($_POST['$f_2'])) ? Rec($_POST['$f_2']) : '';
$f_3 = (isset($_POST['$f_3'])) ? Rec($_POST['$f_3']) : '';
$f_4 = (isset($_POST['$f_4'])) ? Rec($_POST['$f_4']) : '';
$f_5 = (isset($_POST['$f_5'])) ? Rec($_POST['$f_5']) : '';
$f_6 = (isset($_POST['$f_6'])) ? Rec($_POST['$f_6']) : '';
// priorités //
$f_7 = (isset($_POST['$f_7'])) ? Rec($_POST['$f_7']) : '';
$f_8 = (isset($_POST['$f_8'])) ? Rec($_POST['$f_8']) : '';
$f_9 = (isset($_POST['$f_9'])) ? Rec($_POST['$f_9']) : '';
$f_10 = (isset($_POST['$f_10'])) ? Rec($_POST['$f_10']) : '';
$f_11 = (isset($_POST['$f_11'])) ? Rec($_POST['$f_11']) : '';
$f_12 = (isset($_POST['$f_12'])) ? Rec($_POST['$f_12']) : '';
$f_13 = (isset($_POST['$f_13'])) ? Rec($_POST['$f_13']) : '';
// argentique //
$f_14 = (isset($_POST['$f_14'])) ? Rec($_POST['$f_14']) : '';
$f_15 = (isset($_POST['$f_15'])) ? Rec($_POST['$f_15']) : '';
$f_16 = (isset($_POST['$f_16'])) ? Rec($_POST['$f_16']) : '';
$f_17 = (isset($_POST['$f_17'])) ? Rec($_POST['$f_17']) : '';
$f_18 = (isset($_POST['$f_18'])) ? Rec($_POST['$f_18']) : '';
$f_19 = (isset($_POST['$f_19'])) ? Rec($_POST['$f_19']) : '';
$f_20 = (isset($_POST['$f_20'])) ? Rec($_POST['$f_20']) : '';
// logiciels //
$f_21 = (isset($_POST['$f_21'])) ? Rec($_POST['$f_21']) : '';
$f_22 = (isset($_POST['$f_22'])) ? Rec($_POST['$f_22']) : '';
$f_23 = (isset($_POST['$f_23'])) ? Rec($_POST['$f_23']) : '';
$f_24 = (isset($_POST['$f_24'])) ? Rec($_POST['$f_24']) : '';
$f_25 = (isset($_POST['$f_25'])) ? Rec($_POST['$f_25']) : '';
// interssé par //
$f_26 = (isset($_POST['$f_26'])) ? Rec($_POST['$f_26']) : '';
$f_27 = (isset($_POST['$f_27'])) ? Rec($_POST['$f_27']) : '';
$f_28 = (isset($_POST['$f_28'])) ? Rec($_POST['$f_28']) : '';
$f_29 = (isset($_POST['$f_29'])) ? Rec($_POST['$f_29']) : '';
$f_30 = (isset($_POST['$f_30'])) ? Rec($_POST['$f_30']) : '';
$f_31 = (isset($_POST['$f_31'])) ? Rec($_POST['$f_31']) : '';
$f_32 = (isset($_POST['$f_32'])) ? Rec($_POST['$f_32']) : '';
// studio //
$f_33 = (isset($_POST['$f_33'])) ? Rec($_POST['$f_33']) : '';
$f_34 = (isset($_POST['$f_34'])) ? Rec($_POST['$f_34']) : '';
$f_35 = (isset($_POST['$f_35'])) ? Rec($_POST['$f_35']) : '';
$f_36 = (isset($_POST['$f_36'])) ? Rec($_POST['$f_36']) : '';
$f_37 = (isset($_POST['$f_37'])) ? Rec($_POST['$f_37']) : '';
$f_38 = (isset($_POST['$f_38'])) ? Rec($_POST['$f_38']) : '';
$f_39 = (isset($_POST['$f_39'])) ? Rec($_POST['$f_39']) : '';
$f_40 = (isset($_POST['$f_40'])) ? Rec($_POST['$f_40']) : '';
// studio genre //
$f_41 = (isset($_POST['$f_41'])) ? Rec($_POST['$f_41']) : '';
$f_42 = (isset($_POST['$f_42'])) ? Rec($_POST['$f_42']) : '';
$f_43 = (isset($_POST['$f_43'])) ? Rec($_POST['$f_43']) : '';
$f_44 = (isset($_POST['$f_44'])) ? Rec($_POST['$f_44']) : '';
$f_45 = (isset($_POST['$f_45'])) ? Rec($_POST['$f_45']) : '';
$f_46 = (isset($_POST['$f_46'])) ? Rec($_POST['$f_46']) : '';
$f_47 = (isset($_POST['$f_47'])) ? Rec($_POST['$f_47']) : '';
// planning //
$f_48 = (isset($_POST['$f_48'])) ? Rec($_POST['$f_48']) : '';
$f_49 = (isset($_POST['$f_49'])) ? Rec($_POST['$f_49']) : '';
$f_50 = (isset($_POST['$f_50'])) ? Rec($_POST['$f_50']) : '';
$f_51 = (isset($_POST['$f_51'])) ? Rec($_POST['$f_51']) : '';
$f_52 = (isset($_POST['$f_52'])) ? Rec($_POST['$f_52']) : '';
$f_53 = (isset($_POST['$f_53'])) ? Rec($_POST['$f_53']) : '';
$f_54 = (isset($_POST['$f_54'])) ? Rec($_POST['$f_54']) : '';
$f_55 = (isset($_POST['$f_55'])) ? Rec($_POST['$f_55']) : '';
$f_56 = (isset($_POST['$f_56'])) ? Rec($_POST['$f_56']) : '';
$f_57 = (isset($_POST['$f_57'])) ? Rec($_POST['$f_57']) : '';
$f_58 = (isset($_POST['$f_58'])) ? Rec($_POST['$f_58']) : '';
$f_59 = (isset($_POST['$f_59'])) ? Rec($_POST['$f_59']) : '';
// horaires //
$f_60 = (isset($_POST['$f_60'])) ? Rec($_POST['$f_60']) : '';
$f_61 = (isset($_POST['$f_61'])) ? Rec($_POST['$f_61']) : '';
$f_62 = (isset($_POST['$f_62'])) ? Rec($_POST['$f_62']) : '';
$f_63 = (isset($_POST['$f_63'])) ? Rec($_POST['$f_63']) : '';
// mail visiteur//
$f_64_EM = (isset($_POST['$f_64_EM'])) ? Rec($_POST['$f_64_EM']) : '';
// message//
$f_64_M = (isset($_POST['$f_64_M'])) ? Rec($_POST['$f_64_M']) : '';
// On va vérifier les variables et l'email ...
$email = (IsEmail($email)) ? $email : ''; // soit l'email est vide si erroné, soit il vaut l'email entré
if (($nom != '') && ($email != '') && ($objet != '') && ($message != ''))
{
// les 4 variables sont remplies, on génère puis envoie le mail
$headers = 'MIME-Version: 1.0' . "\r\n";
$headers .= 'From:'.$nom.' <'.$email.'>' . "\r\n" .
'Reply-To:'.$email. "\r\n" .
'Content-Type: text/plain; charset="utf-8"; DelSp="Yes"; format=flowed '."\r\n" .
'Content-Disposition: inline'. "\r\n" .
'Content-Transfer-Encoding: 7bit'." \r\n" .
'X-Mailer:PHP/'.phpversion();
// envoyer une copie au visiteur ?
if ($copie == 'non')
{
$cible = $destinataire.','.$email;
}
else
{
$cible = $destinataire;
};
// Remplacement de certains caractères spéciaux
$message = str_replace("'","'",$message);
$message = str_replace("’","'",$message);
$message = str_replace(""",'"',$message);
$message = str_replace('<br>','',$message);
$message = str_replace('<br />','',$message);
$message = str_replace("<","<",$message);
$message = str_replace(">",">",$message);
$message = str_replace("&","&",$message);
// Envoi du mail
if (mail($cible, $objet, $message, $headers))
{
echo '<p>'.$message_envoye.'</p>'."\n";
}
else
{
echo '<p>'.$message_non_envoye.'</p>'."\n";
};
}
else
{
// une des 3 variables (ou plus) est vide ...
echo '<p>'.$message_formulaire_invalide.' <a href="sondage.php">Retour au formulaire de sondage</a></p>'."\n";
};
//};
// fin du if (!isset($_POST['envoi']))
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Sondage</title>
<link rel="stylesheet" type="text/css" href="sondage/formsondage.css"/>
<link rel="stylesheet" type="text/css" href="css-new/page.css"/>
</head>
<body>
<div align="center"><img src="img/IMAGE.jpg" alt="" /><br />
<br />
<div align="center">
<h2>
<div class='txttitre'>
<strong>SONDAGE</strong></h2>
</div>
<!-- formulaire -->
<form action='' method='post' name='Sondage' id="Sondage">
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr> </tr>
<tr>
<td colspan='3'></td>
</tr>
<tr>
<td colspan='3'><div align="center">
<div class='txtform'><strong>Aucun champ est obligatoire. Votre participation est importante !</strong> </div>
<br />
</div></td>
</tr>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Qui êtes vous ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td width="51%" align='right'><span class="txtform">Je n'y comprends rien </td>
<td width="28%"><input type="radio" name='f_1' value='' id="RadioGroup1_1" /></td>
<td width="21%"></td>
</tr>
<tr>
<td align='right'><span class="txtform">Débutant </td>
<td><input type="radio" name='f_2' value='' id="RadioGroup1_2" /></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Amateur
</td>
<td><input type="radio" name='f_3' value='' id="RadioGroup1_3" /></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Amateur éclairé
</td>
<td><input type="radio" name='f_4' value='' id="RadioGroup1_4" /></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Amateur expert
</td>
<td><input type="radio" name='f_5' value='' id="RadioGroup1_5" /></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform"><strong>Autre
</strong></td>
<td><div align="left">
<input type="radio" name='f_6' value='' id="RadioGroup1_6" />
<span class="txtform"><strong><em><img src="img/arrow-right.jpg" alt="" width="20" height="10" /> laissez un message</em></strong></div></td>
<td></td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Que souhaitez vous en priorité ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td width="398" align='right'><span class="txtform">Mieux utiliser mon boitier
<input type="checkbox" name='f_7' value=''/></td>
<td width="217"><div align="right"><span class="txtform">Prise de vues débutant
<input type="checkbox" name='f_8' value=''/>
</div></td>
<td width="175"> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Mieux utiliser mes objectifs
<input type="checkbox" name='f_9' value=''/></td>
<td><div align="right"><span class="txtform">Perfectionnement PdV
<input type="checkbox" name='f_10' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Mieux utiliser mon flash
<input type="checkbox" name='f_11' value=''/></td>
<td><div align="right"><span class="txtform">Post-traitement numérique
<input type="checkbox" name='f_12' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform"> <strong>Autre</strong>
<input type="checkbox" name='f_12' value=''/></td>
<td><div align="left"><img src="img/arrow-right.jpg" alt="" width="20" height="10" /><span class="txtform"><strong> <em>Laissez un message </em></strong></div></td>
<td> </td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>L'argentique ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td width="398" align='right'><span class="txtform"> Je connais un peu l'argentique
<input type="checkbox" name='f_14' value=''/></td>
<td width="194"><div align="right"><span class="txtform">Traitement des films
<input type="checkbox" name='f_15' value=''/>
</div></td>
<td width="198"> </td>
</tr>
<tr>
<td align='right'><span class="txtform"> Je pratique l'argentique
<input type="checkbox" name='f_16' value=''/></td>
<td><div align="right"><span class="txtform">Tirage en laboratoire
<input type="checkbox" name='f_17' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform"> Je souhaite apprendre l'argentique
<input type="checkbox" name='f_18' value=''/></td>
<td><div align="right"><span class="txtform">Perfectionnement
<input type="checkbox" name='f_19' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td colspan="3" align='right'><div align="center"><span class="txtform"><br />
Numériser vos négatifs
<input type="checkbox" name='f_20' value=''/>
<br />
</div></td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Pour vos post-traitement, vous utilisez ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td width="394" align='right'><span class="txtform">Lightroom
<input type="checkbox" name='f_21' value=''/></td>
<td width="202"><div align="right"><span class="txtform">Photoshop
<input type="checkbox" name='f_22' value=''/>
</div></td>
<td width="190"> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Photofiltre
<input type="checkbox" name='f_23' value=''/></td>
<td><div align="right"><span class="txtform">ACDsee
<input type="checkbox" name='f_24' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform"> <strong>Autre</strong>
<input type="checkbox" name='f_25' value=''/></td>
<td><div align="left"><img src="img/arrow-right.jpg" alt="" width="20" height="10" /><span class="txtform"><strong> <em>laissez un message </em></strong></div></td>
<td> </td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Seriez vous intéressé par ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td width="355" align='right'><span class="txtform">Prise de vues en panoramique
<input type="checkbox" name='f_26' value=''/></td>
<td width="237"><div align="right"><span class="txtform">Montage de panoramique
<input type="checkbox" name='f_27' value=''/>
</div></td>
<td width="198"> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Prise de vues de pano QTVR
<input type="checkbox" name='f_28' value=''/></td>
<td><div align="right"><span class="txtform">Montage de pano QTVR
<input type="checkbox" name='f_29' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Fabrication de sténopé
<input type="checkbox" name='f_30' value=''/></td>
<td><div align="right"><span class="txtform">Prise de vues au Sténopé
<input type="checkbox" name='f_32' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform"> <strong>Autre</strong>
<input type="checkbox" name='f_32' value=''/></td>
<td><div align="left"><img src="img/arrow-right.jpg" alt="" width="20" height="10" /><span class="txtform"><strong> <em>laissez un message </em></strong></div></td>
<td> </td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Le studio ... que souhaiteriez vous ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td width="355" align='right'><span class="txtform">Les bases de l'éclairages
<input type="checkbox" name='f_33' value=''/></td>
<td width="237"><div align="right"><span class="txtform">Le flash de studio
<input type="checkbox" name='f_34' value=''/>
</div></td>
<td width="198"> </td>
</tr>
<tr>
<td align='right'><span class="txtform">La lumière continue
<input type="checkbox" name='f_35' value=''/></td>
<td><div align="right"><span class="txtform">Studio avec flash cobra
<input type="checkbox" name='f_36' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Portrait adulte
<input type="checkbox" name='f_37' value=''/></td>
<td><div align="right"><span class="txtform">Portrait enfant
<input type="checkbox" name='f_38' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Animaux
<input type="checkbox" name='f_39' value=' '/></td>
<td><div align="right"><span class="txtform">Les objets
<input type="checkbox" name='f_40' value=''/>
</div></td>
<td> ( <em>nature morte</em> )</td>
</tr>
<tr>
<td align='right'> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">La photo intimiste
<input type="checkbox" name='f_41' value=''/></td>
<td><div align="right"><span class="txtform">Le glamour
<input type="checkbox" name='f_42' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Le nu masculin
<input type="checkbox" name='f_42' value=''/></td>
<td><div align="right"><span class="txtform">Le nu féminin
<input type="checkbox" name='f_44' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td align='right'><span class="txtform">Le nu de couple
<input type="checkbox" name='f_45' value=''/></td>
<td> </td>
<td><span class="txtform"><strong> </strong></td>
</tr>
<tr>
<td align='right'><span class="txtform"> <strong>Autre
<input type="checkbox" name='f_46' value=''/>
</strong></td>
<td><div align="left"><img src="img/arrow-right.jpg" alt="" width="20" height="10" /><span class="txtform"><strong> <em>laissez un message</em></strong> </div></td>
<td> </td>
</tr>
<tr>
<td colspan="3" align='right'><div align="center"><span class="txtform"><br />
Souhaitez vous la participation de modèle</span>
<input type="checkbox" name='f_47' value=''/>
</div></td>
</tr>
<tr>
<td colspan="3" align='right'><div align="center"><span class="txtform"> <br />
</div></td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Vos préférences pour le planning ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td><div align="right"><span class="txtform">Le Week End
<input type="checkbox" name='f_48' value=''/>
</div></td>
<td><div align="right"><span class="txtform">La semaine
<input type="checkbox" name='Lf_49' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td width="381"><div align="right"><span class="txtform">Samedi
<input type="checkbox" name='f_50' value=''/>
</div></td>
<td width="130"><div align="right"><span class="txtform">Lundi
<input type="checkbox" name='f_51' value=''/>
</div></td>
<td width="279"> </td>
</tr>
<tr>
<td><div align="right"><span class="txtform">Dimanche
<input type="checkbox" name='f_52' value=''/>
</div></td>
<td><div align="right"><span class="txtform">Mardi
<input type="checkbox" name='f_53' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td><div align="right"><span class="txtform">Matin
<input type="checkbox" name='f_54' value=''/>
</div></td>
<td><div align="right"><span class="txtform">Mercredi
<input type="checkbox" name='f_55' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td><div align="right"><span class="txtform">Après midi
<input type="checkbox" name='f_56' value=''/>
</div></td>
<td><div align="right"><span class="txtform">Jeudi
<input type="checkbox" name='f_57' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td><div align="right"><span class="txtform">Soir
<input type="checkbox" name='f_58' value=''/>
</div></td>
<td><div align="right"><span class="txtform">Vendredi
<input type="checkbox" name='f_59' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td height="20"> </td>
<td> </td>
<td> </td>
</tr>
</table>
<table align="center" width='800' border='0' cellspacing='2' cellpadding='1'>
<tr>
<td colspan="3" align='center'><div class="txtquest"> <br />
<fieldset>
<strong>Vos préférences pour les horaires ?</strong>
</fieldset>
<br />
<br />
</div></td>
</tr>
<tr>
<td><div align="right"><span class="txtform">9h - 12h
<input type="checkbox" name='f_60' value=''/>
</div></td>
<td><div align="right"><span class="txtform">13h - 16 h
<input type="checkbox" name='f_61 h' value=''/>
</div></td>
<td> </td>
</tr>
<tr>
<td><div align="right"><span class="txtform">17h - 20h
<input type="checkbox" name='f_62' value=''/>
</span></div></td>
<td><div align="right"><span class="txtform">18h - 21h
<input type="checkbox" name='f_63' value=''/>
</span></div></td>
<td> </td>
</tr>
<tr>
<td width="381"> </td>
<td width="130"> </td>
<td width="279"><br /></td>
</tr>
<tr>
<td colspan="3"></td>
</tr>
<tr> </tr>
<tr>
<td colspan="3" align='center'><fieldset>
<div class="txtform">
<strong> <span class="txtquest">MESSAGE :</strong>
</fieldset>
<div class="txtform">
<em class="txterror"><strong><br />
<span class="txterror">Si vous souhaitez une réponse, veuillez indiquez votre adresse e-Mail</strong></em><br />
<br />
<input type='text' name='f_64_EM' value='' size='24' border='0' />
<br />
<br /></td>
</tr>
<tr>
<td></td>
</tr>
<tr>
<td colspan="3" align="center"><textarea name='$64_M' id='message' cols='45' rows='5'></textarea>
<br />
<br />
<input type='submit' name='submit' value='Envoyer votre sondage' border='2'/></td>
</tr>
</table>
</form>
</body>
</html>[/php]