[spoiler]<table width="464" border="0" bordercolor="#000000" cellpadding="0" cellspacing="1" >
<tr>
<td width="133" class="t1_form"><span class="txt_form">*</span>Nom</td>
<td colspan="2"><input name="nom" type="text" size="20"/></td>
<td width="57"> </td>
<td width="136"> </td>
</tr>
<tr>
<td class="t1_form"><span class="txt_form">*</span>Prénom</td>
<td colspan="2"><input name="prenom" type="text" size="20"/></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form">Prénom du conjoint<br />
(si il/elle participe)</td>
<td colspan="2" align="right"><input name="prenom_c" type="text" size="20"/></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form"><span class="txt_form">*</span>Rue et n°</td>
<td colspan="2"><input name="rue" type="text" size="20"/></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form"><span class="txt_form">*</span>NPA</td>
<td colspan="2"><input name="npa" type="text" size="10"/></td>
<td class="t1_form"><span class="txt_form">*</span>Localité</td>
<td><input name="localite" type="text" size="20"/></td>
</tr>
<tr>
<td class="t1_form">Tél.</td>
<td colspan="2"><input name="tel" type="text" size="20"/></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form"><span class="txt_form">*</span>E-mail</td>
<td colspan="2"><input name="email" type="text" size="20" /></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form">Paroisse</td>
<td colspan="2"><input name="paroisse" type="text" size="20"/></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="txt_form">* champs obligatoires</td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="3" class="t2_form">veuillez joindre les noms des personnes:</td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form">Nom</td>
<td colspan="2"><input name="nom1" type="text" size="20"/></td>
<td class="t1_form">Nom</td>
<td><input name="nom3" type="text" size="20" /></td>
</tr>
<tr>
<td class="t1_form">Prénom</td>
<td colspan="2"><input name="prenom1" type="text" size="20"/></td>
<td class="t1_form">Prénom</td>
<td><input name="prenom3" type="text" size="20" /></td>
</tr>
<tr>
<td class="t1_form"> </td>
<td colspan="2"> </td>
<td class="t1_form"> </td>
<td> </td>
</tr>
<tr>
<td class="t1_form">Nom</td>
<td colspan="2"><input name="nom2" type="text" size="20"/></td>
<td class="t1_form">Nom</td>
<td><input name="nom4" type="text" size="20" /></td>
</tr>
<tr>
<td class="t1_form">Prénom</td>
<td colspan="2"><input name="prenom2" type="text" size="20" /></td>
<td class="t1_form">Prénom</td>
<td><input name="prenom4" type="text" size="20" /></td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="4" class="t2_form">Je/nous désire/ons loger dans une chambre à:</td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="t2_form"><input name="selection" type="radio" id="4lits" value="4 lits">
4lits </td>
<td colspan="2" class="t1_form"><select name="liste1" class="t2_form" id="liste1" onChange="fPrix1(this.form.elements['liste1'].options[this.form.elements['liste1'].selectedIndex].value)">
<option value="0"> </option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
</select>
pers. x 170.- = </td>
<td class="result_form"><input name="ctPrix1" id="ctPrix1" type="text" size="5" class="result_form" disabled="disabled" /></td>
<td> </td>
</tr>
<tr>
<td class="t2_form"><input type="radio" name="selection" id="2litsd" value="2 lits double">
2 lits dble</td>
<td colspan="2" class="t1_form"><select name="liste2" class="t2_form" id="liste2" onChange="fPrix2(this.form.elements['liste2'].options[this.form.elements['liste2'].selectedIndex].value)">
<option value="0"> </option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
</select>
pers. x 170.- = </td>
<td class="txt_form"><span class="result_form">
<input name="ctPrix2" id="ctPrix2" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td class="t2_form"><input type="radio" name="selection" id="3lits" value="3 lits"/>
3 lits</td>
<td colspan="2" class="t1_form"><select name="liste3" class="t2_form" id="liste3" onChange="fPrix3(this.form.elements['liste3'].options[this.form.elements['liste3'].selectedIndex].value)">
<option value="0"> </option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
</select>
pers. x 195.- = </td>
<td class="txt_form"><span class="result_form">
<input name="ctPrix3" id="ctPrix3" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td class="t2_form"><input type="radio" name="selection" id="2lits" value="2 lits"/>
2 lits</td>
<td colspan="2" class="t1_form"><select name="liste4" class="t2_form" id="liste4" onChange="fPrix4(this.form.elements['liste4'].options[this.form.elements['liste4'].selectedIndex].value)">
<option value="0"> </option>
<option value="1">1</option>
<option value="2">2</option>
</select>
pers. x 220.- = </td>
<td class="txt_form"><span class="result_form">
<input name="ctPrix4" id="ctPrix4" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td class="t2_form"><input name="selection" type="radio" id="1lit" value="1 lit" onClick="fPrix5(1)"/>
1 lit</td>
<td width="42" class="t1_form"> </td>
<td width="90" class="t1_form"> pers. x 270.- =</td>
<td class="txt_form"><span class="result_form">
<input name="ctPrix5" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="3" class="t2_form">participant «externe» (repas + infrastr.)</td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2" class="t1_form"><select name="liste5" class="t2_form" id="liste5" onChange="fPrix6(this.form.elements['liste5'].options[this.form.elements['liste5'].selectedIndex].value)">
<option value="0"> </option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select>
pers. x 125.- = </td>
<td><span class="result_form">
<input name="ctPrix6" id="ctPrix6" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="3"><span style="font-family: Verdana, Arial, Helvetica, sans-serif;font-size: 12px;font-weight: bold; color: #CC6600;">Prix de la retraite</span></td>
<td> </td>
<td> </td>
</tr>
<tr>
<td class="txt_form">total de personnes</td>
<td colspan="2" class="t1_form"> pers. x 50.- = </td>
<td class="txt_form"><span class="result_form">
<input name="ctPrix7" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2" align="right"><span style="font-family: Verdana, Arial, Helvetica, sans-serif;font-size: 13px;font-weight: bold; color: #2c5372;">TOTAL</span></td>
<td style="font-family: Verdana, Arial, Helvetica, sans-serif;font-size: 12px;font-weight: bold; color: #CC6600; text-align:right;"><span class="result_form">
<input name="ctBigTotal" type="text" size="5" class="result_form" disabled="disabled" />
</span></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2"> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td colspan="2"><input name="valider" type="submit" class="t2_form" id="valider" value="Valider"/>
<input name="reset" type="reset" class="t2_form" id="reset" value="Réinitialiser" /> </td>
<input name="go" type="hidden" value="1"/> </tr>
</table>[/spoiler] |