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<?php
include('parametres.php');

// script permettant d'entrer un nouvel adherent
?>
<center>
<h2>Fiche d'Inscription d'un Nouvel adherent</h2><br><br>
	
	
	
<FORM method=post action="enregistrement_inscription_nouvel_adherent.php" name="Formulaire_nouvel_adherent">

<TABLE BORDER=1>
	<tr>
		<td>
			numero de licence
		</td>
		
		<TD>
			<table border=1><tr><td>
			<SELECT name="lettre_numero_licence" size="1">
				<OPTION>
				<OPTION>A
				<OPTION>B
				<OPTION>C
				<OPTION>D
				<OPTION>E
				<OPTION>F
				<OPTION>G
				<OPTION>H
				<OPTION>I
				<OPTION>J
				<OPTION>K
				<OPTION>L
				<OPTION>M
				<OPTION>N
				<OPTION>A
				<OPTION>P
				<OPTION>Q
				<OPTION>R
				<OPTION>S
				<OPTION>T
				<OPTION>U
				<OPTION>V
				<OPTION>W
				<OPTION>X
				<OPTION>Y
				<OPTION>Z
			</SELECT>
		</TD>
		<td>
			-
		</td>
		<TD>
			<SELECT name="chiffre_1_numero_licence" size="1">
			<OPTION>
				<?php
				     for($i=0;$i < 100;$i++) 
					{ 
						if ($i<10)
						{
							echo "<OPTION>0".$i; 
						}
						else
						{
							echo "<OPTION>".$i; 
						}
						
					} 
				?>
			</SELECT>
		</TD>
		<td>
			-
		</td>
		<TD>
			<SELECT name="chiffre_2_numero_licence" size="1">
			<OPTION>
				<?php
				     for($i=0;$i < 10;$i++) 
					{ 
						echo "<OPTION>".$i; 
									
					} 
				?>
			</SELECT>
		</TD>

<tr>
		<td>
			Niveau de Plong�e
		</td>
		
		<TD>
			<SELECT name="niveau_de_plongee" size="1">
				<OPTION>
				<OPTION>N0
				<OPTION>N1
				<OPTION>N2
				<OPTION>N3
				<OPTION>N4
				<OPTION>N5
				<OPTION>MF1
				<OPTIOn>MF2
				
			</SELECT>

</TD>

</tr>
	
	<tr>
		<td>
			nom
		</td>
		
		<TD>
			<INPUT type=text name="nom_nouvel_adherent">
		</TD>

</tr>

<tr>
		<td>
			prenom
		</td>
		
		<TD>
			<INPUT type=text name="prenom_nouvel_adherent">
		</TD>

</tr>
	
	
	<tr>
		<td>
			adresse email
		</td>
		
		
		<TD>
			<table border=0>
				<tr>
					<td>
						<INPUT type=text name="nom_adresse_email">
					</td>
					<td>
						@
					</td>
					<td>
						<INPUT type=text name="provider">
					</td>
					<td>
						<SELECT name="domaine_adresse_email" size="1">
						<OPTION>
						<OPTION>.fr
						<OPTION>.com
						<OPTION>.biz
						<OPTION>.net
											
					</td>
				</tr>
			</table>
		</TD>

</tr>

<tr>
		<td>
			Date de validit� <br> certificat medical
		</td>
		
		<TD>
			<table><tr><td>
			<SELECT name="jour_date_certificat_medical" size="1">*
				<OPTION>
				<?php
				     for($i=1;$i < 32;$i++) 
					{ 
						if ($i<10)
						{
							echo "<OPTION>0".$i; 
						}
						else
						{
							echo "<OPTION>".$i; 
						}
									
					} 
				?>
			</SELECT>
			</TD>
			<TD>
			<SELECT name="mois_date_certificat_medical" size="1">
			<OPTION>
				<?php
				    for($i=1;$i < 13;$i++) 
					{ 
						if ($i<10)
						{
							echo "<OPTION>0".$i; 
						}
						else
						{
							echo "<OPTION>".$i; 
						}
									
					} 
				?>
			</SELECT>
			</td>
			<TD>
			<SELECT name="annee_date_certificat_medical" size="1">
			<OPTION>
				<?php
				     for($i=2010;$i < 2020;$i++) 
					{ 
						if ($i<10)
						{
							echo "<OPTION>0".$i; 
						}
						else
						{
							echo "<OPTION>".$i; 
						}
									
					} 
				?>
			</SELECT>
			</TD></tr></table>
		</TD>

</tr>
	<tr>
		<td>
			mot de passe Site de Plongee
		</td>
		
		<TD>
			<INPUT type=text name="mot_de_passe" value="<?php echo $mot_de_passe_par_defaut ?>">
		</TD>

</tr>

</table>
<br>
<table border=0>
<tr>
		<TD COLSPAN=2 align="center">
			
			<INPUT type="submit" value="Valider l inscription">
			</form>
		</TD>

</tr>

</center>