prestation/Vue/Creeradherent/index.php

<?php 
	$this->titre = "INTER-SANTE - Ajout Adhérent"; 
	$dateAvenant = $_SESSION['dateAvenant_C']
?>

<form method="post" action="Creeradherent/ajouteradherent">
	<INPUT class="sr-only" TYPE="text" id="idPolice" name="idPolice" value="<?= $_SESSION['idPolice_C'] ?>">
	<INPUT class="sr-only" TYPE="text" id="numeroPolice" name="numeroPolice" value="<?= $_SESSION['numeroPolice_C'] ?>">

	<fieldset>
		<legend> <?= _("Informations sur l'adhérent") ?> </legend>
		<table class="table table-responsive table-condensed">
			<tbody>	
				<tr> 
					
					<td width="12%" class="required"> <?= _("Collège") ?> </td>
					<td>
						<SELECT class="form-control" id="idCollege" NAME="idCollege" required AUTOCOMPLETE="OFF"  autofocus onChange="prorater_prime_adherent();" >
							<?php liste_options($college,""); ?>						
						</SELECT>	
					</td>
					
					<td width="10%" align="center" class="required"> <?= _("Avenant") ?> </td>
					<td>
						<SELECT class="form-control" id="idAvenant" NAME="idAvenant" required AUTOCOMPLETE="OFF"  onChange="changer_avenant_incorporation();">
							<?php liste_options($avenant,""); ?>						
						</SELECT>	
					</td>
				</tr>
				
				<tr> 
					<td class="required"> <?= _("Nom Adhérent") ?> </td>
					<td><INPUT class="form-control majuscule" TYPE="text" id="nom" NAME="nom" required AUTOCOMPLETE="OFF"  style="text-transform: uppercase;"></td>

					<td align="center" class="required"> <?= _("Prénoms") ?> </td>
					<td><INPUT class="form-control majuscule" TYPE="text" id="prenoms" NAME="prenoms" required AUTOCOMPLETE="OFF" ></td>
				</tr>
				
				<tr> 
					<td><?= _("Nature Pièce") ?></td>
					<td>
						<SELECT class="form-control" id="codeNaturePiece" NAME="codeNaturePiece">
							<?php liste_options($naturepiece,""); ?>						
						</SELECT>	
					</td>
					
					<td align="center"><?= _("No Pièce") ?></td>
					<td>
						<INPUT class="form-control majuscule" TYPE="text" id="numeroPiece" NAME="numeroPiece">
					</td>
				</tr>
				
				<tr> 
					<td><?= _("No CMU") ?></td>
					<td>
						<INPUT class="form-control majuscule" TYPE="text" id="numeroCmu" NAME="numeroCmu">
					</td>
					<td align="center"><?= _("Mle Employé") ?></td>
					<td>
						<INPUT class="form-control majuscule" TYPE="text" id="numeroMatricule" NAME="numeroMatricule">
					</td>
				</tr>
				
				<tr> 
					<td class="required">Genre</td>
					<td>
						<SELECT class="form-control" id="sexe" NAME="sexe" required AUTOCOMPLETE="OFF" >
							<?php liste_options($sexe,""); ?>						
						</SELECT>						
					</td>

					<td align="center" class="required"> <?= _("Naissance") ?> </td>
					<td><INPUT class="form-control datepicker" TYPE="text" id="dateNaissance" NAME="dateNaissance" required AUTOCOMPLETE="OFF" 
					onchange="controle_age($('#dateNaissance').datepicker('getDate'), 'A')"></td>

				</tr>
				
				<tr> 
					<td> <?= _("Groupe Sanguin") ?> </td>
					<td>
						<SELECT class="form-control" id="codeGroupeSanguin" NAME="codeGroupeSanguin">
							<?php liste_options($groupesanguin,""); ?>						
						</SELECT>						
					</td>

					<td align="center"> <?= _("Sit. Famille") ?> </td>
					<td>
						<SELECT class="form-control" id="codeSituationFamille" NAME="codeSituationFamille">
							<?php liste_options($situationfamille,""); ?>						
						</SELECT>						
					</td>
				</tr>
				
				<tr> 
					<td> <?= _("Nb Enfants") ?> </td>
					<td><input class="form-control" type="number" id="nombreEnfants" name="nombreEnfants" min="0" max="10" value="0"></td>

					<td align="center"> <?= _("Pays") ?> </td>
					<td>
						<SELECT onChange="ajaxListerVille();" class="form-control" id="codePays" NAME="codePays">
							<?php liste_options($pays, "", false); ?>						
						</SELECT>						
					</td>
				</tr>

				<tr> 
					<td > <?= (isset($_SESSION['affichagedynamique']['Région / District'])) ? _($_SESSION['affichagedynamique']['Région / District']) : _("Région / District") ?> </td>
					<td>
						<div id="listeville" >
							<SELECT onChange="ajaxListerLocalite();" class="form-control" id="codeVille" NAME="codeVille">
								<?php liste_options($ville, $codeVille); ?>						
							</SELECT>
						</div>
					</td>

					<td align="center"> <?= (isset($_SESSION['affichagedynamique']['Commune'])) ? _($_SESSION['affichagedynamique']['Commune']) : _("Commune") ?> </td>
					<td>
						<div id="listelocalite" >
							<SELECT class="form-control" id="codeLocalite" NAME="codeLocalite">
								<?php liste_options($localite, $codeLocalite); ?>						
							</SELECT>
						</div>
					</td>
				</tr>
				
				<tr> 
					<td> <?= _("Adresse Géo") ?> </td>
					<td><INPUT class="form-control" TYPE="text" id="adresseGeo" NAME="adresseGeo"></td>

					<td align="center"> <?= _("Adresse Post") ?> </td>
					<td><INPUT class="form-control" TYPE="text" id="adressePostale" NAME="adressePostale"></td>
				</tr>

				<tr> 
					<td class="required"> <?= _("Tél Port") ?> </td>
					<td>
						<INPUT class="form-control" TYPE="tel" id="telephonePortable" value="<?= $_SESSION['indicatifTelephone'] ?>" NAME="telephonePortable" placeholder="Tél portable obligatoire" required AUTOCOMPLETE="OFF"  >
					</td>					

					<td align="center"> <?= _("Tél Fixe") ?> </td>
					<td><INPUT class="form-control" TYPE="tel" id="telephonFixe" NAME="telephonFixe"></td>					
				</tr>			

				<tr> 
					<td class="required"> <?= _("Entrée") ?> </td>
					<td>
						<div id="div_date_avenant" >
							<INPUT class="form-control datepicker" TYPE="text" id="dateEntree" NAME="dateEntree" value="<?= dateLang($_SESSION['dateAvenant_C']) ?>" required AUTOCOMPLETE="OFF" 
							onChange="prorater_prime_adherent();">
						</div>
					</td>

					<td align="center">E-mail</td>
					<td><INPUT class="form-control" TYPE="email" id="email" NAME="email" placeholder="E-mail"  ></td>	
					
				</tr>			

				<tr> 
					<td> <?= _("Prorata Prime?") ?> </td>
					<td>
						<SELECT class="form-control" id="prorata" NAME="prorata" required AUTOCOMPLETE="OFF"  onChange="prorater_prime_adherent();">
							<?php liste_options($ouinonprorata,"1",true); ?>						
						</SELECT>
					</td>
					

					<td><input style="text-align:center;color:red;" class="form-control" type="text" id="agepersonne" name="agepersonne" value="Age : 0" readonly ></td>
					
					<td><input class = "form-control btn btn-primary" type="submit" value="<?= _("Enregistrer") ?>" /></td>										
				</tr>			
			</tbody>
		</table>	
	</fieldset>
	
	<div id="div_prime">	
		
	</div>				
</form> 

<?php if (isset($msgErreur)): ?>
	<div class="alert alert-danger" style="height:38px; padding:5px;" >
	  <H4><?= $msgErreur ?></H4>
	</div>	
<?php endif; ?>