df
This commit is contained in:
parent
21c109d354
commit
107731c6fc
|
|
@ -1,4 +1,5 @@
|
|||
<div id="div_remplacement_adherent">
|
||||
<!-- -->
|
||||
<div class="card border-primary shadow-sm mb-4">
|
||||
<div class="card-body py-2 bg-light">
|
||||
<div class="row g-2 align-items-center">
|
||||
|
|
@ -62,22 +63,30 @@
|
|||
<div class="card-body p-4">
|
||||
<div class="row g-3 mb-4">
|
||||
<div class="col-md-6">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("Nom") ?></label>
|
||||
<label class="form-label small fw-bold text-uppercase">
|
||||
<?= _("Nom") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<input class="form-control text-uppercase border-success" type="text" id="nom" name="nom" required>
|
||||
</div>
|
||||
<div class="col-md-6">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("Prénoms") ?></label>
|
||||
<label class="form-label small fw-bold text-uppercase">
|
||||
<?= _("Prénoms") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<input class="form-control border-success" type="text" id="prenoms" name="prenoms" required>
|
||||
</div>
|
||||
|
||||
<div class="col-md-4">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("Nature Pièce") ?></label>
|
||||
<select class="form-select" id="codeNaturePiece" name="codeNaturePiece">
|
||||
<label class="form-label small fw-bold text-uppercase">
|
||||
<?= _("Nature Pièce") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<select class="form-select" id="codeNaturePiece" name="codeNaturePiece" required>
|
||||
<?php liste_options($naturepiece,""); ?>
|
||||
</select>
|
||||
</div>
|
||||
<div class="col-md-4">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("N° Pièce") ?></label>
|
||||
<label class="form-label small fw-bold text-uppercase">
|
||||
<?= _("N° Pièce") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<input class="form-control" type="text" id="numeroPiece" name="numeroPiece" onblur="controler_piece_beneficiaire();"
|
||||
required autocomplete="off">
|
||||
</div>
|
||||
|
|
@ -87,13 +96,17 @@
|
|||
</div>
|
||||
|
||||
<div class="col-md-4">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("Genre") ?></label>
|
||||
<select class="form-select" id="sexe" name="sexe">
|
||||
<label class="form-label small fw-bold text-uppercase">
|
||||
<?= _("Genre") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<select class="form-select" id="sexe" name="sexe" required>
|
||||
<?php liste_options($sexe,""); ?>
|
||||
</select>
|
||||
</div>
|
||||
<div class="col-md-4">
|
||||
<label class="form-label fw-bold small text-uppercase"><?= _("Date de Naissance") ?></label>
|
||||
<label class="form-label fw-bold small text-uppercase">
|
||||
<?= _("Date de Naissance") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<div class="input-group">
|
||||
<span class="input-group-text bg-white text-muted"><i class="fas fa-calendar-alt"></i></span>
|
||||
<input type="text" class="form-control datepicker" id="dateNaissance" name="dateNaissance" required
|
||||
|
|
@ -141,8 +154,10 @@
|
|||
</div>
|
||||
|
||||
<div class="col-md-4">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("Téléphone Portable") ?></label>
|
||||
<input class="form-control" type="tel" id="telephonePortable" name="telephonePortable" value="<?= $_SESSION['indicatifTelephone'] ?>">
|
||||
<label class="form-label small fw-bold text-uppercase">
|
||||
<?= _("Téléphone Portable") ?><span class="required-star">*</span>
|
||||
</label>
|
||||
<input class="form-control" type="tel" id="telephonePortable" name="telephonePortable" value="<?= $_SESSION['indicatifTelephone'] ?>" required>
|
||||
</div>
|
||||
<div class="col-md-4">
|
||||
<label class="form-label small fw-bold text-uppercase"><?= _("E-mail") ?></label>
|
||||
|
|
|
|||
Loading…
Reference in New Issue
Block a user