<label for="location"><?php _e('Ville','cp'); ?> <span>*</span></label> <input type="text" id="location" class="adfields" name="location" size="60" maxlength="100" value="<?php echo stripslashes($_POST['location']); ?>" />
<label for="region"><?php _e('>Région et Département','cp'); ?><span>*</span></label> <select name='region' id='region'> <option value='-1'>Votre choix</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Alsace</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Aquitaine</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Auvergne</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Basse Normandie</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Bourgogne</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Bretagne</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Centre</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Champagne-Ardenne</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Corse</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Franche Comté</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Haute Normandie</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">île de France</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Languedoc-Roussillon</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Limousin</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Lorraine</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Midi-Pyrénées</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Nord-Pas-de-Calais</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Outre mer</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">PACA</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Pays de la Loire</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Picardie</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Poitou-Charentes</option> <option class="level-0" value="<?php echo stripslashes($_POST['region']); ?>">Rhônes-Alpes</option> </select>
There are currently 1 users browsing this thread. (0 members and 1 guests)