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ajout_pharmacie.html
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ajout_pharmacie.html
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<!DOCTYPE html>
<html lang="fr">
<head>
<meta charset="utf-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>Ajouter pharmacies ~ EduPalu ~ FCRM & Fongwama</title>
<link rel="icon" href="favicon.ico" type="image/x-icon"/>
<link href="css/bootstrap.min.css" rel="stylesheet">
<link href="css/style.css" rel="stylesheet">
<link rel="stylesheet" href="css/adresses.css" />
</head>
<body>
<header class="jumbotron">
<a href="index.html">
<img src="img/logo.png" alt="logo EduPalu" class="center-block" />
</a>
</header>
<section class="container">
<div class="col-md-12">
<div class="row">
<div class="col-md-6">
<legend><h1><span class="text-primary">Ajoutez des pharmacies</span></h1></legend>
<form id="form_pharmacie" class="ajax-pharma-json" action="api/AddPharma.php" method="post">
<div class="form-group">
<label for="input_name">
<span class="text-uppercase">Nom pharmacie</span>
</label>
<input id="input_name" name="nom" class="form-control" type="text" value=""/>
</div>
<div class="form-group">
<label for="input_address">
<span class="text-uppercase">Adresse pharmacie</span>
</label>
<input id="input_address" name="adresse" class="form-control search" type="text" value=""/>
</div>
<div class="form-group">
<label for="input_ville">
<span class="text-uppercase">Ville</span>
</label>
<input id="input_ville" name="ville" class="form-control search" type="text" value=""/>
</div>
<div class="form-group">
<label for="input_contact">
<span class="text-uppercase">Contact pharmacie</span>
</label>
<input id="input_contact" name="contact" class="form-control search" type="text" value=""/>
</div>
<div class="form-group">
<label for="input_quartier">
<span class="text-uppercase">Quartier ou Arrondissement</span>
</label>
<input id="input_quartier" name="quartier" class="form-control search" type="text" value=""/>
</div>
<div class="form-group">
<label for="input_numero">
<span class="text-uppercase">Numéro ou mail de l'envoyeur</span>
</label>
<input id="input_numero" name="numero" class="form-control search" type="text" value=""/>
</div>
<input class="btnAjouter btn-block btn btn-primary" type="submit" value="Ajouter">
</form>
</div>
</div>
</div>
</section>
<footer>
<p>
<a href="http://www.fongwama.com">Fongwama</a> - 2016
</p>
</footer>
<!-- inclusion des fichiers javascript -->
<script type="text/javascript" src="js/jquery-1.11.3.min.js"></script>
<!-- Bootstrap JavaScript File Include -->
<script type="text/javascript" src="js/bootstrap.min.js"></script>
<script type="application/javascript" src="js/backend.js"></script>
</body>
</html>