Bonjour,
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<legend class="texte_contenu">Identification</legend>
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<td width="120" align="right" valign="middle" class="bit">* Nom : </td>
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<input name="nom" type="text" id="nom" size="40" maxlength="50" />
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<td align="right" valign="middle" class="bit">* Prénoms : </td>
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<td align="right" valign="middle" class="bit"> Société : </td>
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<td width="120" align="right" valign="middle" class="bit">Adresse : </td>
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<td width="120" align="right" valign="middle" class="bit">* Téléphone : </td>
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<input name="telephone" type="text" id="telephone" size="20" maxlength="20" />
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<td width="120" align="right" valign="middle" class="bit">* Email : </td>
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<input name="mail" type="text" id="mail" size="30" />
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<td colspan="7" align="left" valign="top"><fieldset style="border-color:#000000"><legend class="texte_contenu">Formation (s) souhaitée (s)</legend><table width="590" border="0" align="center" cellpadding="0" cellspacing="0">
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<td colspan="4" align="left" valign="top" class="bit2">Ethical Hacking </td>
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<input name="hacking&securite " type="checkbox" id="hacking&securite " value="hacking&securite" />
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<td width="560" align="left" valign="middle" class="texte_contenu">Hacking & Sécurité</td>
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<td> </td>
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<input name="pentest" type="checkbox" id="pentest" value="pentest" />
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<td align="left" valign="middle" class="texte_contenu">Penetration Testing : Mise en situation d'audit </td>
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<td colspan="4" align="left" valign="top" class="bit2">Certification Securité Technique </td>
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<td> </td>
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<input name="ceh" type="checkbox" id="ceh" value="ceh" />
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<td align="left" valign="middle" class="texte_contenu">Certified Ethical Hackers v7 </td>
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<input name="eccouncillcertified" type="checkbox" id="eccouncillcertified" value="eccouncillcertified" />
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<td align="left" valign="middle" class="texte_contenu">ECCouncilCertified Security Analyst / LPT V3</td>
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<td> </td>
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<input name="computer hacking" type="checkbox" id="computer hacking" value="computer hacking" />
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<td align="left" valign="middle" class="texte_contenu">Computer Hacking Forensic Investigator v4</td>
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<input name="eccouncill network" type="checkbox" id="eccouncill network" value="eccouncill network" />
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<td align="left" valign="middle" class="texte_contenu">ECCouncil Network Security Administrator v4</td>
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<input name="eccouncill certified disaster" type="checkbox" id="eccouncill certified disaster" value="eccouncill certified disaster" />
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<td align="left" valign="middle" class="texte_contenu">ECCouncil Certified Disaster-Virtualization Technology</td>
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<input name="eccouncill certified voip" type="checkbox" id="eccouncill certified voip" value="eccouncill certified voip" />
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<td align="left" valign="middle" class="texte_contenu">ECCouncil Certified VoIP Professional</td>
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<input name="soumettre" type="submit" class="texte_contenu" id="soumettre" value="Soumettre" />
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<td colspan="7" align="left" valign="middle" class="pti_bit">NB : Les champs marqués d'une astérisque sont obligatoires.</td>
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