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<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Name/Nom</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_aed1a3239e" id="fld_aed1a3239e" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Surname/Prénom</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_a63fec475a" id="fld_a63fec475a" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Adress</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<textarea name="fld_b2404b1c29" id="fld_b2404b1c29" rows="5" style="width:100%"></textarea>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Zip/Code postal</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_b9791017eb" id="fld_b9791017eb" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">City/Ville</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_c1c14cc39e" id="fld_c1c14cc39e" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Country/Pays</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_ad60646585" id="fld_ad60646585" style="width:100%">
<option value='Afganistan'>Afghanistan</option>
<option value='Albania'>Albania</option>
<option value='Algeria'>Algeria</option>
<option value='American Samoa'>American Samoa</option>
<option value='Andorra'>Andorra</option>
<option value='Angola'>Angola</option>
<option value='Anguilla'>Anguilla</option>
<option value='Antigua & Barbuda'>Antigua & Barbuda</option>
<option value='Argentina'>Argentina</option>
<option value='Armenia'>Armenia</option>
<option value='Aruba'>Aruba</option>
<option value='Australia'>Australia</option>
<option value='Austria'>Austria</option>
<option value='Azerbaijan'>Azerbaijan</option>
<option value='Azores'>Azores</option>
<option value='Bahamas'>Bahamas</option>
<option value='Bahrain'>Bahrain</option>
<option value='Bangladesh'>Bangladesh</option>
<option value='Barbados'>Barbados</option>
<option value='Belarus'>Belarus</option>
<option value='Belgium'>Belgium</option>
<option value='Belize'>Belize</option>
<option value='Benin'>Benin</option>
<option value='Bermuda'>Bermuda</option>
<option value='Bhutan'>Bhutan</option>
<option value='Bolivia'>Bolivia</option>
<option value='Bonaire'>Bonaire</option>
<option value='Bosnia & Herzegovina'>Bosnia & Herzegovina</option>
<option value='Botswana'>Botswana</option>
<option value='Brazil'>Brazil</option>
<option value='British Indian Ocean Ter'>British Indian Ocean Ter</option>
<option value='Brunei'>Brunei</option>
<option value='Bulgaria'>Bulgaria</option>
<option value='Burkina Faso'>Burkina Faso</option>
<option value='Burundi'>Burundi</option>
<option value='Cambodia'>Cambodia</option>
<option value='Cameroon'>Cameroon</option>
<option value='Canada'>Canada</option>
<option value='Canary Islands'>Canary Islands</option>
<option value='Cape Verde'>Cape Verde</option>
<option value='Cayman Islands'>Cayman Islands</option>
<option value='Central African Republic'>Central African Republic</option>
<option value='Chad'>Chad</option>
<option value='Channel Islands'>Channel Islands</option>
<option value='Chile'>Chile</option>
<option value='China'>China</option>
<option value='Christmas Island'>Christmas Island</option>
<option value='Cocos Island'>Cocos Island</option>
<option value='Columbia'>Columbia</option>
<option value='Comoros'>Comoros</option>
<option value='Congo'>Congo</option>
<option value='Cook Islands'>Cook Islands</option>
<option value='Costa Rica'>Costa Rica</option>
<option value='Cote DIvoire'>Cote D'Ivoire</option>
<option value='Croatia'>Croatia</option>
<option value='Cuba'>Cuba</option>
<option value='Curaco'>Curacao</option>
<option value='Cyprus'>Cyprus</option>
<option value='Czech Republic'>Czech Republic</option>
<option value='Denmark'>Denmark</option>
<option value='Djibouti'>Djibouti</option>
<option value='Dominica'>Dominica</option>
<option value='Dominican Republic'>Dominican Republic</option>
<option value='East Timor'>East Timor</option>
<option value='Ecuador'>Ecuador</option>
<option value='Egypt'>Egypt</option>
<option value='El Salvador'>El Salvador</option>
<option value='Equatorial Guinea'>Equatorial Guinea</option>
<option value='Eritrea'>Eritrea</option>
<option value='Estonia'>Estonia</option>
<option value='Ethiopia'>Ethiopia</option>
<option value='Falkland Islands'>Falkland Islands</option>
<option value='Faroe Islands'>Faroe Islands</option>
<option value='Fiji'>Fiji</option>
<option value='Finland'>Finland</option>
<option value='France'>France</option>
<option value='French Guiana'>French Guiana</option>
<option value='French Polynesia'>French Polynesia</option>
<option value='French Southern Ter'>French Southern Ter</option>
<option value='Gabon'>Gabon</option>
<option value='Gambia'>Gambia</option>
<option value='Georgia'>Georgia</option>
<option value='Germany'>Germany</option>
<option value='Ghana'>Ghana</option>
<option value='Gibraltar'>Gibraltar</option>
<option value='Great Britain'>Great Britain</option>
<option value='Greece'>Greece</option>
<option value='Greenland'>Greenland</option>
<option value='Grenada'>Grenada</option>
<option value='Guadeloupe'>Guadeloupe</option>
<option value='Guam'>Guam</option>
<option value='Guatemala'>Guatemala</option>
<option value='Guinea'>Guinea</option>
<option value='Guyana'>Guyana</option>
<option value='Haiti'>Haiti</option>
<option value='Hawaii'>Hawaii</option>
<option value='Honduras'>Honduras</option>
<option value='Hong Kong'>Hong Kong</option>
<option value='Hungary'>Hungary</option>
<option value='Iceland'>Iceland</option>
<option value='India'>India</option>
<option value='Indonesia'>Indonesia</option>
<option value='Iran'>Iran</option>
<option value='Iraq'>Iraq</option>
<option value='Ireland'>Ireland</option>
<option value='Isle of Man'>Isle of Man</option>
<option value='Israel'>Israel</option>
<option value='Italy'>Italy</option>
<option value='Jamaica'>Jamaica</option>
<option value='Japan'>Japan</option>
<option value='Jordan'>Jordan</option>
<option value='Kazakhstan'>Kazakhstan</option>
<option value='Kenya'>Kenya</option>
<option value='Kiribati'>Kiribati</option>
<option value='Korea North'>Korea North</option>
<option value='Korea Sout'>Korea South</option>
<option value='Kuwait'>Kuwait</option>
<option value='Kyrgyzstan'>Kyrgyzstan</option>
<option value='Laos'>Laos</option>
<option value='Latvia'>Latvia</option>
<option value='Lebanon'>Lebanon</option>
<option value='Lesotho'>Lesotho</option>
<option value='Liberia'>Liberia</option>
<option value='Libya'>Libya</option>
<option value='Liechtenstein'>Liechtenstein</option>
<option value='Lithuania'>Lithuania</option>
<option value='Luxembourg'>Luxembourg</option>
<option value='Macau'>Macau</option>
<option value='Macedonia'>Macedonia</option>
<option value='Madagascar'>Madagascar</option>
<option value='Malawi'>Malawi</option>
<option value='Malaysia'>Malaysia</option>
<option value='Maldives'>Maldives</option>
<option value='Mali'>Mali</option>
<option value='Malta'>Malta</option>
<option value='Marshall Islands'>Marshall Islands</option>
<option value='Martinique'>Martinique</option>
<option value='Mauritania'>Mauritania</option>
<option value='Mauritius'>Mauritius</option>
<option value='Mayotte'>Mayotte</option>
<option value='Mexico'>Mexico</option>
<option value='Midway Islands'>Midway Islands</option>
<option value='Moldova'>Moldova</option>
<option value='Monaco'>Monaco</option>
<option value='Mongolia'>Mongolia</option>
<option value='Montserrat'>Montserrat</option>
<option value='Morocco'>Morocco</option>
<option value='Mozambique'>Mozambique</option>
<option value='Myanmar'>Myanmar</option>
<option value='Nambia'>Nambia</option>
<option value='Nauru'>Nauru</option>
<option value='Nepal'>Nepal</option>
<option value='Netherland Antilles'>Netherland Antilles</option>
<option value='Netherlands'>Netherlands</option>
<option value='Nevis'>Nevis</option>
<option value='New Caledonia'>New Caledonia</option>
<option value='New Zealand'>New Zealand</option>
<option value='Nicaragua'>Nicaragua</option>
<option value='Niger'>Niger</option>
<option value='Nigeria'>Nigeria</option>
<option value='Niue'>Niue</option>
<option value='Norfolk Island'>Norfolk Island</option>
<option value='Norway'>Norway</option>
<option value='Oman'>Oman</option>
<option value='Pakistan'>Pakistan</option>
<option value='Palau Island'>Palau Island</option>
<option value='Palestine'>Palestine</option>
<option value='Panama'>Panama</option>
<option value='Papua New Guinea'>Papua New Guinea</option>
<option value='Paraguay'>Paraguay</option>
<option value='Peru'>Peru</option>
<option value='Phillipines'>Philippines</option>
<option value='Pitcairn Island'>Pitcairn Island</option>
<option value='Poland'>Poland</option>
<option value='Portugal'>Portugal</option>
<option value='Puerto Rico'>Puerto Rico</option>
<option value='Qatar'>Qatar</option>
<option value='Reunion'>Reunion</option>
<option value='Romania'>Romania</option>
<option value='Russia'>Russia</option>
<option value='Rwanda'>Rwanda</option>
<option value='Saipan'>Saipan</option>
<option value='Samoa'>Samoa</option>
<option value='Samoa American'>Samoa American</option>
<option value='San Marino'>San Marino</option>
<option value='Sao Tome & Principe'>Sao Tome & Principe</option>
<option value='Saudi Arabia'>Saudi Arabia</option>
<option value='Senegal'>Senegal</option>
<option value='Serbia & Montenegro'>Serbia & Montenegro</option>
<option value='Seychelles'>Seychelles</option>
<option value='Sierra Leone'>Sierra Leone</option>
<option value='Singapore'>Singapore</option>
<option value='Slovakia'>Slovakia</option>
<option value='Slovenia'>Slovenia</option>
<option value='Solomon Islands'>Solomon Islands</option>
<option value='Somalia'>Somalia</option>
<option value='South Africa'>South Africa</option>
<option value='Spain'>Spain</option>
<option value='Sri Lanka'>Sri Lanka</option>
<option value='St Barthelemy'>St Barthelemy</option>
<option value='St Eustatius'>St Eustatius</option>
<option value='St Helena'>St Helena</option>
<option value='St Kitts-Nevis'>St Kitts-Nevis</option>
<option value='St Lucia'>St Lucia</option>
<option value='St Maarten'>St Maarten</option>
<option value='St Pierre & Miquelon'>St Pierre & Miquelon</option>
<option value='St Vincent & Grenadines'>St Vincent & Grenadines</option>
<option value='Sudan'>Sudan</option>
<option value='Suriname'>Suriname</option>
<option value='Swaziland'>Swaziland</option>
<option value='Sweden'>Sweden</option>
<option value='Switzerland'>Switzerland</option>
<option value='Syria'>Syria</option>
<option value='Tahiti'>Tahiti</option>
<option value='Taiwan'>Taiwan</option>
<option value='Tajikistan'>Tajikistan</option>
<option value='Tanzania'>Tanzania</option>
<option value='Thailand'>Thailand</option>
<option value='Togo'>Togo</option>
<option value='Tokelau'>Tokelau</option>
<option value='Tonga'>Tonga</option>
<option value='Trinidad & Tobago'>Trinidad & Tobago</option>
<option value='Tunisia'>Tunisia</option>
<option value='Turkey'>Turkey</option>
<option value='Turkmenistan'>Turkmenistan</option>
<option value='Turks & Caicos Is'>Turks & Caicos Is</option>
<option value='Tuvalu'>Tuvalu</option>
<option value='Uganda'>Uganda</option>
<option value='Ukraine'>Ukraine</option>
<option value='United Arab Erimates'>United Arab Emirates</option>
<option value='United Kingdom'>United Kingdom</option>
<option value='United States of America'>United States of America</option>
<option value='Uraguay'>Uruguay</option>
<option value='Uzbekistan'>Uzbekistan</option>
<option value='Vanuatu'>Vanuatu</option>
<option value='Vatican City State'>Vatican City State</option>
<option value='Venezuela'>Venezuela</option>
<option value='Vietnam'>Vietnam</option>
<option value='Virgin Islands (Brit)'>Virgin Islands (Brit)</option>
<option value='Virgin Islands (USA)'>Virgin Islands (USA)</option>
<option value='Wake Island'>Wake Island</option>
<option value='Wallis & Futana Is'>Wallis & Futana Is</option>
<option value='Yemen'>Yemen</option>
<option value='Zaire'>Zaire</option>
<option value='Zambia'>Zambia</option>
<option value='Zimbabwe'>Zimbabwe</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Email</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_8653b491ec" id="fld_8653b491ec" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Class #1</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_4fc8912aa7" id="fld_4fc8912aa7" style="width:100%">
<option value='2WD' selected>2WD</option>
<option value='4WD'>4WD</option>
<option value='Truck'>Truck</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Personal AMB Transponder</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_c91dcdfa4b" id="fld_c91dcdfa4b" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Frequencies</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_06a89e2326" id="fld_06a89e2326" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Class #2</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_7a52b8dee0" id="fld_7a52b8dee0" style="width:100%">
<option value='2WD'>2WD</option>
<option value='4WD' selected>4WD</option>
<option value='Truck'>Truck</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Personal AMB Transponder</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_2dcdae85cd" id="fld_2dcdae85cd" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Frequencies</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_2864f65e70" id="fld_2864f65e70" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Payment Mode</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_a8c8701387" id="fld_a8c8701387" style="width:100%">
<option value='Chèque bancaire (only France)'>Chèque bancaire (only France)</option>
<option value='Paypal'>Paypal</option>
<option value='Bank transfert'>Bank transfert</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Skill level</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_4187b6e834" id="fld_4187b6e834" style="width:100%">
<option value='1. Rookie'>1. Rookie</option>
<option value='2. Club'>2. Club</option>
<option value='3. Regional'>3. Regional</option>
<option value='4. National'>4. National</option>
<option value='5. World/International'>5. World/International</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Tshirt size</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_cb45778eeb" id="fld_cb45778eeb" style="width:100%">
<option value='S'>S</option>
<option value='M'>M</option>
<option value='L' selected>L</option>
<option value='XL'>XL</option>
<option value='XXL'>XXL</option>
<option value='XXXL'>XXXL</option>
</select>
</div></td>
</tr>
<tr>
<!-- Buttons -->
<td colspan="2" align="center" class="phpForms_main">
<input type="button" value="Submit" onClick='CheckPagee5cc9eeb2e();' style="width:30%; background-color : #a2a2a2" class="phpForms_btn">
</td>
<span style="">Name/Nom</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_aed1a3239e" id="fld_aed1a3239e" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Surname/Prénom</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_a63fec475a" id="fld_a63fec475a" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Adress</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<textarea name="fld_b2404b1c29" id="fld_b2404b1c29" rows="5" style="width:100%"></textarea>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Zip/Code postal</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_b9791017eb" id="fld_b9791017eb" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">City/Ville</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_c1c14cc39e" id="fld_c1c14cc39e" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Country/Pays</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_ad60646585" id="fld_ad60646585" style="width:100%">
<option value='Afganistan'>Afghanistan</option>
<option value='Albania'>Albania</option>
<option value='Algeria'>Algeria</option>
<option value='American Samoa'>American Samoa</option>
<option value='Andorra'>Andorra</option>
<option value='Angola'>Angola</option>
<option value='Anguilla'>Anguilla</option>
<option value='Antigua & Barbuda'>Antigua & Barbuda</option>
<option value='Argentina'>Argentina</option>
<option value='Armenia'>Armenia</option>
<option value='Aruba'>Aruba</option>
<option value='Australia'>Australia</option>
<option value='Austria'>Austria</option>
<option value='Azerbaijan'>Azerbaijan</option>
<option value='Azores'>Azores</option>
<option value='Bahamas'>Bahamas</option>
<option value='Bahrain'>Bahrain</option>
<option value='Bangladesh'>Bangladesh</option>
<option value='Barbados'>Barbados</option>
<option value='Belarus'>Belarus</option>
<option value='Belgium'>Belgium</option>
<option value='Belize'>Belize</option>
<option value='Benin'>Benin</option>
<option value='Bermuda'>Bermuda</option>
<option value='Bhutan'>Bhutan</option>
<option value='Bolivia'>Bolivia</option>
<option value='Bonaire'>Bonaire</option>
<option value='Bosnia & Herzegovina'>Bosnia & Herzegovina</option>
<option value='Botswana'>Botswana</option>
<option value='Brazil'>Brazil</option>
<option value='British Indian Ocean Ter'>British Indian Ocean Ter</option>
<option value='Brunei'>Brunei</option>
<option value='Bulgaria'>Bulgaria</option>
<option value='Burkina Faso'>Burkina Faso</option>
<option value='Burundi'>Burundi</option>
<option value='Cambodia'>Cambodia</option>
<option value='Cameroon'>Cameroon</option>
<option value='Canada'>Canada</option>
<option value='Canary Islands'>Canary Islands</option>
<option value='Cape Verde'>Cape Verde</option>
<option value='Cayman Islands'>Cayman Islands</option>
<option value='Central African Republic'>Central African Republic</option>
<option value='Chad'>Chad</option>
<option value='Channel Islands'>Channel Islands</option>
<option value='Chile'>Chile</option>
<option value='China'>China</option>
<option value='Christmas Island'>Christmas Island</option>
<option value='Cocos Island'>Cocos Island</option>
<option value='Columbia'>Columbia</option>
<option value='Comoros'>Comoros</option>
<option value='Congo'>Congo</option>
<option value='Cook Islands'>Cook Islands</option>
<option value='Costa Rica'>Costa Rica</option>
<option value='Cote DIvoire'>Cote D'Ivoire</option>
<option value='Croatia'>Croatia</option>
<option value='Cuba'>Cuba</option>
<option value='Curaco'>Curacao</option>
<option value='Cyprus'>Cyprus</option>
<option value='Czech Republic'>Czech Republic</option>
<option value='Denmark'>Denmark</option>
<option value='Djibouti'>Djibouti</option>
<option value='Dominica'>Dominica</option>
<option value='Dominican Republic'>Dominican Republic</option>
<option value='East Timor'>East Timor</option>
<option value='Ecuador'>Ecuador</option>
<option value='Egypt'>Egypt</option>
<option value='El Salvador'>El Salvador</option>
<option value='Equatorial Guinea'>Equatorial Guinea</option>
<option value='Eritrea'>Eritrea</option>
<option value='Estonia'>Estonia</option>
<option value='Ethiopia'>Ethiopia</option>
<option value='Falkland Islands'>Falkland Islands</option>
<option value='Faroe Islands'>Faroe Islands</option>
<option value='Fiji'>Fiji</option>
<option value='Finland'>Finland</option>
<option value='France'>France</option>
<option value='French Guiana'>French Guiana</option>
<option value='French Polynesia'>French Polynesia</option>
<option value='French Southern Ter'>French Southern Ter</option>
<option value='Gabon'>Gabon</option>
<option value='Gambia'>Gambia</option>
<option value='Georgia'>Georgia</option>
<option value='Germany'>Germany</option>
<option value='Ghana'>Ghana</option>
<option value='Gibraltar'>Gibraltar</option>
<option value='Great Britain'>Great Britain</option>
<option value='Greece'>Greece</option>
<option value='Greenland'>Greenland</option>
<option value='Grenada'>Grenada</option>
<option value='Guadeloupe'>Guadeloupe</option>
<option value='Guam'>Guam</option>
<option value='Guatemala'>Guatemala</option>
<option value='Guinea'>Guinea</option>
<option value='Guyana'>Guyana</option>
<option value='Haiti'>Haiti</option>
<option value='Hawaii'>Hawaii</option>
<option value='Honduras'>Honduras</option>
<option value='Hong Kong'>Hong Kong</option>
<option value='Hungary'>Hungary</option>
<option value='Iceland'>Iceland</option>
<option value='India'>India</option>
<option value='Indonesia'>Indonesia</option>
<option value='Iran'>Iran</option>
<option value='Iraq'>Iraq</option>
<option value='Ireland'>Ireland</option>
<option value='Isle of Man'>Isle of Man</option>
<option value='Israel'>Israel</option>
<option value='Italy'>Italy</option>
<option value='Jamaica'>Jamaica</option>
<option value='Japan'>Japan</option>
<option value='Jordan'>Jordan</option>
<option value='Kazakhstan'>Kazakhstan</option>
<option value='Kenya'>Kenya</option>
<option value='Kiribati'>Kiribati</option>
<option value='Korea North'>Korea North</option>
<option value='Korea Sout'>Korea South</option>
<option value='Kuwait'>Kuwait</option>
<option value='Kyrgyzstan'>Kyrgyzstan</option>
<option value='Laos'>Laos</option>
<option value='Latvia'>Latvia</option>
<option value='Lebanon'>Lebanon</option>
<option value='Lesotho'>Lesotho</option>
<option value='Liberia'>Liberia</option>
<option value='Libya'>Libya</option>
<option value='Liechtenstein'>Liechtenstein</option>
<option value='Lithuania'>Lithuania</option>
<option value='Luxembourg'>Luxembourg</option>
<option value='Macau'>Macau</option>
<option value='Macedonia'>Macedonia</option>
<option value='Madagascar'>Madagascar</option>
<option value='Malawi'>Malawi</option>
<option value='Malaysia'>Malaysia</option>
<option value='Maldives'>Maldives</option>
<option value='Mali'>Mali</option>
<option value='Malta'>Malta</option>
<option value='Marshall Islands'>Marshall Islands</option>
<option value='Martinique'>Martinique</option>
<option value='Mauritania'>Mauritania</option>
<option value='Mauritius'>Mauritius</option>
<option value='Mayotte'>Mayotte</option>
<option value='Mexico'>Mexico</option>
<option value='Midway Islands'>Midway Islands</option>
<option value='Moldova'>Moldova</option>
<option value='Monaco'>Monaco</option>
<option value='Mongolia'>Mongolia</option>
<option value='Montserrat'>Montserrat</option>
<option value='Morocco'>Morocco</option>
<option value='Mozambique'>Mozambique</option>
<option value='Myanmar'>Myanmar</option>
<option value='Nambia'>Nambia</option>
<option value='Nauru'>Nauru</option>
<option value='Nepal'>Nepal</option>
<option value='Netherland Antilles'>Netherland Antilles</option>
<option value='Netherlands'>Netherlands</option>
<option value='Nevis'>Nevis</option>
<option value='New Caledonia'>New Caledonia</option>
<option value='New Zealand'>New Zealand</option>
<option value='Nicaragua'>Nicaragua</option>
<option value='Niger'>Niger</option>
<option value='Nigeria'>Nigeria</option>
<option value='Niue'>Niue</option>
<option value='Norfolk Island'>Norfolk Island</option>
<option value='Norway'>Norway</option>
<option value='Oman'>Oman</option>
<option value='Pakistan'>Pakistan</option>
<option value='Palau Island'>Palau Island</option>
<option value='Palestine'>Palestine</option>
<option value='Panama'>Panama</option>
<option value='Papua New Guinea'>Papua New Guinea</option>
<option value='Paraguay'>Paraguay</option>
<option value='Peru'>Peru</option>
<option value='Phillipines'>Philippines</option>
<option value='Pitcairn Island'>Pitcairn Island</option>
<option value='Poland'>Poland</option>
<option value='Portugal'>Portugal</option>
<option value='Puerto Rico'>Puerto Rico</option>
<option value='Qatar'>Qatar</option>
<option value='Reunion'>Reunion</option>
<option value='Romania'>Romania</option>
<option value='Russia'>Russia</option>
<option value='Rwanda'>Rwanda</option>
<option value='Saipan'>Saipan</option>
<option value='Samoa'>Samoa</option>
<option value='Samoa American'>Samoa American</option>
<option value='San Marino'>San Marino</option>
<option value='Sao Tome & Principe'>Sao Tome & Principe</option>
<option value='Saudi Arabia'>Saudi Arabia</option>
<option value='Senegal'>Senegal</option>
<option value='Serbia & Montenegro'>Serbia & Montenegro</option>
<option value='Seychelles'>Seychelles</option>
<option value='Sierra Leone'>Sierra Leone</option>
<option value='Singapore'>Singapore</option>
<option value='Slovakia'>Slovakia</option>
<option value='Slovenia'>Slovenia</option>
<option value='Solomon Islands'>Solomon Islands</option>
<option value='Somalia'>Somalia</option>
<option value='South Africa'>South Africa</option>
<option value='Spain'>Spain</option>
<option value='Sri Lanka'>Sri Lanka</option>
<option value='St Barthelemy'>St Barthelemy</option>
<option value='St Eustatius'>St Eustatius</option>
<option value='St Helena'>St Helena</option>
<option value='St Kitts-Nevis'>St Kitts-Nevis</option>
<option value='St Lucia'>St Lucia</option>
<option value='St Maarten'>St Maarten</option>
<option value='St Pierre & Miquelon'>St Pierre & Miquelon</option>
<option value='St Vincent & Grenadines'>St Vincent & Grenadines</option>
<option value='Sudan'>Sudan</option>
<option value='Suriname'>Suriname</option>
<option value='Swaziland'>Swaziland</option>
<option value='Sweden'>Sweden</option>
<option value='Switzerland'>Switzerland</option>
<option value='Syria'>Syria</option>
<option value='Tahiti'>Tahiti</option>
<option value='Taiwan'>Taiwan</option>
<option value='Tajikistan'>Tajikistan</option>
<option value='Tanzania'>Tanzania</option>
<option value='Thailand'>Thailand</option>
<option value='Togo'>Togo</option>
<option value='Tokelau'>Tokelau</option>
<option value='Tonga'>Tonga</option>
<option value='Trinidad & Tobago'>Trinidad & Tobago</option>
<option value='Tunisia'>Tunisia</option>
<option value='Turkey'>Turkey</option>
<option value='Turkmenistan'>Turkmenistan</option>
<option value='Turks & Caicos Is'>Turks & Caicos Is</option>
<option value='Tuvalu'>Tuvalu</option>
<option value='Uganda'>Uganda</option>
<option value='Ukraine'>Ukraine</option>
<option value='United Arab Erimates'>United Arab Emirates</option>
<option value='United Kingdom'>United Kingdom</option>
<option value='United States of America'>United States of America</option>
<option value='Uraguay'>Uruguay</option>
<option value='Uzbekistan'>Uzbekistan</option>
<option value='Vanuatu'>Vanuatu</option>
<option value='Vatican City State'>Vatican City State</option>
<option value='Venezuela'>Venezuela</option>
<option value='Vietnam'>Vietnam</option>
<option value='Virgin Islands (Brit)'>Virgin Islands (Brit)</option>
<option value='Virgin Islands (USA)'>Virgin Islands (USA)</option>
<option value='Wake Island'>Wake Island</option>
<option value='Wallis & Futana Is'>Wallis & Futana Is</option>
<option value='Yemen'>Yemen</option>
<option value='Zaire'>Zaire</option>
<option value='Zambia'>Zambia</option>
<option value='Zimbabwe'>Zimbabwe</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Email</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_8653b491ec" id="fld_8653b491ec" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Class #1</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_4fc8912aa7" id="fld_4fc8912aa7" style="width:100%">
<option value='2WD' selected>2WD</option>
<option value='4WD'>4WD</option>
<option value='Truck'>Truck</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Personal AMB Transponder</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_c91dcdfa4b" id="fld_c91dcdfa4b" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Frequencies</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_06a89e2326" id="fld_06a89e2326" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Class #2</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_7a52b8dee0" id="fld_7a52b8dee0" style="width:100%">
<option value='2WD'>2WD</option>
<option value='4WD' selected>4WD</option>
<option value='Truck'>Truck</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Personal AMB Transponder</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_2dcdae85cd" id="fld_2dcdae85cd" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Frequencies</span>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<input type="text" name="fld_2864f65e70" id="fld_2864f65e70" value="" style="width:100%">
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Payment Mode</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_a8c8701387" id="fld_a8c8701387" style="width:100%">
<option value='Chèque bancaire (only France)'>Chèque bancaire (only France)</option>
<option value='Paypal'>Paypal</option>
<option value='Bank transfert'>Bank transfert</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Skill level</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_4187b6e834" id="fld_4187b6e834" style="width:100%">
<option value='1. Rookie'>1. Rookie</option>
<option value='2. Club'>2. Club</option>
<option value='3. Regional'>3. Regional</option>
<option value='4. National'>4. National</option>
<option value='5. World/International'>5. World/International</option>
</select>
</div></td>
</tr>
<tr>
<td width="30%" align="left" bgcolor="#cdcdcd" valign="top">
<span style="">Tshirt size</span> <font color='red'>*</font>
</td>
<td align="left" bgcolor="#cdcdcd">
<div align="center">
<select name="fld_cb45778eeb" id="fld_cb45778eeb" style="width:100%">
<option value='S'>S</option>
<option value='M'>M</option>
<option value='L' selected>L</option>
<option value='XL'>XL</option>
<option value='XXL'>XXL</option>
<option value='XXXL'>XXXL</option>
</select>
</div></td>
</tr>
<tr>
<!-- Buttons -->
<td colspan="2" align="center" class="phpForms_main">
<input type="button" value="Submit" onClick='CheckPagee5cc9eeb2e();' style="width:30%; background-color : #a2a2a2" class="phpForms_btn">
</td>
Ssylvainsab
Messages postés
2884
Date d'inscription
samedi 29 juillet 2006
Statut
Modérateur
Dernière intervention
15 août 2020
825
16 déc. 2006 à 01:44
16 déc. 2006 à 01:44
Bonsoir.
En adaptant un peu ceci tu devrais avoir ce qui te convient :
webmaster un formulaire de contact pour votre site
En adaptant un peu ceci tu devrais avoir ce qui te convient :
webmaster un formulaire de contact pour votre site
Ssylvainsab
Messages postés
2884
Date d'inscription
samedi 29 juillet 2006
Statut
Modérateur
Dernière intervention
15 août 2020
825
16 déc. 2006 à 02:04
16 déc. 2006 à 02:04
Le forum est fait pour ca, il vaut mieux mettre le code ici.
Quelles sont les coordonnées que tu dois recevoir ?
Quelles sont les coordonnées que tu dois recevoir ?