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<TABLE borderColor=#cccccc cellSpacing=0 cellPadding=8 width=420 border=1>
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<TR bgColor=#ffffcc>
<TD class=small>Nom - Prénom</TD>
<TD><INPUT class=small size=35 maxLength="50" name=nom></TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Numéro de téléphone</TD>
<TD><INPUT class=small size=35 maxLength="20" name=tel></TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Adresse email</TD>
<TD><INPUT class=small size=35 maxLength="40" name=email></TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Pays d'origine</TD>
<TD>
<SELECT class=small name=pays>
<OPTION selected>Pays</OPTION>
<option value="AF">AFGHANISTAN</option>
<option value="ZA">AFRIQUE DU SUD</option>
<option value="AX">ÅLAND, ÎLES</option>
<option value="AL">ALBANIE</option>
<option value="DZ">ALGÉRIE</option>
<option value="DE">ALLEMAGNE</option>
<option value="AD">ANDORRE</option>
<option value="AO">ANGOLA</option>
<option value="AI">ANGUILLA</option>
<option value="AQ">ANTARCTIQUE</option>
<option value="AG">ANTIGUA-ET-BARBUDA</option>
<option value="AN">ANTILLES NÉERLANDAISES</option>
<option value="SA">ARABIE SAOUDITE</option>
<option value="AR">ARGENTINE</option>
<option value="AM">ARMÉNIE</option>
<option value="AW">ARUBA</option>
<option value="AU">AUSTRALIE</option>
<option value="AT">AUTRICHE</option>
<option value="AZ">AZERBAÏDJAN</option>
<option value="BS">BAHAMAS</option>
<option value="BH">BAHREÏN</option>
<option value="BD">BANGLADESH</option>
<option value="BB">BARBADE</option>
<option value="BY">BÉLARUS</option>
<option value="BE">BELGIQUE</option>
<option value="BZ">BELIZE</option>
<option value="BJ">BÉNIN</option>
<option value="BM">BERMUDES</option>
<option value="BT">BHOUTAN</option>
<option value="BO">BOLIVIE</option>
<option value="BA">BOSNIE-HERZÉGOVINE</option>
<option value="BW">BOTSWANA</option>
<option value="BV">BOUVET, ÎLE</option>
<option value="BR">BRÉSIL</option>
<option value="BN">BRUNÉI DARUSSALAM</option>
<option value="BG">BULGARIE</option>
<option value="BF">BURKINA FASO</option>
<option value="BI">BURUNDI</option>
<option value="KY">CAÏMANES, ÎLES</option>
<option value="KH">CAMBODGE</option>
<option value="CM">CAMEROUN</option>
<option value="CA">CANADA</option>
<option value="CV">CAP-VERT</option>
<option value="CF">CENTRAFRICAINE, RÉPUBLIQUE</option>
<option value="CL">CHILI</option>
<option value="CN">CHINE</option>
<option value="CX">CHRISTMAS, ÎLE</option>
<option value="CY">CHYPRE</option>
<option value="CC">COCOS (KEELING), ÎLES</option>
<option value="CO">COLOMBIE</option>
<option value="KM">COMORES</option>
<option value="CG">CONGO</option>
<option value="CD">CONGO, LA RÉPUBLIQUE DÉMOCRATIQUE DU</option>
<option value="CK">COOK, ÎLES</option>
<option value="KR">CORÉE, RÉPUBLIQUE DE</option>
<option value="KP">CORÉE, RÉPUBLIQUE POPULAIRE DE</option>
<option value="CR">COSTA RICA</option>
<option value="CI">CÔTE D'IVOIRE</option>
<option value="HR">CROATIE</option>
<option value="CU">CUBA</option>
<option value="DK">DANEMARK</option>
<option value="DJ">DJIBOUTI</option>
<option value="DO">DOMINICAINE, RÉPUBLIQUE</option>
<option value="DM">DOMINIQUE</option>
<option value="EG">ÉGYPTE</option>
<option value="SV">EL SALVADOR</option>
<option value="AE">ÉMIRATS ARABES UNIS</option>
<option value="EC">ÉQUATEUR</option>
<option value="ER">ÉRYTHRÉE</option>
<option value="ES">ESPAGNE</option>
<option value="EE">ESTONIE</option>
<option value="US">ÉTATS-UNIS</option>
<option value="ET">ÉTHIOPIE</option>
<option value="FK">FALKLAND, ÎLES (MALVINAS)</option>
<option value="FO">FÉROÉ, ÎLES</option>
<option value="FJ">FIDJI</option>
<option value="FI">FINLANDE</option>
<option value="FR" selected>FRANCE</option>
<option value="GA">GABON</option>
<option value="GM">GAMBIE</option>
<option value="GE">GÉORGIE</option>
<option value="GS">GÉORGIE ET ÎLES SANDWICH DU SUD</option>
<option value="GH">GHANA</option>
<option value="GI">GIBRALTAR</option>
<option value="GR">GRÈCE</option>
<option value="GD">GRENADE</option>
<option value="GL">GROENLAND</option>
<option value="GP">GUADELOUPE</option>
<option value="GU">GUAM</option>
<option value="GT">GUATEMALA</option>
<option value="GN">GUINÉE</option>
<option value="GW">GUINÉE-BISSAU</option>
<option value="GQ">GUINÉE ÉQUATORIALE</option>
<option value="GY">GUYANA</option>
<option value="GF">GUYANE FRANÇAISE</option>
<option value="HT">HAÏTI</option>
<option value="HM">HEARD, ÎLE ET MCDONALD, ÎLES</option>
<option value="HN">HONDURAS</option>
<option value="HK">HONG-KONG</option>
<option value="HU">HONGRIE</option>
<option value="UM">ÎLES MINEURES</option>
<option value="VG">ÎLES VIERGES BRITANNIQUES</option>
<option value="VI">ÎLES VIERGES DES ÉTATS-UNIS</option>
<option value="IN">INDE</option>
<option value="ID">INDONÉSIE</option>
<option value="IR">IRAN, RÉPUBLIQUE ISLAMIQUE D'</option>
<option value="IQ">IRAQ</option>
<option value="IE">IRLANDE</option>
<option value="IS">ISLANDE</option>
<option value="IL">ISRAËL</option>
<option value="IT">ITALIE</option>
<option value="JM">JAMAÏQUE</option>
<option value="JP">JAPON</option>
<option value="JO">JORDANIE</option>
<option value="KZ">KAZAKHSTAN</option>
<option value="KE">KENYA</option>
<option value="KG">KIRGHIZISTAN</option>
<option value="KI">KIRIBATI</option>
<option value="KW">KOWEÏT</option>
<option value="LA">LAO, RÉP. DÉMOCRATIQUE POPULAIRE</option>
<option value="LS">LESOTHO</option>
<option value="LV">LETTONIE</option>
<option value="LB">LIBAN</option>
<option value="LR">LIBÉRIA</option>
<option value="LY">LIBYENNE, JAMAHIRIYA ARABE</option>
<option value="LI">LIECHTENSTEIN</option>
<option value="LT">LITUANIE</option>
<option value="LU">LUXEMBOURG</option>
<option value="MO">MACAO</option>
<option value="MK">MACÉDOINE</option>
<option value="MG">MADAGASCAR</option>
<option value="MY">MALAISIE</option>
<option value="MW">MALAWI</option>
<option value="MV">MALDIVES</option>
<option value="ML">MALI</option>
<option value="MT">MALTE</option>
<option value="MP">MARIANNES DU NORD, ÎLES</option>
<option value="MA">MAROC</option>
<option value="MH">MARSHALL, ÎLES</option>
<option value="MQ">MARTINIQUE</option>
<option value="MU">MAURICE</option>
<option value="MR">MAURITANIE</option>
<option value="YT">MAYOTTE</option>
<option value="MX">MEXIQUE</option>
<option value="FM">MICRONÉSIE</option>
<option value="MD">MOLDOVA, RÉPUBLIQUE DE</option>
<option value="MC">MONACO</option>
<option value="MN">MONGOLIE</option>
<option value="MS">MONTSERRAT</option>
<option value="MZ">MOZAMBIQUE</option>
<option value="MM">MYANMAR</option>
<option value="NA">NAMIBIE</option>
<option value="NR">NAURU</option>
<option value="NP">NÉPAL</option>
<option value="NI">NICARAGUA</option>
<option value="NE">NIGER</option>
<option value="NG">NIGÉRIA</option>
<option value="NU">NIUÉ</option>
<option value="NF">NORFOLK, ÎLE</option>
<option value="NO">NORVÈGE</option>
<option value="NC">NOUVELLE-CALÉDONIE</option>
<option value="NZ">NOUVELLE-ZÉLANDE</option>
<option value="IO">OCÉAN INDIEN</option>
<option value="OM">OMAN</option>
<option value="UG">OUGANDA</option>
<option value="UZ">OUZBÉKISTAN</option>
<option value="PK">PAKISTAN</option>
<option value="PW">PALAOS</option>
<option value="PS">PALESTINIEN, TERRITOIRE</option>
<option value="PA">PANAMA</option>
<option value="PG">PAPOUASIE-NOUVELLE-GUINÉE</option>
<option value="PY">PARAGUAY</option>
<option value="NL">PAYS-BAS</option>
<option value="PE">PÉROU</option>
<option value="PH">PHILIPPINES</option>
<option value="PN">PITCAIRN</option>
<option value="PL">POLOGNE</option>
<option value="PF">POLYNÉSIE FRANÇAISE</option>
<option value="PR">PORTO RICO</option>
<option value="PT">PORTUGAL</option>
<option value="QA">QATAR</option>
<option value="RE">RÉUNION</option>
<option value="RO">ROUMANIE</option>
<option value="GB">ROYAUME-UNI</option>
<option value="RU">RUSSIE, FÉDÉRATION DE</option>
<option value="RW">RWANDA</option>
<option value="EH">SAHARA OCCIDENTAL</option>
<option value="SH">SAINTE-HÉLÈNE</option>
<option value="LC">SAINTE-LUCIE</option>
<option value="KN">SAINT-KITTS-ET-NEVIS</option>
<option value="SM">SAINT-MARIN</option>
<option value="PM">SAINT-PIERRE-ET-MIQUELON</option>
<option value="VC">SAINT-VINCENT-ET-LES GRENADINES</option>
<option value="SB">SALOMON, ÎLES</option>
<option value="WS">SAMOA</option>
<option value="AS">SAMOA AMÉRICAINES</option>
<option value="ST">SAO TOMÉ-ET-PRINCIPE</option>
<option value="SN">SÉNÉGAL</option>
<option value="CS">SERBIE-ET-MONTÉNÉGRO</option>
<option value="SC">SEYCHELLES</option>
<option value="SL">SIERRA LEONE</option>
<option value="SG">SINGAPOUR</option>
<option value="SK">SLOVAQUIE</option>
<option value="SI">SLOVÉNIE</option>
<option value="SO">SOMALIE</option>
<option value="SD">SOUDAN</option>
<option value="LK">SRI LANKA</option>
<option value="SE">SUÈDE</option>
<option value="CH">SUISSE</option>
<option value="SR">SURINAME</option>
<option value="SJ">SVALBARD ET ÎLE JAN MAYEN</option>
<option value="SZ">SWAZILAND</option>
<option value="SY">SYRIENNE, RÉPUBLIQUE ARABE</option>
<option value="TJ">TADJIKISTAN</option>
<option value="TW">TAÏWAN, PROVINCE DE CHINE</option>
<option value="TZ">TANZANIE, RÉPUBLIQUE-UNIE DE</option>
<option value="TD">TCHAD</option>
<option value="CZ">TCHÈQUE, RÉPUBLIQUE</option>
<option value="TF">TERRES AUSTRALES FRANÇAISES</option>
<option value="TH">THAÏLANDE</option>
<option value="TL">TIMOR-LESTE</option>
<option value="TG">TOGO</option>
<option value="TK">TOKELAU</option>
<option value="TO">TONGA</option>
<option value="TT">TRINITÉ-ET-TOBAGO</option>
<option value="TN">TUNISIE</option>
<option value="TM">TURKMÉNISTAN</option>
<option value="TC">TURKS ET CAÏQUES, ÎLES</option>
<option value="TR">TURQUIE</option>
<option value="TV">TUVALU</option>
<option value="UA">UKRAINE</option>
<option value="UY">URUGUAY</option>
<option value="VU">VANUATU</option>
<option value="VA">VATICAN</option>
<option value="VE">VENEZUELA</option>
<option value="VN">VIET NAM</option>
<option value="WF">WALLIS ET FUTUNA</option>
<option value="YE">YÉMEN</option>
<option value="ZM">ZAMBIE</option>
<option value="ZW">ZIMBABWE</option>
</SELECT>
</TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Date d'arrivée</TD>
<TD>
<SELECT class=small size=1 name=arr_jour>
<OPTION selected value=''>Jour<OPTION value=1>1<OPTION value=2>2<OPTION value=3>3<OPTION value=4>4<OPTION value=5>5<OPTION value=6>6<OPTION value=7>7<OPTION value=8>8<OPTION value=9>9<OPTION value=10>10<OPTION value=11>11<OPTION value=12>12<OPTION value=13>13<OPTION value=14>14<OPTION value=15>15<OPTION value=16>16<OPTION value=17>17<OPTION value=18>18<OPTION value=19>19<OPTION value=20>20<OPTION value=21>21<OPTION value=22>22<OPTION value=23>23<OPTION value=24>24<OPTION value=25>25<OPTION value=26>26<OPTION value=27>27<OPTION value=28>28<OPTION value=29>29<OPTION value=30>30<OPTION value=31>31</OPTION></SELECT>
<SELECT class=small size=1 name=arr_mois>
<OPTION selected value=''>Mois<OPTION value=Jan>Janvier<OPTION value=Feb>Février<OPTION value=Mar>Mars<OPTION value=Apr>Avril<OPTION value=May>Mai<OPTION value=Jun>Juin<OPTION value=Jul>Juillet<OPTION value=Aug>Août<OPTION value=Sep>Septembre<OPTION value=Oct>Octobre<OPTION value=Nov>Novembre<OPTION value=Dec>Décembre</OPTION></SELECT>
<SELECT class=small size=1 name=arr_annee>
<OPTION selected value=''>Année<OPTION value=2006>2006<OPTION value=2007>2007<OPTION value=2008>2008</OPTION></SELECT>
<A id=anchor1 title="cal1" onclick="cal1.showCalendar('anchor1',getDateString(document.myform.arr_annee,document.myform.arr_mois,document.myform.arr_jour)); return false;" href="#" name=anchor1><img src='calendrier.gif' border='0' hspace='8' align='middle' alt='calendrier'></A>
</TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Date de départ</TD>
<TD>
<SELECT class=small size=1 name=dep_jour>
<OPTION selected value=''>Jour<OPTION value=1>1<OPTION value=2>2<OPTION value=3>3<OPTION value=4>4<OPTION value=5>5<OPTION value=6>6<OPTION value=7>7<OPTION value=8>8<OPTION value=9>9<OPTION value=10>10<OPTION value=11>11<OPTION value=12>12<OPTION value=13>13<OPTION value=14>14<OPTION value=15>15<OPTION value=16>16<OPTION value=17>17<OPTION value=18>18<OPTION value=19>19<OPTION value=20>20<OPTION value=21>21<OPTION value=22>22<OPTION value=23>23<OPTION value=24>24<OPTION value=25>25<OPTION value=26>26<OPTION value=27>27<OPTION value=28>28<OPTION value=29>29<OPTION value=30>30<OPTION value=31>31</OPTION></SELECT>
<SELECT class=small size=1 name=dep_mois>
<OPTION selected value=''>Mois<OPTION value=Jan>Janvier<OPTION value=Feb>Février<OPTION value=Mar>Mars<OPTION value=Apr>Avril<OPTION value=May>Mai<OPTION value=Jun>Juin<OPTION value=Jul>Juillet<OPTION value=Aug>Août<OPTION value=Sep>Septembre<OPTION value=Oct>Octobre<OPTION value=Nov>Novembre<OPTION value=Dec>Décembre</OPTION></SELECT>
<SELECT class=small size=1 name=dep_annee>
<OPTION selected value=''>Année<OPTION value=2006>2006<OPTION value=2007>2007<OPTION value=2008>2008</OPTION></SELECT>
<A id=anchor2 title="cal2" onclick="var d=getDateString(document.myform.dep_annee,document.myform.dep_mois,document.myform.dep_jour); cal2.showCalendar('anchor2',(d==null)?getDateString(document.myform.arr_annee,document.myform.arr_mois,document.myform.arr_jour):d); return false;" href="#" name=anchor2><img src='calendrier.gif' border='0' hspace='8' align='middle' alt='calendrier'></A>
</TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Dates flexibles<BR></TD>
<TD class=small><INPUT type=radio checked value=Oui name=flexible> Oui <INPUT type=radio value=Non name=flexible> Non
</TD></TR>
<TR bgColor=#ffffcc>
<TD class=small>Nombre de personnes</TD>
<TD><INPUT class=small size=4 maxLength="2" name=nombre> </TD></TR>
<TR bgColor=#ffffcc>
<TD height=153 class=small>Message</TD>
<TD><TEXTAREA class=small name=message rows=7 cols=40></TEXTAREA>
</TD></TR>
</TBODY>
</TABLE>
<TABLE cellSpacing=0 cellPadding=8 width=420 align=center border=0>
<tr><td> </td><td><INPUT type=submit value="Cliquer ici pour envoyer votre demande." name=envoi></td></tr>
</TABLE>
</FORM><BR>
<i>Si ce formulaire venait à ne pas fonctionner, vous pouvez nous contacter par mail en <a href="mailto:info@vacancesfloride.com">cliquant ici</a>.</i>
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