The Voice 7 - Tentez de gagner votre place pour assister à l'émission

<p>IMAGE DE LA RADIO 970x444</p>
<p></p>
<h2>Soutenez votre talent pr&eacute;f&eacute;r&eacute; pour THE VOICE</h2>
<p><br />TEXTE DE LA RADIO ICI</p>
<p></p>
<p><br /><br /></p>
<div class="entry">
<div class="box error_box" style="display: none;">
<table>
<tbody>
<tr>
<td>&nbsp;</td>
<td>Votre message n'a pu &ecirc;tre correctement envoy&eacute;. <br />Il y a des erreurs dans le formulaire.</td>
</tr>
</tbody>
</table>
</div>
<div class="contform"><form action="http://www.beurfm.net/thevoice.php?action=envoi" method="post">
<div class="row">
<div class="col-sm-12">
<p>Les champs marqu&eacute;s par une * sont obligatoires.</p>
</div>
</div>
<div class="row">
<div class="form_info col-sm-6">
<p class="fl"><label for="name">Nom et Pr&eacute;nom<span class="yellow">*</span></label></p>
<div class="inp_l">
<div class="inp_r"><input class="form-control" type="text" name="name" id="name" value=" " size="22" tabindex="3" /></div>
</div>
</div>
<div class="form_info col-sm-6">
<p class="fl"><label for="email">Email <span class="yellow">*</span></label></p>
<div class="inp_l">
<div class="inp_r"><input class="form-control" type="text" name="email" id="email" value="" size="22" tabindex="4" /></div>
</div>
</div>
</div>
<br /><br />
<div class="row">
<div class="form_info col-sm-6">
<p class="fl"><label for="subject"> Ville <span class="yellow">*</span></label></p>
<div class="inp_l">
<div class="inp_r"><input class="form-control" type="text" name="subject" id="subject" value="" size="22" tabindex="6" /></div>
</div>
</div>
<div class="form_info col-sm-6">
<p class="fl"><label for="url">Ann&eacute;e de naissance</label></p>
<div class="inp_l">
<div class="inp_r"><input class="form-control" type="text" name="annee" id="annee" value="" size="22" tabindex="5" /></div>
</div>
</div>
</div>
<br /><br />
<div class="row">
<div class="form_info col-sm-12">
<p class="fl"><label for="message">Votre message de soutien <span class="yellow">*</span></label></p>
<textarea name="message" id="message" cols="28" rows="6" class="form-control" tabindex="7"></textarea></div>
</div>
<div class="cl"></div>
<br /><br />
<div class="row" style="line-height: 80px;">
<div class="pull-left">
<div class="g-recaptcha" data-sitekey="6LcspjUUAAAAAErx5MO4bRw6h_-0QY6246dxPkjK"></div>
</div>
<div class="pull-right"><input type="submit" value="Envoyer votre soutien" style="width: 500px;" /></div>
</div>
<script src="https://www.google.com/recaptcha/api.js"></script>
</form></div>
</div>