<script type="text/javascript"> 
        window.addEvent('domready', function() {    
   			new FormCheck('ChronoContact_Contact');        
			
		});
        </script>
		                						        <form name="ChronoContact_Contact" id="ChronoContact_Contact" method="post" action="http://www.medays.org/index.php?option=com_chronocontact&task=send&chronoformname=Contact&Itemid=34" enctype="multipart/form-data">
		
				<div class="form_contact">


	 
<div  class="form_item">
        <div class="form_element cf_textbox">
<label class="cf_label">Nom complet <span>*</span> :</label>
            <span class="sp_input"><input class="validate['required','alpha'] cf_inputbox"  maxlength="150" size="30" id="nom" name="nom" type="text"></span>
            <br class="spacer" />
        </div>
    </div>

    <div  class="form_item">
        <div class="form_element cf_textbox">
            <label class="cf_label">Email <span>*</span> :</label>
            <span class="sp_input"><input class="validate['required','email'] cf_inputbox" maxlength="150" size="30" id="email" name="email" type="text"></span>
            <br class="spacer" />
        </div>
    </div>
    

    
    <div  class="form_item">
        <div class="form_element cf_textbox">
            <label class="cf_label">Téléphone <span>*</span> :</label>
            <span class="sp_input"><input class="validate['required','phone'] cf_inputbox" maxlength="150" size="30" id="telephone" name="telephone" type="text"></span>
            <br class="spacer" />
        </div>
    </div>
    
     <div  class="form_item">
        <div class="form_element cf_textbox">
            <label class="cf_label">Objet <span>*</span> :</label>
            <span class="sp_input"><input class="validate['required'] cf_inputbox"  maxlength="150" size="30" id="objet" name="objet" type="text"></span>
            <br class="spacer" />
        </div>
    </div>
<div  class="form_item">
        <div class="form_element cf_textarea">
            <label class="cf_label">Message <span>*</span> :</label>
            <span class="sp_txtarea"><textarea class="validate['required'] cf_inputbox"  rows="3" id="message" cols="30" name="message"></textarea></span>
            <br class="spacer" />
        </div>
    </div>

    <div  class="form_item">
        <div class="form_element cf_captcha"> 
        	<label class="cf_label">Recopier le code <span>*</span> :</label>
            <span class="capatcha"></span>
             <label class="cf_label2">veuillez recopier le code numérique présent dans l'image</label>
        </div>
    </div>
<br class="spacer" />
 <div  class="form_item">
        <div class="form_element cf_text">
        	<span class="cf_text"><span>*</span>Tous les champs marqués d'un<span>*</span> sont obligatoires</span>
            <br class="spacer" />
        </div>
    </div>
    
 <div  class="form_item2">
        <div class="form_element cf_button">
        	<a href="#" onClick="document.ChronoContact_Contact.reset();">Cancel</a>
            <input value="Envoyer" onFocus="this.blur();" name="Envoyer" type="submit">
        </div>
    </div>
</div>		<input type="hidden" name="4122af62e9821379fd169fe6fe132d3d" value="1" />	
                	<input type="hidden" name="1cf1" value="357201b01bc1cdf2282f347bbf69ac6f" />
                </form>