document.write("<br /><form method='post' action='traitement/voter.php'><input type='hidden' name='lid_sondage' value='111644'><table border='0' cellpadding='2' cellspacing='0' width='500'><tr><td align='left' colspan='2' class='fond_question_sondage'><b>Quel âge avez-vous ?</b></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411266' checked  style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411266'></td><td align='left' width='470'><label for='chval_sond411266'>Moins de 10 ans</label></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411267' style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411267'></td><td align='left' width='470'><label for='chval_sond411267'>Entre 10 et 19 ans</label></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411268' style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411268'></td><td align='left' width='470'><label for='chval_sond411268'>Entre 20 et 29 ans</label></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411269' style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411269'></td><td align='left' width='470'><label for='chval_sond411269'>Entre 30 et 39 ans</label></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411270' style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411270'></td><td align='left' width='470'><label for='chval_sond411270'>Entre 40 et 49 ans</label></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411271' style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411271'></td><td align='left' width='470'><label for='chval_sond411271'>Entre 50 et 59 ans</label></td></tr><tr><td align='center' width='30'><input type='radio' name='reponse_sondage' value='411272' style='width: 18px; background-color: none; background: none; border: none' id='chval_sond411272'></td><td align='left' width='470'><label for='chval_sond411272'>60 ans et plus</label></td></tr><tr><td align='left' colspan='2' class='fond_question_sondage' height='10'></td></tr><tr><td align='center' colspan='2'><input type='submit' name='voter_sondage' value='Valider' class='bouton_normal' onmouseover='this.className='bouton_enfonce';' onmouseout='this.className='bouton_normal';' /> &nbsp; &nbsp; &nbsp; <input type='button' name='histo_sond' value='Historique' onclick=JavaScript:window.open('./designs/design2/include/historique_sondages.php?lnb_hist=2148&co=2','','width=550,height=400,left=0,top=0,scrollbars=yes,resizable=yes');></td></tr></table></form><br />");