<form action="//submit.form" method="post">
<div style="width: 400px;"> </div>
<div style="padding: 10px; font-size: 24px;">Newsletter Subscription</div>
<div style="padding: 10px;">Nom<span style="color: red;"> *</span><br /> <input id="data_2" class="form-control" style="width: 100%;" name="data_2" type="text" /></div>
<div style="padding: 10px;">Prénom<span style="color: red;"> *</span><br /> <input id="data_3" class="form-control" style="width: 100%;" name="data_3" type="text" /></div>
<div style="padding: 10px;">Email<span style="color: red;"> *</span><br /> <input id="data_4" class="form-control" style="width: 100%;" name="data_4" type="text" /></div>
<div style="padding: 10px;"><input id="data_5_0" name="data_5" type="checkbox" value="J'accepte de recevoir les lettres d'information de Médecines Parallèles" /> J'accepte de recevoir les lettres d'information de Médecines Parallèles</div>
<div style="padding: 10px;"><input id="data_6_0" name="data_6" type="checkbox" value="J'accepte les Règles Générales d'utilisation" /> J'accepte les Règles Générales d'utilisation</div>
<div style="padding: 10px;"><input name="skip_Submit" type="submit" value="Envoyer" /></div>
</form>

<script type="text/javascript">
function validateForm() {
if (isEmpty(document.getElementById('data_2').value.trim())) {
alert('Nom is required!');
return false;
}
if (isEmpty(document.getElementById('data_3').value.trim())) {
alert('Prénom is required!');
return false;
}
if (isEmpty(document.getElementById('data_4').value.trim())) {
alert('Email is required!');
return false;
}
if (!validateEmail(document.getElementById('data_4').value.trim())) {
alert('Email must be a valid email address!');
return false;
}
if (!document.getElementById('data_5_0').checked ) {
alert(' is required!');
return false;}
if (!document.getElementById('data_6_0').checked ) {
alert(' is required!');
return false;}
return true;
}
function isEmpty(str) { return (str.length === 0 || !str.trim()); }
function validateEmail(email) {
var re = /^([w-]+(?:.[w-]+)*)@((?:[w-]+.)*w[w-]{0,66}).([a-z]{2,15}(?:.[a-z]{2})?)$/i;
return isEmpty(email) || re.test(email);
}
</script>