{"id":24121,"date":"2024-04-17T22:43:28","date_gmt":"2024-04-17T20:43:28","guid":{"rendered":"https:\/\/occostyle.com\/?page_id=24121"},"modified":"2024-10-02T10:25:50","modified_gmt":"2024-10-02T08:25:50","slug":"inscription-mineur","status":"publish","type":"page","link":"https:\/\/occostyle.com\/index.php\/inscription-mineur\/","title":{"rendered":"Inscription Mineur"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-342014fe-5db4-4987-b9e1-511b0342d98d wpforms-render-modern\" id=\"wpforms-24055\"><form id=\"wpforms-form-24055\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"24055\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/24121?wpforms_form_id=24055\" data-token=\"ca814b040333de865e95faf27a5513b0\" data-token-time=\"1780220849\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-24055-field_71-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"71\"><div id=\"wpforms-24055-field_71\" aria-errormessage=\"wpforms-24055-field_71-error\"><strong><h1>FORMULAIRE D&#8217;INSCRIPTION MINEUR ENTRE 08 ET 17 ANS<\/h1><\/strong>\r\n<p><em><strong>POUR TOUTE INSCRIPTION DE MINEUR, IL EST OBLIGATOIRE DE VENIR SUR PLACE LE PREMIER JOUR POUR FAIRE LES FORMALIT\u00c9S, QU&#8217;IL S&#8217;INCRIVE AU COURS AVEC UN ACCOMPAGNANT OU QU&#8217;IL FASSE LES COURS SEUL.<\/strong><\/em>\r\n<div>\r\n#1 Remplir ce formulaire\r\n<div>\r\n#2 Remplir la feuille d\u2019inscription (sur place ou la t\u00e9l\u00e9charger\r\n<div>\r\n#3 R\u00e9gler l\u2019abonnement (en CB via le site ou sur place) <\/div><\/div><\/div><\/p><\/div><\/div><div id=\"wpforms-24055-field_36-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"36\"><fieldset><legend class=\"wpforms-field-label\">Comment avez-vous connu l&#039;association ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_36\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_36_1\" name=\"wpforms[fields][36]\" value=\"Bouche \u00e0 oreille\" aria-errormessage=\"wpforms-24055-field_36_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_36_1\">Bouche \u00e0 oreille<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_36_2\" name=\"wpforms[fields][36]\" value=\"Site Internet\" aria-errormessage=\"wpforms-24055-field_36_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_36_2\">Site Internet<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_36_3\" name=\"wpforms[fields][36]\" value=\"R\u00e9seaux sociaux\" aria-errormessage=\"wpforms-24055-field_36_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_36_3\">R\u00e9seaux sociaux<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_36_5\" name=\"wpforms[fields][36]\" value=\"Divers\" aria-errormessage=\"wpforms-24055-field_36_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_36_5\">Divers<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_72-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"72\"><fieldset><legend class=\"wpforms-field-label\">Inscription : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_72\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_72_1\" name=\"wpforms[fields][72]\" value=\"Seul(e)\" aria-errormessage=\"wpforms-24055-field_72_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_72_1\">Seul(e)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_72_2\" name=\"wpforms[fields][72]\" value=\"Avec un adulte\" aria-errormessage=\"wpforms-24055-field_72_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_72_2\">Avec un adulte<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_49-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"49\"><div id=\"wpforms-24055-field_49\" aria-errormessage=\"wpforms-24055-field_49-error\"><strong><h2>RENSEIGNEMENTS PERSONNELS<\/h2><\/strong>\r\n<p><em><strong>Toutes fausses informations radieront automatiquement l&#8217;\u00e9l\u00e8ve et aucun remboursement ne sera effectu\u00e9.\r\n<\/strong><\/em><\/p><\/div><\/div><div id=\"wpforms-24055-field_52-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_52\">Photo type identit\u00e9 (photo de face, de la t\u00eate aux \u00e9paules sans accessoires, sans filtre) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"52\"\n\t\tdata-form-id=\"24055\"\n\t\tdata-input-name=\"wpforms_24055_52\"\n\t\tdata-extensions=\"pdf,png,jpg\"\n\t\tdata-max-size=\"10485760\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"536870912\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Cliquez ou d\u00e9placez un fichier dans cette zone pour le t\u00e9l\u00e9verser.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-24055-field_52\"\n\t\tname=\"wpforms_24055_52\" required\t\tvalue=\"\">\n<div id=\"wpforms-24055-field_52-description\" class=\"wpforms-field-description\">Fichiers autoris\u00e9s : .png, .jpg, .jpeg ; Taille maximum : 10 Mo<\/div><\/div><div id=\"wpforms-24055-field_97-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">Civilit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_97\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_97_1\" name=\"wpforms[fields][97]\" value=\"Monsieur\" aria-errormessage=\"wpforms-24055-field_97_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_97_1\">Monsieur<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_97_2\" name=\"wpforms[fields][97]\" value=\"Madame\" aria-errormessage=\"wpforms-24055-field_97_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_97_2\">Madame<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_1\">Nom (\u00e0 \u00e9crire en MAJUSCULES) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-24055-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-24055-field_1-error\" required><\/div><div id=\"wpforms-24055-field_152-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"152\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_152\">Pr\u00e9nom (\u00e0 \u00e9crire en MAJUSCULES) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-24055-field_152\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][152]\" aria-errormessage=\"wpforms-24055-field_152-error\" required><\/div><div id=\"wpforms-24055-field_54-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_54\">Pseudonyme (facultatif)<\/label><input type=\"text\" id=\"wpforms-24055-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-24055-field_54-error\" ><\/div><div id=\"wpforms-24055-field_56-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"56\"><fieldset><legend class=\"wpforms-field-label\">Date de naissance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][56][date][d]\" id=\"wpforms-24055-field_56-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Jour\"  required><option value=\"\" class=\"placeholder\" selected disabled>JJ<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][56][date][m]\" id=\"wpforms-24055-field_56-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Mois\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][56][date][y]\" id=\"wpforms-24055-field_56-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Ann\u00e9e\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_59-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"59\"><fieldset><legend class=\"wpforms-field-label\">Adresse <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_59\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][59][address1]\" aria-errormessage=\"wpforms-24055-field_59-error\" required><label for=\"wpforms-24055-field_59\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_59-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][59][address2]\" aria-errormessage=\"wpforms-24055-field_59-address2-error\" ><label for=\"wpforms-24055-field_59-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_59-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][59][city]\" aria-errormessage=\"wpforms-24055-field_59-city-error\" required><label for=\"wpforms-24055-field_59-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_59-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][59][state]\" value=\"NE PAS REMPLIR\" placeholder=\"NE PAS REMPLIR\" aria-errormessage=\"wpforms-24055-field_59-state-error\" required><label for=\"wpforms-24055-field_59-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_59-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][59][postal]\" aria-errormessage=\"wpforms-24055-field_59-postal-error\" required><label for=\"wpforms-24055-field_59-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-24055-field_59-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][59][country]\" value=\"FR\" aria-errormessage=\"wpforms-24055-field_59-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/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=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\"  selected='selected'>France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/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=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/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=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/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=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard et McDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-24055-field_59-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_2\">Adresse e-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-24055-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-24055-field_2-error\" required><\/div><div id=\"wpforms-24055-field_76-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_76\">Num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-24055-field_76\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][76]\" aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-24055-field_76-error\" required><\/div><div id=\"wpforms-24055-field_60-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"60\"><div id=\"wpforms-24055-field_60\" aria-errormessage=\"wpforms-24055-field_60-error\"><strong><h3>M\u00c9DICAL<\/h3><\/strong>\r\n<em>Ce questionnaire de sant\u00e9 permet de savoir si vous devez fournir un certificat m\u00e9dical pour renouveler votre licence sportive. R\u00e9pondez aux questions suivantes par OUI ou par NON*<\/em><\/div><\/div><div id=\"wpforms-24055-field_112-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"112\"><div id=\"wpforms-24055-field_112\" aria-errormessage=\"wpforms-24055-field_112-error\"><strong><h4>DURANT LES 12 DERNIERS MOIS<\/h4><\/strong>\r\n<\/div><\/div><div id=\"wpforms-24055-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"96\"><fieldset><legend class=\"wpforms-field-label\">Un membre de votre famille est-il d\u00e9c\u00e9d\u00e9 subitement d\u2019une cause cardiaque ou inexpliqu\u00e9e ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_96\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_96_1\" name=\"wpforms[fields][96]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_96_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_96_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_96_2\" name=\"wpforms[fields][96]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_96_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_96_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">Avez-vous ressenti une douleur dans la poitrine, des palpitations, un essoufflement inhabituel ou un malaise ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_101\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_101_1\" name=\"wpforms[fields][101]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_101_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_101_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_101_2\" name=\"wpforms[fields][101]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_101_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_101_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">Avez-vous eu un \u00e9pisode de respiration sifflante (asthme) ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_102\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_102_1\" name=\"wpforms[fields][102]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_102_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_102_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_102_2\" name=\"wpforms[fields][102]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_102_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_102_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_103-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"103\"><fieldset><legend class=\"wpforms-field-label\">Avez-vous eu une perte de connaissance ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_103\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_103_1\" name=\"wpforms[fields][103]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_103_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_103_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_103_2\" name=\"wpforms[fields][103]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_103_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_103_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_104-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"104\"><fieldset><legend class=\"wpforms-field-label\">Si vous avez arr\u00eat\u00e9 le sport pendant 30 jours ou plus pour des raisons de sant\u00e9, avez-vous repris sans l\u2019accord d\u2019un m\u00e9decin ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_104\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_104_1\" name=\"wpforms[fields][104]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_104_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_104_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_104_2\" name=\"wpforms[fields][104]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_104_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_104_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_105-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"105\"><fieldset><legend class=\"wpforms-field-label\">Avez-vous d\u00e9but\u00e9 un traitement m\u00e9dical de longue dur\u00e9e (hors contraception et d\u00e9sensibilisation aux allergies) ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_105\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_105_1\" name=\"wpforms[fields][105]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_105_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_105_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_105_2\" name=\"wpforms[fields][105]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_105_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_105_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_153-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"153\"><div id=\"wpforms-24055-field_153\" aria-errormessage=\"wpforms-24055-field_153-error\"><strong><h4>\u00c0 CE JOUR<\/h4><\/strong>\r\n<\/div><\/div><div id=\"wpforms-24055-field_107-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">Ressentez-vous une douleur, un manque de force ou une raideur suite \u00e0 un probl\u00e8me osseux, articulaire ou musculaire (fracture, entorse, luxation, d\u00e9chirure, tendinite, etc\u2026) survenu durant les 12 derniers mois ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_107\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_107_1\" name=\"wpforms[fields][107]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_107_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_107_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_107_2\" name=\"wpforms[fields][107]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_107_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_107_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">Votre pratique sportive est-elle interrompue pour des raisons de sant\u00e9 ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_106\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_106_1\" name=\"wpforms[fields][106]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_106_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_106_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_106_2\" name=\"wpforms[fields][106]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_106_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_106_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_109-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"109\"><fieldset><legend class=\"wpforms-field-label\">Pensez-vous avoir besoin d\u2019un avis m\u00e9dical pour poursuivre votre pratique sportive ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_109\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_109_1\" name=\"wpforms[fields][109]\" value=\"OUI\" aria-errormessage=\"wpforms-24055-field_109_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_109_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_109_2\" name=\"wpforms[fields][109]\" value=\"NON\" aria-errormessage=\"wpforms-24055-field_109_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_109_2\">NON<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_154-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"154\"><div id=\"wpforms-24055-field_154\" aria-errormessage=\"wpforms-24055-field_154-error\"><em>*NB : Les r\u00e9ponses formul\u00e9es rel\u00e8vent de la seule responsabilit\u00e9 du licenci\u00e9.\r\nSi vous avez r\u00e9pondu NON \u00e0 toutes les questions : Pas de certificat m\u00e9dical \u00e0 fournir. Simplement remplir et signer l&#8217;attestation sur l&#8217;honneur sur votre \u00e9tat de sant\u00e9.\r\nSi vous avez r\u00e9pondu OUI \u00e0 une ou plusieurs questions :\r\nCertificat m\u00e9dical \u00e0 fournir \u00e0 fournir dans les plus brefs d\u00e9lais (moins de 30 jours apr\u00e8s la signature).<\/em><\/div><\/div><div id=\"wpforms-24055-field_61-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"61\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Certificat M\u00e9dical <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_61\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_61_1\" name=\"wpforms[fields][61]\" value=\"OUI, je le remets dans moins de 30 jours\" aria-errormessage=\"wpforms-24055-field_61_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_61_1\">OUI, je le remets dans moins de 30 jours<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_61_4\" name=\"wpforms[fields][61]\" value=\"NON, je dois juste remplir une attestation sur l\u2019honneur\" aria-errormessage=\"wpforms-24055-field_61_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_61_4\">NON, je dois juste remplir une attestation sur l\u2019honneur<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_73-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"73\"><div id=\"wpforms-24055-field_73\" aria-errormessage=\"wpforms-24055-field_73-error\"><strong><h2>RESPONSABLES L\u00c9GAUX<\/h2><\/strong>\r\n<p><em><strong>Toutes fausses informations radieront automatiquement l&#8217;\u00e9l\u00e8ve et aucun remboursement ne sera effectu\u00e9.\r\n<\/strong><\/em><\/p><\/div><\/div><div id=\"wpforms-24055-field_80-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"80\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\" ><div id=\"wpforms-24055-field_77-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"77\"><div id=\"wpforms-24055-field_77\" aria-errormessage=\"wpforms-24055-field_77-error\"><strong><h3>PARENT 1<\/h3><\/strong>\r\n\r\n<\/div><\/div><div id=\"wpforms-24055-field_98-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label\">Civilit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_98\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_98_1\" name=\"wpforms[fields][98]\" value=\"Monsieur\" aria-errormessage=\"wpforms-24055-field_98_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_98_1\">Monsieur<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_98_2\" name=\"wpforms[fields][98]\" value=\"Madame\" aria-errormessage=\"wpforms-24055-field_98_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_98_2\">Madame<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_79-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"79\"><fieldset><legend class=\"wpforms-field-label\">Pr\u00e9nom et Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_79\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][79][first]\" placeholder=\"Pr\u00e9nom\" aria-errormessage=\"wpforms-24055-field_79-error\" required><label for=\"wpforms-24055-field_79\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_79-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][79][last]\" placeholder=\"Nom\" aria-errormessage=\"wpforms-24055-field_79-last-error\" required><label for=\"wpforms-24055-field_79-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_78-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\">Adresse <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_78\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][78][address1]\" aria-errormessage=\"wpforms-24055-field_78-error\" required><label for=\"wpforms-24055-field_78\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_78-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][78][address2]\" aria-errormessage=\"wpforms-24055-field_78-address2-error\" ><label for=\"wpforms-24055-field_78-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_78-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][78][city]\" aria-errormessage=\"wpforms-24055-field_78-city-error\" required><label for=\"wpforms-24055-field_78-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_78-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][78][state]\" aria-errormessage=\"wpforms-24055-field_78-state-error\" required><label for=\"wpforms-24055-field_78-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_78-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][78][postal]\" aria-errormessage=\"wpforms-24055-field_78-postal-error\" required><label for=\"wpforms-24055-field_78-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-24055-field_78-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][78][country]\" value=\"FR\" aria-errormessage=\"wpforms-24055-field_78-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/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=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\"  selected='selected'>France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/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=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/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=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/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=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard et McDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-24055-field_78-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_75-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_75\">Adresse e-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-24055-field_75\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][75]\" spellcheck=\"false\" aria-errormessage=\"wpforms-24055-field_75-error\" required><\/div><div id=\"wpforms-24055-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_3\">Num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-24055-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-24055-field_3-error\" required><\/div><div id=\"wpforms-24055-field_155-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"155\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_155\">Profession <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-24055-field_155\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][155]\" required=\"required\"><option value=\"Agriculteur\" >Agriculteur<\/option><option value=\"Artisan\" >Artisan<\/option><option value=\"Artiste\" >Artiste<\/option><option value=\"Commer\u00e7ant\" >Commer\u00e7ant<\/option><option value=\"Chef d&#039;entreprise\" >Chef d&#039;entreprise<\/option><option value=\"Profession lib\u00e9rale\" >Profession lib\u00e9rale<\/option><option value=\"Cadre\" >Cadre<\/option><option value=\"Technicien\" >Technicien<\/option><option value=\"Enseignant\" >Enseignant<\/option><option value=\"Employ\u00e9\" >Employ\u00e9<\/option><option value=\"Ouvrier\" >Ouvrier<\/option><option value=\"\u00c9tudiant\" >\u00c9tudiant<\/option><option value=\"Retrait\u00e9\" >Retrait\u00e9<\/option><option value=\"Ch\u00f4meur\" >Ch\u00f4meur<\/option><option value=\"Sans profession\" >Sans profession<\/option><option value=\"Divers\" >Divers<\/option><\/select><\/div><div id=\"wpforms-24055-field_151-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"151\"><fieldset><legend class=\"wpforms-field-label\">Serez-vous l\u2019accompagnant de votre enfant ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_151\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_151_1\" name=\"wpforms[fields][151]\" value=\"Oui\" aria-errormessage=\"wpforms-24055-field_151_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_151_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_151_2\" name=\"wpforms[fields][151]\" value=\"Non\" aria-errormessage=\"wpforms-24055-field_151_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_151_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><\/div><\/div><\/div><div id=\"wpforms-24055-field_82-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"82\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\" ><div id=\"wpforms-24055-field_83-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"83\"><div id=\"wpforms-24055-field_83\" aria-errormessage=\"wpforms-24055-field_83-error\"><strong><h3>PARENT 2<\/h3><\/strong>\r\n\r\n<\/div><\/div><div id=\"wpforms-24055-field_99-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">Civilit\u00e9<\/legend><ul id=\"wpforms-24055-field_99\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_99_1\" name=\"wpforms[fields][99]\" value=\"Monsieur\" aria-errormessage=\"wpforms-24055-field_99_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_99_1\">Monsieur<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_99_2\" name=\"wpforms[fields][99]\" value=\"Madame\" aria-errormessage=\"wpforms-24055-field_99_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_99_2\">Madame<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_85-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"85\"><fieldset><legend class=\"wpforms-field-label\">Pr\u00e9nom et Nom<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_85\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][85][first]\" placeholder=\"Pr\u00e9nom\" aria-errormessage=\"wpforms-24055-field_85-error\" ><label for=\"wpforms-24055-field_85\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_85-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][85][last]\" placeholder=\"Nom\" aria-errormessage=\"wpforms-24055-field_85-last-error\" ><label for=\"wpforms-24055-field_85-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_86-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"86\"><fieldset><legend class=\"wpforms-field-label\">Adresse<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_86\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][86][address1]\" aria-errormessage=\"wpforms-24055-field_86-error\" ><label for=\"wpforms-24055-field_86\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_86-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][86][address2]\" aria-errormessage=\"wpforms-24055-field_86-address2-error\" ><label for=\"wpforms-24055-field_86-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_86-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][86][city]\" aria-errormessage=\"wpforms-24055-field_86-city-error\" ><label for=\"wpforms-24055-field_86-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_86-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][86][state]\" aria-errormessage=\"wpforms-24055-field_86-state-error\" ><label for=\"wpforms-24055-field_86-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_86-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][86][postal]\" aria-errormessage=\"wpforms-24055-field_86-postal-error\" ><label for=\"wpforms-24055-field_86-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-24055-field_86-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][86][country]\" value=\"FR\" aria-errormessage=\"wpforms-24055-field_86-country-error\" ><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/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=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\"  selected='selected'>France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/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=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/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=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/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=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard et McDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-24055-field_86-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_87-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_87\">Adresse e-mail<\/label><input type=\"email\" id=\"wpforms-24055-field_87\" class=\"wpforms-field-medium\" name=\"wpforms[fields][87]\" spellcheck=\"false\" aria-errormessage=\"wpforms-24055-field_87-error\" ><\/div><div id=\"wpforms-24055-field_88-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_88\">Num\u00e9ro de t\u00e9l\u00e9phone<\/label><input type=\"tel\" id=\"wpforms-24055-field_88\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][88]\" aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-24055-field_88-error\" ><\/div><div id=\"wpforms-24055-field_156-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"156\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_156\">Profession<\/label><select id=\"wpforms-24055-field_156\" class=\"wpforms-field-medium\" name=\"wpforms[fields][156]\"><option value=\"Agriculteur\" >Agriculteur<\/option><option value=\"Artisan\" >Artisan<\/option><option value=\"Artiste\" >Artiste<\/option><option value=\"Commer\u00e7ant\" >Commer\u00e7ant<\/option><option value=\"Chef d&#039;entreprise\" >Chef d&#039;entreprise<\/option><option value=\"Profession lib\u00e9rale\" >Profession lib\u00e9rale<\/option><option value=\"Cadre\" >Cadre<\/option><option value=\"Technicien\" >Technicien<\/option><option value=\"Enseignant\" >Enseignant<\/option><option value=\"Employ\u00e9\" >Employ\u00e9<\/option><option value=\"Ouvrier\" >Ouvrier<\/option><option value=\"\u00c9tudiant\" >\u00c9tudiant<\/option><option value=\"Retrait\u00e9\" >Retrait\u00e9<\/option><option value=\"Ch\u00f4meur\" >Ch\u00f4meur<\/option><option value=\"Sans profession\" >Sans profession<\/option><option value=\"Divers\" >Divers<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><\/div><\/div><\/div><div id=\"wpforms-24055-field_136-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"136\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\" ><div id=\"wpforms-24055-field_146-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"146\" style=\"display:none;\"><div id=\"wpforms-24055-field_146\" aria-errormessage=\"wpforms-24055-field_146-error\"><strong><h2>ACCOMPAGNANT ADULTE EN COURS<\/h2><\/strong>\r\n<\/div><\/div><div id=\"wpforms-24055-field_144-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"144\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_144\">Lien de parent\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-24055-field_144\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][144]\" aria-errormessage=\"wpforms-24055-field_144-error\" required><\/div><div id=\"wpforms-24055-field_138-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"138\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Civilit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_138\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_138_1\" name=\"wpforms[fields][138]\" value=\"Monsieur\" aria-errormessage=\"wpforms-24055-field_138_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_138_1\">Monsieur<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-24055-field_138_2\" name=\"wpforms[fields][138]\" value=\"Madame\" aria-errormessage=\"wpforms-24055-field_138_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-24055-field_138_2\">Madame<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-24055-field_139-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"139\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Pr\u00e9nom et Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_139\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][139][first]\" placeholder=\"Pr\u00e9nom\" aria-errormessage=\"wpforms-24055-field_139-error\" required><label for=\"wpforms-24055-field_139\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_139-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][139][last]\" placeholder=\"Nom\" aria-errormessage=\"wpforms-24055-field_139-last-error\" required><label for=\"wpforms-24055-field_139-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_140-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"140\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Adresse <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_140\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][140][address1]\" aria-errormessage=\"wpforms-24055-field_140-error\" required><label for=\"wpforms-24055-field_140\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-24055-field_140-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][140][address2]\" aria-errormessage=\"wpforms-24055-field_140-address2-error\" ><label for=\"wpforms-24055-field_140-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_140-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][140][city]\" aria-errormessage=\"wpforms-24055-field_140-city-error\" required><label for=\"wpforms-24055-field_140-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-24055-field_140-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][140][state]\" aria-errormessage=\"wpforms-24055-field_140-state-error\" required><label for=\"wpforms-24055-field_140-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-24055-field_140-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][140][postal]\" aria-errormessage=\"wpforms-24055-field_140-postal-error\" required><label for=\"wpforms-24055-field_140-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-24055-field_140-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][140][country]\" value=\"FR\" aria-errormessage=\"wpforms-24055-field_140-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/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=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\"  selected='selected'>France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/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=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/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=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/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=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard et McDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-24055-field_140-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-24055-field_141-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"141\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_141\">Adresse e-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-24055-field_141\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][141]\" spellcheck=\"false\" aria-errormessage=\"wpforms-24055-field_141-error\" required><\/div><div id=\"wpforms-24055-field_142-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"142\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_142\">Num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-24055-field_142\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][142]\" aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-24055-field_142-error\" required><\/div><div id=\"wpforms-24055-field_157-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"157\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-24055-field_157\">Profession <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-24055-field_157\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][157]\" required=\"required\"><option value=\"Agriculteur\" >Agriculteur<\/option><option value=\"Artisan\" >Artisan<\/option><option value=\"Artiste\" >Artiste<\/option><option value=\"Commer\u00e7ant\" >Commer\u00e7ant<\/option><option value=\"Chef d&#039;entreprise\" >Chef d&#039;entreprise<\/option><option value=\"Profession lib\u00e9rale\" >Profession lib\u00e9rale<\/option><option value=\"Cadre\" >Cadre<\/option><option value=\"Technicien\" >Technicien<\/option><option value=\"Enseignant\" >Enseignant<\/option><option value=\"Employ\u00e9\" >Employ\u00e9<\/option><option value=\"Ouvrier\" >Ouvrier<\/option><option value=\"\u00c9tudiant\" >\u00c9tudiant<\/option><option value=\"Retrait\u00e9\" >Retrait\u00e9<\/option><option value=\"Ch\u00f4meur\" >Ch\u00f4meur<\/option><option value=\"Sans profession\" >Sans profession<\/option><option value=\"Divers\" >Divers<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><\/div><\/div><\/div><div id=\"wpforms-24055-field_70-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"70\"><fieldset><legend class=\"wpforms-field-label\">R\u00e8glement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-24055-field_70\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input 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