{"id":8169,"date":"2025-05-06T07:57:02","date_gmt":"2025-05-06T06:57:02","guid":{"rendered":"http:\/\/bajamorocco.com\/index.php\/formulaire-dinscription-equipe-dassistance-2025\/"},"modified":"2025-05-06T07:58:06","modified_gmt":"2025-05-06T06:58:06","slug":"formulaire-dinscription-equipe-dassistance-2025","status":"publish","type":"page","link":"https:\/\/bajamorocco.com\/fr\/index.php\/formulaire-dinscription-equipe-dassistance-2025\/","title":{"rendered":"Formulaire d&#8217;inscription \u00c9quipe d&#8217;assistance 2025"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text css=&#8221;&#8221; css_params=&#8221;&#8221;]<style id=\"wpforms-css-vars-8134\">\n\t\t\t\t#wpforms-8134 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-8134\"><form id=\"wpforms-form-8134\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"8134\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169?wpforms_form_id=8134\" data-token=\"ec23413fe0b54cfb19679450973f5812\" data-token-time=\"1778075901\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-page-indicator connector\" data-indicator=\"connector\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"4\" tabindex=\"-1\"><div class=\"wpforms-page-indicator-page active wpforms-page-indicator-page-1\" style=\"width:25%;\"><span class=\"wpforms-page-indicator-page-number\" style=\"background-color:#066aab\">1<span class=\"wpforms-page-indicator-page-triangle\" style=\"border-top-color:#066aab\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Frais d&#039;inscription - Info \u00c9quipe<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-2\" style=\"width:25%;\"><span class=\"wpforms-page-indicator-page-number\">2<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">V\u00c9HICLE DE SERVICE<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-3\" style=\"width:25%;\"><span class=\"wpforms-page-indicator-page-number\">3<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">\u00c9QUIPE D&#039;ASSISTANCE<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-4\" style=\"width:25%;\"><span class=\"wpforms-page-indicator-page-number\">4<span class=\"wpforms-page-indicator-page-triangle\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Important<\/span><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-8134-field_17-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"17\"><\/div><div id=\"wpforms-8134-field_2-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"2\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_4-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"4\"><div id=\"wpforms-8134-field_4\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_4-error\"><p><img loading=\"lazy\" decoding=\"async\" height=\"300\" width=\"224\" alt=\"\" src=\"http:\/\/bajamorocco.com\/wp-content\/uploads\/2023\/04\/BAJA_MOROCCO-10-224x300.png\" class=\"alignnone wp-image-2910 size-medium\"><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_3-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"3\"><div id=\"wpforms-8134-field_3\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_3-error\"><h1><span style=\"color:#000000\">Formulaire inscription 2025<\/span><\/h1>\n<h3>\u00c9QUIPE D'ASSISTANCE<\/h3>\n<p><span style=\"color:#000000\">BAJA MOROCCO 2025 | Morocco | 02.10 - 06.10.2025<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_6-container\" class=\"wpforms-field wpforms-field-payment-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Checkbox Items<\/legend><ul id=\"wpforms-8134-field_6\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_6_1\" class=\"wpforms-payment-price\" data-amount=\"1.200,00\" name=\"wpforms[fields][6][]\" value=\"1\" aria-errormessage=\"wpforms-8134-field_6_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_6_1\">SERVICE PAR PERSONNE (avec h\u00e9bergement en tente berb\u00e8re) - <span class=\"wpforms-currency-symbol\">1.200,00 &euro;<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"checkbox\" id=\"wpforms-8134-field_6_2\" class=\"wpforms-payment-price\" data-amount=\"850,00\" name=\"wpforms[fields][6][]\" value=\"2\" aria-errormessage=\"wpforms-8134-field_6_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_6_2\">M\u00c9CANICIEN PAR PERSONNE ( Sans h\u00e9bergement ) - <span class=\"wpforms-currency-symbol\">850,00 &euro;<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"checkbox\" id=\"wpforms-8134-field_6_3\" class=\"wpforms-payment-price\" data-amount=\"450,00\" name=\"wpforms[fields][6][]\" value=\"3\" aria-errormessage=\"wpforms-8134-field_6_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_6_3\">V\u00c9HICLE &lt; 3.5 TONS * - <span class=\"wpforms-currency-symbol\">450,00 &euro;<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"checkbox\" id=\"wpforms-8134-field_6_4\" class=\"wpforms-payment-price\" data-amount=\"600,00\" name=\"wpforms[fields][6][]\" value=\"4\" aria-errormessage=\"wpforms-8134-field_6_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_6_4\">V\u00c9HICLE &gt; 3.5 TONS * - <span class=\"wpforms-currency-symbol\">600,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8134-field_7-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"7\"><div id=\"wpforms-8134-field_7\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_7-error\"><p>* Pour les 4x4 ou camions &lt; &lt;3,5TT avec remorque (gratuit pour les 4x4 &lt;3,5T) &lt;<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-8134-field_8-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"8\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-100\"><div class=\"wpforms-layout-column wpforms-layout-column-100\" ><div id=\"wpforms-8134-field_9-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"9\"><div id=\"wpforms-8134-field_9\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_9-error\"><h3><span style=\"color:#000000\"><strong>LES FRAIS INCLUS :<\/strong><\/span><\/h3>\n<ul>\n<li>\u2022 Demi-pension pendant 7 jours<\/li>\n<li>\u2022 Soir\u00e9e\/diner de remise des prix<\/li>\n<li>\u2022 Assurance responsabilit\u00e9 civile de l'organisation<\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_10-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"10\"><div id=\"wpforms-8134-field_10\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_10-error\"><h3><span style=\"color:#000000\"><strong>** LES FRAIS NON INCLUS :<\/strong><\/span><\/h3>\n<ul>\n<li>\u2022 Assurance rapatriement m\u00e9dicale (recommand\u00e9e)<\/li>\n<li>\u2022 Carburant<\/li>\n<li>\u2022 D\u00e9jeuners<\/li>\n<li>\u2022 Boissons<\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-8134-field_12-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"12\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-100\"><div class=\"wpforms-layout-column wpforms-layout-column-100\" ><div id=\"wpforms-8134-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_15\">ASSISTANCE POUR QUELLE \u00c9QUIPE ? <\/label><input type=\"text\" id=\"wpforms-8134-field_15\" class=\"wpforms-field-large\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-8134-field_15-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_13-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"13\"><h3 id=\"wpforms-8134-field_13\" aria-errormessage=\"wpforms-8134-field_13-error\">INFO \u00c9QUIPE<\/h3><\/div><div id=\"wpforms-8134-field_143-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"143\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-8134-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_14\">NOM DE L&#039;\u00c9QUIPE<\/label><input type=\"text\" id=\"wpforms-8134-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-8134-field_14-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-8134-field_142-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"142\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_142\">NOM DU TEAM MANAGER<\/label><input type=\"text\" id=\"wpforms-8134-field_142\" class=\"wpforms-field-medium\" name=\"wpforms[fields][142]\" aria-errormessage=\"wpforms-8134-field_142-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-8134-field_146-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"146\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_146\">NUM\u00c9RO DE T\u00c9L\u00c9PHONE MOBILE DU TEAM MANAGER<\/label><input type=\"text\" id=\"wpforms-8134-field_146\" class=\"wpforms-field-medium\" name=\"wpforms[fields][146]\" aria-errormessage=\"wpforms-8134-field_146-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-8134-field_144-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"144\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_144\">SITE WEB DE L&#039;\u00c9QUIPE<\/label><input type=\"text\" id=\"wpforms-8134-field_144\" class=\"wpforms-field-medium\" name=\"wpforms[fields][144]\" aria-errormessage=\"wpforms-8134-field_144-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_16-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"16\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"8134\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next - V\u00c9HICLE DE SERVICE<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Sauvegarder et reprendre plus tard<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-8134-field_20-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">V\u00c9HICLE DE SERVICE<\/legend><ul id=\"wpforms-8134-field_20\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_20_1\" name=\"wpforms[fields][20][]\" value=\"V\u00c9HICLE &lt; 3.5 TONS *\" aria-errormessage=\"wpforms-8134-field_20_1-error\" aria-describedby=\"wpforms-8134-field_20-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_20_1\">V\u00c9HICLE &lt; 3.5 TONS *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_20_2\" name=\"wpforms[fields][20][]\" value=\"V\u00c9HICLE &gt; 3.5 TONS *\" aria-errormessage=\"wpforms-8134-field_20_2-error\" aria-describedby=\"wpforms-8134-field_20-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_20_2\">V\u00c9HICLE &gt; 3.5 TONS *<\/label><\/li><\/ul><div id=\"wpforms-8134-field_20-description\" class=\"wpforms-field-description\">* Pour les 4x4 ou camions &lt; &lt;3,5 T avec remorque (gratuit pour les 4x4 &lt;3,5T) &lt;<\/div><\/fieldset><\/div><div id=\"wpforms-8134-field_21-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"21\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_22\">PAYS D&#039;IMMATRICULATION<\/label><input type=\"text\" id=\"wpforms-8134-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-8134-field_22-error\" ><\/div><div id=\"wpforms-8134-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_24\">FABRICANT<\/label><input type=\"text\" id=\"wpforms-8134-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-8134-field_24-error\" ><\/div><div id=\"wpforms-8134-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_26\">COULEUR DU V\u00c9HICULE<\/label><input type=\"text\" id=\"wpforms-8134-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-8134-field_26-error\" ><\/div><div id=\"wpforms-8134-field_28-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_28\">DATE DE LA PREMI\u00c8RE IMMATRICULATION<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_28\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][28][date]\" aria-errormessage=\"wpforms-8134-field_28-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_23\">PLAQUE D&#039;IMMATRICULATION<\/label><input type=\"text\" id=\"wpforms-8134-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-8134-field_23-error\" ><\/div><div id=\"wpforms-8134-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_25\">MOD\u00c8LE<\/label><input type=\"text\" id=\"wpforms-8134-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-8134-field_25-error\" ><\/div><div id=\"wpforms-8134-field_27-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Multiple Choice<\/legend><ul id=\"wpforms-8134-field_27\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-8134-field_27_1\" name=\"wpforms[fields][27]\" value=\"Petrol\" aria-errormessage=\"wpforms-8134-field_27_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_27_1\">Petrol<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-8134-field_27_2\" name=\"wpforms[fields][27]\" value=\"Diesel\" aria-errormessage=\"wpforms-8134-field_27_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_27_2\">Diesel<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_29-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"29\"><div id=\"wpforms-8134-field_29\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_29-error\"><h3><span style=\"color:#000000\">Lors de l'envoi de votre candidature, nous avons besoin de copies des documents suivants :<\/span><\/h3>\n<h4><span style=\"color:#000000\">Pour chaque v\u00e9hicule :<\/span><\/h4>\n<ul>\n<li><span style=\"color:#000000\">- Documents relatifs au v\u00e9hicule<\/span><\/li>\n<li><span style=\"color:#000000\">- Procuration \u00e9ventuelle pour le v\u00e9hicule<\/span><\/li>\n<li><span style=\"color:#000000\">- Attestation d'assurance valable pour le Maroc<\/span><\/li>\n<li><span style=\"color:#000000\">- Nous vous recommandons vivement de souscrire une assurance de r\u00e9cup\u00e9ration de v\u00e9hicule.<\/span><\/li>\n<\/ul>\n<p><span style=\"color:#000000\">Veillez \u00e0 une bonne lisibilit\u00e9 et \u00e0 ce que le volume de donn\u00e9es soit le plus faible possible.<br \/>\n<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-8134-field_30-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_30\">T\u00e9l\u00e9chargement de fichiers<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"30\"\n\t\tdata-form-id=\"8134\"\n\t\tdata-input-name=\"wpforms_8134_30\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages,m3u8,mpd\"\n\t\tdata-max-size=\"268435456\"\n\t\tdata-max-file-number=\"10\"\n\t\tdata-post-max-size=\"268435456\"\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 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">Vous pouvez t\u00e9l\u00e9verser jusqu\u2019\u00e0 10 fichiers.<\/span>\n\t\t\t<\/div>\n<\/div>\n\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-8134-field_30\"\n\t\tname=\"wpforms_8134_30\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-8134-field_31-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"31\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"8134\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous - \u00c9QUIPE D&#039;ASSISTANCE<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"8134\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next - \u00c9QUIPE D&#039;ASSISTANCE<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Sauvegarder et reprendre plus tard<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-8134-field_46-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"46\"><h3 id=\"wpforms-8134-field_46\" aria-errormessage=\"wpforms-8134-field_46-error\">PERSONNE<\/h3><\/div><div id=\"wpforms-8134-field_32-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"32\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_33-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_33\">NOM<\/label><input type=\"text\" id=\"wpforms-8134-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" aria-errormessage=\"wpforms-8134-field_33-error\" ><\/div><div id=\"wpforms-8134-field_35-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_35\">DATE DE NAISSANCE<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_35\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][35][date]\" aria-errormessage=\"wpforms-8134-field_35-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_37-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"37\"><fieldset><legend class=\"wpforms-field-label\">Sexe<\/legend><ul id=\"wpforms-8134-field_37\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_37_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][37][]\" value=\"Homme\" aria-errormessage=\"wpforms-8134-field_37_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_37_1\">Homme<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_37_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][37][]\" value=\"Femme\" aria-errormessage=\"wpforms-8134-field_37_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_37_2\">Femme<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_34\">PR\u00c9NOM<\/label><input type=\"text\" id=\"wpforms-8134-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-8134-field_34-error\" ><\/div><div id=\"wpforms-8134-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_36\">LIEU ET PAYS DE NAISSANCE<\/label><input type=\"text\" id=\"wpforms-8134-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-8134-field_36-error\" ><\/div><div id=\"wpforms-8134-field_38-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"38\"><fieldset><legend class=\"wpforms-field-label\">TAILLE DU T-SHIRT<\/legend><ul id=\"wpforms-8134-field_38\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_38_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][38][]\" value=\"S\" aria-errormessage=\"wpforms-8134-field_38_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_38_1\">S<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_38_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][38][]\" value=\"M\" aria-errormessage=\"wpforms-8134-field_38_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_38_2\">M<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_38_6\" data-rule-check-limit=\"true\" name=\"wpforms[fields][38][]\" value=\"L\" aria-errormessage=\"wpforms-8134-field_38_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_38_6\">L<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_38_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][38][]\" value=\"XL\" aria-errormessage=\"wpforms-8134-field_38_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_38_5\">XL<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_38_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][38][]\" value=\"XXL\" aria-errormessage=\"wpforms-8134-field_38_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_38_4\">XXL<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_45-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"45\"><h3 id=\"wpforms-8134-field_45\" aria-errormessage=\"wpforms-8134-field_45-error\">Contact<\/h3><\/div><div id=\"wpforms-8134-field_40-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"40\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_41-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_41\">T\u00c9L\u00c9PHONE MOBILE (OBLIGATOIRE)<\/label><input type=\"tel\" id=\"wpforms-8134-field_41\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][41]\" aria-label=\"T\u00c9L\u00c9PHONE MOBILE (OBLIGATOIRE)\" aria-errormessage=\"wpforms-8134-field_41-error\" ><\/div><div id=\"wpforms-8134-field_43-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"43\"><fieldset><legend class=\"wpforms-field-label\">ADRESSE E-MAIL<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-8134-field_43\" class=\"wpforms-field-email-primary\" name=\"wpforms[fields][43][primary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8134-field_43-error\" ><label for=\"wpforms-8134-field_43\" class=\"wpforms-field-sublabel after\">E-mail<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-8134-field_43-secondary\" class=\"wpforms-field-email-secondary\" data-rule-confirm=\"#wpforms-8134-field_43\" name=\"wpforms[fields][43][secondary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8134-field_43-secondary-error\" ><label for=\"wpforms-8134-field_43-secondary\" class=\"wpforms-field-sublabel after\">Confirmez l\u2019e-mail<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_42-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_42\">T\u00c9L\u00c9PHONE A DOMICILE<\/label><input type=\"tel\" id=\"wpforms-8134-field_42\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][42]\" aria-label=\"T\u00c9L\u00c9PHONE A DOMICILE\" aria-errormessage=\"wpforms-8134-field_42-error\" ><\/div><div id=\"wpforms-8134-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_44\">FACEBOOK ETC<\/label><input type=\"text\" id=\"wpforms-8134-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-8134-field_44-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_47-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"47\"><h3 id=\"wpforms-8134-field_47\" aria-errormessage=\"wpforms-8134-field_47-error\">PASSEPORT<\/h3><\/div><div id=\"wpforms-8134-field_48-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"48\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_49\">NATIONALIT\u00c9<\/label><input type=\"text\" id=\"wpforms-8134-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-8134-field_49-error\" ><\/div><div id=\"wpforms-8134-field_51-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_51\">DATE D&#039;\u00c9MISSION<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_51\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][51][date]\" aria-errormessage=\"wpforms-8134-field_51-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_53\">\u00c9MIS PAR<\/label><input type=\"text\" id=\"wpforms-8134-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-8134-field_53-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_50\">NUM\u00c9RO DE PASSEPORT<\/label><input type=\"text\" id=\"wpforms-8134-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-8134-field_50-error\" ><\/div><div id=\"wpforms-8134-field_52-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_52\">VALIDE JUSQU&#039;\u00c0<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_52\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][52][date]\" aria-errormessage=\"wpforms-8134-field_52-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_54\">MAROC ID<\/label><input type=\"text\" id=\"wpforms-8134-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-8134-field_54-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_55-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"55\"><h3 id=\"wpforms-8134-field_55\" aria-errormessage=\"wpforms-8134-field_55-error\">M\u00c9DICAL<\/h3><\/div><div id=\"wpforms-8134-field_56-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"56\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_57\">GROUPE SANGUIN<\/label><input type=\"text\" id=\"wpforms-8134-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-8134-field_57-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_58-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_58\">ALLERGIES<\/label><input type=\"text\" id=\"wpforms-8134-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-8134-field_58-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_59-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_59\">M\u00c9DICAMENTS PRIS<\/label><input type=\"text\" id=\"wpforms-8134-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-8134-field_59-error\" ><\/div><div id=\"wpforms-8134-field_60-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"60\"><h3 id=\"wpforms-8134-field_60\" aria-errormessage=\"wpforms-8134-field_60-error\">CONTACT D&#039;URGENCE<\/h3><\/div><div id=\"wpforms-8134-field_61-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"61\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_62-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_62\">NOM<\/label><input type=\"text\" id=\"wpforms-8134-field_62\" class=\"wpforms-field-medium\" name=\"wpforms[fields][62]\" aria-errormessage=\"wpforms-8134-field_62-error\" ><\/div><div id=\"wpforms-8134-field_64-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_64\">LIEN DE PARENT\u00c9 (\u00c9POUSE, PARENT)<\/label><input type=\"text\" id=\"wpforms-8134-field_64\" class=\"wpforms-field-medium\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-8134-field_64-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_63\">PR\u00c9NOM<\/label><input type=\"text\" id=\"wpforms-8134-field_63\" class=\"wpforms-field-medium\" name=\"wpforms[fields][63]\" aria-errormessage=\"wpforms-8134-field_63-error\" ><\/div><div id=\"wpforms-8134-field_65-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_65\">NUM\u00c9RO DE T\u00c9L\u00c9PHONE D&#039;URGENCE<\/label><input type=\"tel\" id=\"wpforms-8134-field_65\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][65]\" aria-label=\"NUM\u00c9RO DE T\u00c9L\u00c9PHONE D&#039;URGENCE\" aria-errormessage=\"wpforms-8134-field_65-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_66-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">Vous avez besoin d&#039;un autre membre de l&#039;\u00e9quipe de service ?<\/legend><ul id=\"wpforms-8134-field_66\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_66_1\" name=\"wpforms[fields][66][]\" value=\"Oui\" aria-errormessage=\"wpforms-8134-field_66_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_66_1\">Oui<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8134-field_67-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"67\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_67\" aria-errormessage=\"wpforms-8134-field_67-error\">2\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_68-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"68\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_69-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"69\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_69\">NOM DE FAMILLE 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_69\" class=\"wpforms-field-medium\" name=\"wpforms[fields][69]\" aria-errormessage=\"wpforms-8134-field_69-error\" ><\/div><div id=\"wpforms-8134-field_70-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"70\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_70\">DATE DE NAISSANCE 2\u00e8me personne<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_70\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][70][date]\" aria-errormessage=\"wpforms-8134-field_70-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_71-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"71\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Sex 2\u00e8me personne<\/legend><ul id=\"wpforms-8134-field_71\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_71_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][71][]\" value=\"Homme\" aria-errormessage=\"wpforms-8134-field_71_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_71_1\">Homme<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_71_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][71][]\" value=\"Femme\" aria-errormessage=\"wpforms-8134-field_71_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_71_2\">Femme<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_72-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"72\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_72\">PR\u00c9NOM 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_72\" class=\"wpforms-field-medium\" name=\"wpforms[fields][72]\" aria-errormessage=\"wpforms-8134-field_72-error\" ><\/div><div id=\"wpforms-8134-field_73-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_73\">LIEU ET PAYS DE NAISSANCE 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_73\" class=\"wpforms-field-medium\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-8134-field_73-error\" ><\/div><div id=\"wpforms-8134-field_74-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"74\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">TAILLE T-SHIRT 2\u00e8me personne<\/legend><ul id=\"wpforms-8134-field_74\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_74_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][74][]\" value=\"S\" aria-errormessage=\"wpforms-8134-field_74_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_74_1\">S<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_74_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][74][]\" value=\"M\" aria-errormessage=\"wpforms-8134-field_74_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_74_2\">M<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_74_6\" data-rule-check-limit=\"true\" name=\"wpforms[fields][74][]\" value=\"L\" aria-errormessage=\"wpforms-8134-field_74_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_74_6\">L<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_74_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][74][]\" value=\"XL\" aria-errormessage=\"wpforms-8134-field_74_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_74_5\">XL<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_74_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][74][]\" value=\"XXL\" aria-errormessage=\"wpforms-8134-field_74_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_74_4\">XXL<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_76-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_76\" aria-errormessage=\"wpforms-8134-field_76-error\">Contact 2\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_77-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"77\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_78-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"78\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_78\">T\u00c9L\u00c9PHONE MOBILE (OBLIGATOIRE) 2eme personne<\/label><input type=\"tel\" id=\"wpforms-8134-field_78\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][78]\" aria-label=\"T\u00c9L\u00c9PHONE MOBILE (OBLIGATOIRE) 2eme personne\" aria-errormessage=\"wpforms-8134-field_78-error\" ><\/div><div id=\"wpforms-8134-field_79-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"79\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">E-mail 2eme personne <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-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-8134-field_79\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][79][primary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8134-field_79-error\" required><label for=\"wpforms-8134-field_79\" class=\"wpforms-field-sublabel after\">E-mail<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-8134-field_79-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-8134-field_79\" name=\"wpforms[fields][79][secondary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8134-field_79-secondary-error\" required><label for=\"wpforms-8134-field_79-secondary\" class=\"wpforms-field-sublabel after\">Confirmez l\u2019e-mail<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_80-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"80\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_80\">NUM\u00c9RO DE R\u00c9SEAU FIXE 2\u00e8me personne<\/label><input type=\"tel\" id=\"wpforms-8134-field_80\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][80]\" aria-label=\"NUM\u00c9RO DE R\u00c9SEAU FIXE 2\u00e8me personne\" aria-errormessage=\"wpforms-8134-field_80-error\" ><\/div><div id=\"wpforms-8134-field_81-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"81\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_81\">FACEBOOK ETC 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_81\" class=\"wpforms-field-medium\" name=\"wpforms[fields][81]\" aria-errormessage=\"wpforms-8134-field_81-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_105-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"105\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_105\" aria-errormessage=\"wpforms-8134-field_105-error\">PASSEPORT 2\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_82-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"82\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_83-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"83\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_83\">NATIONALIT\u00c9 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_83\" class=\"wpforms-field-medium\" name=\"wpforms[fields][83]\" aria-errormessage=\"wpforms-8134-field_83-error\" ><\/div><div id=\"wpforms-8134-field_84-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"84\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_84\">DATE D&#039;EMISSION 2\u00e8me personne<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_84\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][84][date]\" aria-errormessage=\"wpforms-8134-field_84-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_85-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"85\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_85\">\u00c9MIS PAR 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_85\" class=\"wpforms-field-medium\" name=\"wpforms[fields][85]\" aria-errormessage=\"wpforms-8134-field_85-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_86-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"86\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_86\">NUM\u00c9RO DE PASSEPORT NO 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_86\" class=\"wpforms-field-medium\" name=\"wpforms[fields][86]\" aria-errormessage=\"wpforms-8134-field_86-error\" ><\/div><div id=\"wpforms-8134-field_87-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"87\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_87\">DATE D&#039;EXPIRATION 2eme personne<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_87\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][87][date]\" aria-errormessage=\"wpforms-8134-field_87-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_88-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"88\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_88\">MAROC ID 2eme personne<\/label><input type=\"text\" id=\"wpforms-8134-field_88\" class=\"wpforms-field-medium\" name=\"wpforms[fields][88]\" aria-errormessage=\"wpforms-8134-field_88-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_120-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"120\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_120\" aria-errormessage=\"wpforms-8134-field_120-error\">M\u00e9dical 2eme personne<\/h3><\/div><div id=\"wpforms-8134-field_121-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"121\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_122-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"122\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_122\">GROUPE SANGUIN 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_122\" class=\"wpforms-field-medium\" name=\"wpforms[fields][122]\" aria-errormessage=\"wpforms-8134-field_122-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_123-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"123\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_123\">ALLERGIES 2eme personne<\/label><input type=\"text\" id=\"wpforms-8134-field_123\" class=\"wpforms-field-medium\" name=\"wpforms[fields][123]\" aria-errormessage=\"wpforms-8134-field_123-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_124-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"124\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_124\">MEDICAMENTS PRIS 2eme personne<\/label><input type=\"text\" id=\"wpforms-8134-field_124\" class=\"wpforms-field-medium\" name=\"wpforms[fields][124]\" aria-errormessage=\"wpforms-8134-field_124-error\" ><\/div><div id=\"wpforms-8134-field_125-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"125\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_125\" aria-errormessage=\"wpforms-8134-field_125-error\">Contact d&#039;urgence 2\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_126-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"126\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_127-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"127\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_127\">NOM DE FAMILLE 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_127\" class=\"wpforms-field-medium\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-8134-field_127-error\" ><\/div><div id=\"wpforms-8134-field_129-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"129\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_129\">LIEN DE PARENT\u00c9 (\u00c9POUSE, PARENT) 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_129\" class=\"wpforms-field-medium\" name=\"wpforms[fields][129]\" aria-errormessage=\"wpforms-8134-field_129-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_128-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"128\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_128\">PR\u00c9NOM 2\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_128\" class=\"wpforms-field-medium\" name=\"wpforms[fields][128]\" aria-errormessage=\"wpforms-8134-field_128-error\" ><\/div><div id=\"wpforms-8134-field_130-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"130\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_130\">T\u00c9L\u00c9PHONE 2\u00e8me personne<\/label><input type=\"tel\" id=\"wpforms-8134-field_130\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][130]\" aria-label=\"T\u00c9L\u00c9PHONE 2\u00e8me personne\" aria-errormessage=\"wpforms-8134-field_130-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_89-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"89\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Vous avez besoin d&#039;un autre membre de l&#039;\u00e9quipe de service ?<\/legend><ul id=\"wpforms-8134-field_89\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_89_1\" name=\"wpforms[fields][89][]\" value=\"Oui\" aria-errormessage=\"wpforms-8134-field_89_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_89_1\">Oui<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8134-field_90-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"90\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_90\" aria-errormessage=\"wpforms-8134-field_90-error\">3\u00e8me personne d&#039;assistance<\/h3><\/div><div id=\"wpforms-8134-field_91-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"91\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_92-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"92\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_92\">NOM DE FAMILLE 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_92\" class=\"wpforms-field-medium\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-8134-field_92-error\" ><\/div><div id=\"wpforms-8134-field_93-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"93\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_93\">DATE DE NAISSANCE 3\u00e8me personne<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_93\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][93][date]\" aria-errormessage=\"wpforms-8134-field_93-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_94-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"94\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Sexe 3\u00e8me personne<\/legend><ul id=\"wpforms-8134-field_94\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_94_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"Homme\" aria-errormessage=\"wpforms-8134-field_94_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_94_1\">Homme<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_94_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][94][]\" value=\"Femme\" aria-errormessage=\"wpforms-8134-field_94_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_94_2\">Femme<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_95-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"95\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_95\">PR\u00c9NOM 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_95\" class=\"wpforms-field-medium\" name=\"wpforms[fields][95]\" aria-errormessage=\"wpforms-8134-field_95-error\" ><\/div><div id=\"wpforms-8134-field_96-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"96\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_96\">LIEU ET PAYS DE NAISSANCE 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_96\" class=\"wpforms-field-medium\" name=\"wpforms[fields][96]\" aria-errormessage=\"wpforms-8134-field_96-error\" ><\/div><div id=\"wpforms-8134-field_97-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"97\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">TAILLE DE T-SHIRT 3\u00e8me personne<\/legend><ul id=\"wpforms-8134-field_97\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_97_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"S\" aria-errormessage=\"wpforms-8134-field_97_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_97_1\">S<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_97_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"M\" aria-errormessage=\"wpforms-8134-field_97_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_97_2\">M<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_97_6\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"L\" aria-errormessage=\"wpforms-8134-field_97_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_97_6\">L<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_97_5\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"XL\" aria-errormessage=\"wpforms-8134-field_97_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_97_5\">XL<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-8134-field_97_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][97][]\" value=\"XXL\" aria-errormessage=\"wpforms-8134-field_97_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_97_4\">XXL<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_98-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"98\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_98\" aria-errormessage=\"wpforms-8134-field_98-error\">Contact 3\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_100-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"100\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_101-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"101\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_101\">T\u00c9L\u00c9PHONE PORTABLE (OBLIGATOIRE) 3\u00e8me personne<\/label><input type=\"tel\" id=\"wpforms-8134-field_101\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][101]\" aria-label=\"T\u00c9L\u00c9PHONE PORTABLE (OBLIGATOIRE) 3\u00e8me personne\" aria-errormessage=\"wpforms-8134-field_101-error\" ><\/div><div id=\"wpforms-8134-field_102-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"102\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">E-mail 3\u00e8me personne <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-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-8134-field_102\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][102][primary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8134-field_102-error\" required><label for=\"wpforms-8134-field_102\" class=\"wpforms-field-sublabel after\">E-mail<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-8134-field_102-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-8134-field_102\" name=\"wpforms[fields][102][secondary]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8134-field_102-secondary-error\" required><label for=\"wpforms-8134-field_102-secondary\" class=\"wpforms-field-sublabel after\">Confirmez l\u2019e-mail<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_103-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"103\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_103\">T\u00c9L\u00c9PHONE FIXE 3\u00e8me personne<\/label><input type=\"tel\" id=\"wpforms-8134-field_103\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][103]\" aria-label=\"T\u00c9L\u00c9PHONE FIXE 3\u00e8me personne\" aria-errormessage=\"wpforms-8134-field_103-error\" ><\/div><div id=\"wpforms-8134-field_104-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_104\">FACEBOOK ETC 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_104\" class=\"wpforms-field-medium\" name=\"wpforms[fields][104]\" aria-errormessage=\"wpforms-8134-field_104-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_113-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"113\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_113\" aria-errormessage=\"wpforms-8134-field_113-error\">Passeport 3\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_106-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"106\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_107-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_107\">NATIONALIT\u00c9 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_107\" class=\"wpforms-field-medium\" name=\"wpforms[fields][107]\" aria-errormessage=\"wpforms-8134-field_107-error\" ><\/div><div id=\"wpforms-8134-field_108-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"108\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_108\">DATE \u00c9MIS 3\u00e8me personne<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_108\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][108][date]\" aria-errormessage=\"wpforms-8134-field_108-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_109-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"109\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_109\">\u00c9MIS PAR 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_109\" class=\"wpforms-field-medium\" name=\"wpforms[fields][109]\" aria-errormessage=\"wpforms-8134-field_109-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_110-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"110\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_110\">NUM\u00c9RO DE PASSEPORT 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" aria-errormessage=\"wpforms-8134-field_110-error\" ><\/div><div id=\"wpforms-8134-field_111-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"111\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_111\">DATE D&#039;EXPIRATION 3\u00e8me personne<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-8134-field_111\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][111][date]\" aria-errormessage=\"wpforms-8134-field_111-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-8134-field_112-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"112\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_112\">MAROC ID 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_112\" class=\"wpforms-field-medium\" name=\"wpforms[fields][112]\" aria-errormessage=\"wpforms-8134-field_112-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_114-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"114\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_114\" aria-errormessage=\"wpforms-8134-field_114-error\">M\u00e9dical 3\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_115-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"115\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_116-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"116\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_116\">GROUPE SANGUIN 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_116\" class=\"wpforms-field-medium\" name=\"wpforms[fields][116]\" aria-errormessage=\"wpforms-8134-field_116-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_117-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"117\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_117\">ALLERGIES 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_117\" class=\"wpforms-field-medium\" name=\"wpforms[fields][117]\" aria-errormessage=\"wpforms-8134-field_117-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_118-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_118\">M\u00c9DICAMENTS PRIS 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_118\" class=\"wpforms-field-large\" name=\"wpforms[fields][118]\" aria-errormessage=\"wpforms-8134-field_118-error\" ><\/div><div id=\"wpforms-8134-field_119-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"119\" style=\"display:none;\"><h3 id=\"wpforms-8134-field_119\" aria-errormessage=\"wpforms-8134-field_119-error\">CONTACT D&#039;URGENCE 3\u00e8me personne<\/h3><\/div><div id=\"wpforms-8134-field_131-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"131\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_132-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"132\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_132\">NOM DE FAMILLE 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_132\" class=\"wpforms-field-large\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-8134-field_132-error\" ><\/div><div id=\"wpforms-8134-field_134-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"134\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_134\">LIEN DE PARENT\u00c9 (\u00c9POUSE, PARENT) 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_134\" class=\"wpforms-field-large\" name=\"wpforms[fields][134]\" aria-errormessage=\"wpforms-8134-field_134-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-8134-field_133-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"133\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_133\">PR\u00c9NOM 3\u00e8me personne<\/label><input type=\"text\" id=\"wpforms-8134-field_133\" class=\"wpforms-field-large\" name=\"wpforms[fields][133]\" aria-errormessage=\"wpforms-8134-field_133-error\" ><\/div><div id=\"wpforms-8134-field_135-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"135\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_135\">T\u00e9l\u00e9phone 3\u00e8me personne<\/label><input type=\"tel\" id=\"wpforms-8134-field_135\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][135]\" aria-label=\"T\u00e9l\u00e9phone 3\u00e8me personne\" aria-errormessage=\"wpforms-8134-field_135-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-8134-field_136-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"136\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"8134\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Pr\u00e9c\u00e8dent - V\u00e9hicule d&#039;assistance<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"8134\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Suivant - Important<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Sauvegarder et reprendre plus tard<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4 last \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-8134-field_137-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"137\"><div id=\"wpforms-8134-field_137\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-8134-field_137-error\"><p><span style=\"color:#000000\">Au r\u00e8glement de l'acompte, joindre copie lisible des documents suivants. Veuillez les telechargez sous forme de fichiers PDF <\/span><\/p>\n<p><span style=\"color:#000000\">Veillez \u00e0 une bonne lisibilit\u00e9 et \u00e0 ce que le volume de donn\u00e9es soit le plus faible possible.<\/span><\/p>\n<h3><span style=\"color:#000000\">Pour chaque voiture :<\/span><\/h3>\n<ul>\n<li><span style=\"color:#000000\">Document d'immatriculation<\/span><\/li>\n<li><span style=\"color:#000000\">Assurance v\u00e9hicule (couvrant le Maroc)<\/span><\/li>\n<\/ul>\n<p><strong><span style=\"color:#000000\">Il est vivement conseill\u00e9 de souscrire \u00e0 une assurance rapatriement du v\u00e9hicule.<\/span><\/strong><\/p>\n<h3><span style=\"color:#000000\">Pour chaque personne :<\/span><\/h3>\n<ul>\n<li><span style=\"color:#000000\">Passeport (valable minimum 3 mois de date du d\u00e9part du rallye)<\/span><\/li>\n<li><span style=\"color:#000000\">Permis de conduire<\/span><\/li>\n<li>Assurance rapatriement m\u00e9dical (conseillee)<\/li>\n<\/ul>\n<h3><span style=\"color:#000000\">CONDITIONS DE PAIEMENT :<\/span><\/h3>\n<p><span style=\"color:#000000\">Le paiement d'une caution de 1000 \u20ac par \u00e9quipe valide l'inscription d'une \u00e9quipe dans une cat\u00e9gorie. Le num\u00e9ro de d\u00e9part n'est attribu\u00e9 que lorsque le montant total des droits a \u00e9t\u00e9 re\u00e7u, et attribu\u00e9 en fonction de la date de r\u00e9ception du paiement total. Le solde doit \u00eatre pay\u00e9 dans les 30 jours suivant le d\u00e9p\u00f4t initial.  <\/span><\/p>\n<p><strong><span style=\"color:#000000\">Bar\u00e8me des d\u00e9ductions en cas d'annulation :<\/span><\/strong><\/p>\n<ul>\n<li><span style=\"color:#000000\">1000 \u20ac par \u00e9quipe si annule avant le 15\/08\/2025<\/span><\/li>\n<li><span style=\"color:#000000\">50 % du montant total si annulation entre le 15\/08\/2025 et le 15\/09\/2025<\/span><\/li>\n<li><span style=\"color:#000000\">100 % du montant total si annulation apr\u00e8s le 15\/09\/2025<\/span><\/li>\n<\/ul>\n<h3><span style=\"color:#000000\">CONTACT :<\/span><\/h3>\n<p><span style=\"color:#000000\">Chris Armelin<\/span><\/p>\n<p><span style=\"color:#000000\">+44 7966 207715 ou <a href=\"mailto:ca@bajamorocco.com\">ca@bajamorocco.com<\/a><\/span><\/p>\n<h3><span style=\"color:#000000\">COORDONN\u00c9ES BANCAIRES<\/span><\/h3>\n<ul>\n<li><span style=\"color:#000000\">Carta Rallye Ltd.<\/span><\/li>\n<li><span style=\"color:#000000\">Banque Barclays<\/span><\/li>\n<li><span style=\"color:#000000\">IBAN : GB13 BUKB 2090 5679 0356 77<\/span><\/li>\n<li><span style=\"color:#000000\">SWIFTBIC : BUKBGB22<\/span><\/li>\n<\/ul>\n<p>Ref: Nom du pilote<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-8134-field_138-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"138\"><fieldset><legend class=\"wpforms-field-label\">Termes et conditions<\/legend><ul id=\"wpforms-8134-field_138\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"checkbox\" id=\"wpforms-8134-field_138_1\" name=\"wpforms[fields][138][]\" value=\"Accepter\" aria-errormessage=\"wpforms-8134-field_138_1-error\" aria-describedby=\"wpforms-8134-field_138-description\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-8134-field_138_1\">Accepter<\/label><\/li><\/ul><div id=\"wpforms-8134-field_138-description\" class=\"wpforms-field-description\">En signant ce formulaire, vous confirmez que vous acceptez et respectez les conditions d'inscription pour l'evenement et<br>le r\u00e8glement de l'evenement.<\/div><\/fieldset><\/div><div id=\"wpforms-8134-field_139-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"139\"><fieldset><legend class=\"wpforms-field-label\">Nom<\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8134-field_139\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][139][first]\" aria-errormessage=\"wpforms-8134-field_139-error\" ><label for=\"wpforms-8134-field_139\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8134-field_139-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][139][last]\" aria-errormessage=\"wpforms-8134-field_139-last-error\" ><label for=\"wpforms-8134-field_139-last\" class=\"wpforms-field-sublabel after\">Nom de famille<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-8134-field_140-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"140\"><label class=\"wpforms-field-label\" for=\"wpforms-8134-field_140\">Signature<\/label><input type=\"text\" id=\"wpforms-8134-field_140\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][140]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-8134-field_140-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-8134-field_140-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Effacer la signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Effacer la signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-8134-field_18-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"18\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"8134\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Pr\u00e9c\u00e8dent - \u00c9quipe d&#039;assistance<\/button><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"8134\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-8134\" class=\"wpforms-submit\" data-alt-text=\"Envoy\u00e9\" data-submit-text=\"Soumettre\" aria-live=\"assertive\" value=\"wpforms-submit\">Soumettre<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/bajamorocco.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Sauvegarder et reprendre plus tard<\/span><\/a><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<div class=\"wpforms-save-resume-confirmation\" id=\"wpforms-save-resume-confirmation-8134\" style=\"display: none\">\n\n\t\n\t<div class=\"message\">\n\t\t<p>Votre formulaire d'inscription a \u00e9t\u00e9 sauvegard\u00e9e et un lien unique a \u00e9t\u00e9 cr\u00e9\u00e9, auquel vous pouvez acc\u00e9der pour reprendre ce formulaire.<\/p>\n<p>Saisissez votre adresse \u00e9lectronique pour recevoir le lien par courrier \u00e9lectronique. Vous pouvez \u00e9galement copier et enregistrer le lien ci-dessous.<\/p>\n<p>Veuillez noter que ce lien ne doit pas \u00eatre partag\u00e9 et qu'il expirera dans 30 jours, apr\u00e8s quoi votre entr\u00e9e dans le formulaire sera supprim\u00e9e.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-save-resume-actions\">\n\t\t\t\t\t<div class=\"wpforms-field\">\n\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\tCopier le lien\t\t\t\t<\/label>\n\t\t\t\t<div class=\"wpforms-save-resume-shortcode-container\">\n\t\t\t\t\t<input type=\"text\" class=\"wpforms-save-resume-shortcode\" value=\"\" disabled \/>\n\t\t\t\t\t<span class=\"wpforms-save-resume-shortcode-copy\" title=\"Copier le lien pour reprendre dans le presse-papiers\">\n\t\t\t\t\t\t\t<span class=\"copy-icon\"><\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\t\t\t\t\t<form class=\"wpforms-validate wpforms-form wpforms-save-resume-email-notification\" method=\"post\" action=\"\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169\" data-token=\"177c776bea0ad66f7d4e267887d76d87\">\n\t\t\t\t<div class=\"wpforms-field wpforms-field-email\">\n\t\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\t\tE-mail\t\t\t\t\t\t<span class=\"wpforms-required-label\">*<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<input type=\"email\" name=\"wpforms[save_resume_email]\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-submit-container\">\n\t\t\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"5d108935f5\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169\" \/>\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[form_id]\" value=\"8134\">\n\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[entry_id]\" class=\"wpforms-save-resume-entry-id\" value=\"\">\n\t\t\t\t\t<button type=\"submit\" name=\"wpforms[save-resume]\" class=\"wpforms-submit\" value=\"wpforms-submit\" disabled>\n\t\t\t\t\t\tEnvoyer le lien\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<\/div>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text css=&#8221;&#8221; css_params=&#8221;&#8221;][\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"pgc_sgb_lightbox_settings":"","footnotes":""},"class_list":["post-8169","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/comments?post=8169"}],"version-history":[{"count":2,"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169\/revisions"}],"predecessor-version":[{"id":8171,"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/pages\/8169\/revisions\/8171"}],"wp:attachment":[{"href":"https:\/\/bajamorocco.com\/fr\/index.php\/wp-json\/wp\/v2\/media?parent=8169"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}