{"id":2877,"date":"2024-09-08T16:54:56","date_gmt":"2024-09-08T14:54:56","guid":{"rendered":"https:\/\/locupali.com\/WordPress\/?page_id=2877"},"modified":"2025-08-27T12:18:43","modified_gmt":"2025-08-27T10:18:43","slug":"adhesion-a-locupali","status":"publish","type":"page","link":"https:\/\/locupali.com\/WordPress\/index.php\/adhesion-a-locupali\/","title":{"rendered":"Adh\u00e9sion \u00e0 LOCUPALI"},"content":{"rendered":"\n<h2 class=\"wp-block-heading has-text-align-center has-black-color has-text-color has-link-color wp-elements-a0524e81163fd87f4e28c65c15e990fe\"><strong>Veuillez remplir le formulaire suivant pour adh\u00e9rer \u00e0 l&#8217;association<\/strong><br>(UN formulaire par personne, s&#8217;il vous pla\u00eet)<\/h2>\n\n\n<div class='fluentform ff-default fluentform_wrapper_21  ff_guten_block ff_guten_block-21 ffs_custom_wrap'><form data-form_id=\"21\" id=\"fluentform_21\" class=\"frm-fluent-form fluent_form_21 ff-el-form-top ff_form_instance_21_1 ff-form-loading ffs_custom\" data-form_instance=\"ff_form_instance_21_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">FICHE INDIVIDUELLE D&#8217;INSCRIPTION (#7) (#21)<\/legend><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"22\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p>        <div\n                style=\"display: none!important; position: absolute!important; transform: translateX(1000%)!important;\"\n                class=\"ff-el-group ff-hpsf-container\"\n        >\n            <div class=\"ff-el-input--label asterisk-right\">\n                <label for=\"ff_21_item_sf\" aria-label=\"Newsletter\">\n                    Newsletter                <\/label>\n            <\/div>\n            <div class=\"ff-el-input--content\">\n                <input type=\"text\"\n                       name=\"item_21__fluent_sf\"\n                       class=\"ff-el-form-control\"\n                       id=\"ff_21_item_sf\"\n                \/>\n            <\/div>\n        <\/div>\n        <input type='hidden' name='__fluent_form_embded_post_id' value='2877' \/><input type=\"hidden\" id=\"_fluentform_21_fluentformnonce\" name=\"_fluentform_21_fluentformnonce\" value=\"13de8ea47b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/WordPress\/index.php\/wp-json\/wp\/v2\/pages\/2877\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-21_1\" ><div>\n<h3 class=\"Corps\" style=\"text-align: center\" align=\"center\"><span class=\"Aucun\"><b><i><u>Afin de pouvoir vous informer rapidement en cas de n\u00e9cessit\u00e9, il est important de donner un num\u00e9ro de t\u00e9l\u00e9phone mobile et une adresse email<\/u><\/i><\/b><\/span><u><\/u><\/h3>\n<\/div>\n<h4 style=\"text-align: center\"><span class=\"Aucun\"><span lang=\"EN-US\">(A d\u00e9faut, vous pouvez donner l&#8217;email d\u2019un autre adh\u00e9rent qui s\u2019engage \u00e0 vous communiquer les informations qu\u2019il recevra)<\/span><\/span><\/h4><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_names_1_first_name_' id='label_ff_21_names_1_first_name_' >Nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_21_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"nom\" tabindex=\"1\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_names_1_last_name_' id='label_ff_21_names_1_last_name_' >Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_21_names_1_last_name_\" class=\"ff-el-form-control\" placeholder=\"prenom\" tabindex=\"2\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 13.2%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_input_text_1' id='label_ff_21_input_text_1' aria-label=\"Ann\u00e9e de naissance\">Ann\u00e9e de naissance<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" tabindex=\"3\" id=\"ff_21_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 86.8%;'><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 60.18%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_email_adherent' id='label_ff_21_email_adherent' aria-label=\"E-mail\">E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_adherent\" id=\"ff_21_email_adherent\" class=\"ff-el-form-control\" data-name=\"email_adherent\" tabindex=\"4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 39.82%;'><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 62.49%;'><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 37.51%;'><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_address_1_address_line_1_' id='label_ff_21_address_1_address_line_1_' aria-label=\"Adresse\">Adresse<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_21_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"adresse\" data-key_name=\"address_line_1\" tabindex=\"5\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_address_1_city_' id='label_ff_21_address_1_city_' aria-label=\"Ville\">Ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_21_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"ville\" data-key_name=\"city\" tabindex=\"6\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_address_1_zip_' id='label_ff_21_address_1_zip_' aria-label=\"Code Postal\">Code Postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_21_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"codePostal\" data-key_name=\"zip\" tabindex=\"7\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_phone' id='label_ff_21_phone' aria-label=\"T\u00e9l\u00e9phone fixe\">T\u00e9l\u00e9phone fixe<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"telephone\" data-name=\"phone\" id=\"ff_21_phone\" tabindex=\"8\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_21_phone_1' id='label_ff_21_phone_1' aria-label=\"T\u00e9l\u00e9phone mobile\">T\u00e9l\u00e9phone mobile<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_1\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"mobile\" data-name=\"phone_1\" id=\"ff_21_phone_1\" tabindex=\"9\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Comment avez-vous connu LOCUPALI ?\">Comment avez-vous connu LOCUPALI ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_c4efc78b676b8a9e30d0e5ef4c190420'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"10\" value=\"Par vos amis ou relations\"  id='input_radio_3_c4efc78b676b8a9e30d0e5ef4c190420' aria-label='Par vos amis ou relations' aria-invalid='false' aria-required=true> <span>Par vos amis ou relations<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_5c784a70f8494c1356559628495d8e8a'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Par communication (journal, prospectus)\"  id='input_radio_3_5c784a70f8494c1356559628495d8e8a' aria-label='Par communication (journal, prospectus)' aria-invalid='false' aria-required=true> <span>Par communication (journal, prospectus)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_d73fa62e681fdaef7c9f45707531dcb0'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Autre\"  id='input_radio_3_d73fa62e681fdaef7c9f45707531dcb0' aria-label='Autre' aria-invalid='false' aria-required=true> <span>Autre<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_input_text' id='label_ff_21_input_text' aria-label=\"Si &quot;Autre&quot;, merci de pr\u00e9ciser :\">Si &#8220;Autre&#8221;, merci de pr\u00e9ciser :<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" tabindex=\"11\" id=\"ff_21_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Montant de la cotisation de 15 \u20ac, r\u00e9gl\u00e9 par :\">Montant de la cotisation de 15 \u20ac, r\u00e9gl\u00e9 par :<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_3865d67b973564c6b2d535673581f797'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"12\" value=\"Ch\u00e8que\"  id='input_radio_2_3865d67b973564c6b2d535673581f797' aria-label='Ch\u00e8que' aria-invalid='false' aria-required=true> <span>Ch\u00e8que<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_02fd6d4a4140c89d14cf97d746002bb8'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Virement\"  id='input_radio_2_02fd6d4a4140c89d14cf97d746002bb8' aria-label='Virement' aria-invalid='false' aria-required=true> <span>Virement<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-21_2\" ><p><strong>\u00a0 \u00a0<span style=\"text-decoration: underline\">ATTENTION<\/span> :\u00a0Vous allez recevoir un e-mail qui vous donnera les informations n\u00e9cessaires pour effectuer le virement si vous avez choisi cette formule de p<\/strong><strong>aiement.<\/strong><\/p>\n<p><strong>\u00a0 \u00a0Pour cette derni\u00e8re,\u00a0ne pas oublier de mentionner les nom et pr\u00e9nom de la personne concern\u00e9e.<\/strong><\/p><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-21_3\" ><h2 style=\"text-align: center\"><span style=\"color: #993366\"><strong>_______________________________________________________________<\/strong><\/span><\/h2><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-21_4\" ><div>\n<h3 class=\"Default\"><span class=\"Aucun\">\u00a0 \u00a0Personne(s) \u00e0 pr\u00e9venir en cas d\u2019accident :<\/span><b><\/b><\/h3>\n<\/div>\n<div><i><span lang=\"EN-US\">\u00a0 \u00a0Pour votre s\u00e9curit\u00e9, nous vous remercions de renseigner le(s) nom(s) de personne \u00e0 pr\u00e9venir au cas o\u00f9 vous auriez un accident pendant l\u2019une de nos sorties.<\/span><\/i><\/div><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_names_first_name_' id='label_ff_21_names_first_name_' >Nom contact 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_21_names_first_name_\" class=\"ff-el-form-control\" tabindex=\"13\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_names_last_name_' id='label_ff_21_names_last_name_' >Pr\u00e9nom contact 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_21_names_last_name_\" class=\"ff-el-form-control\" tabindex=\"14\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 49.65%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_phone_2' id='label_ff_21_phone_2' aria-label=\"T\u00e9l\u00e9phone contact 1\">T\u00e9l\u00e9phone contact 1<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_2\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" data-name=\"phone_2\" id=\"ff_21_phone_2\" tabindex=\"15\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50.35%;'><\/div><\/div><div data-type=\"name-element\" data-name=\"names_2\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_names_2_first_name_' id='label_ff_21_names_2_first_name_' >Nom contact 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[first_name]\" id=\"ff_21_names_2_first_name_\" class=\"ff-el-form-control\" tabindex=\"16\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_names_2_last_name_' id='label_ff_21_names_2_last_name_' >Pr\u00e9nom contact 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[last_name]\" id=\"ff_21_names_2_last_name_\" class=\"ff-el-form-control\" tabindex=\"17\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50.15%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_phone_3' id='label_ff_21_phone_3' aria-label=\"T\u00e9l\u00e9phone contact 2\">T\u00e9l\u00e9phone contact 2<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_3\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" data-name=\"phone_3\" id=\"ff_21_phone_3\" tabindex=\"18\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 49.85%;'><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 17.36%;'><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_21_datetime' id='label_ff_21_datetime' aria-label=\"Date\">Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" value=\"05\/04\/2026\" id=\"ff_21_datetime\" class=\"ff-el-form-control ff-el-datepicker ff-read-only\" data-name=\"datetime\" tabindex=\"19\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 49.31%;'><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_1013827c9daad8d756b4c70f5b1b45b3'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"20\" value=\"Je d\u00e9clare avoir pris connaissance du r\u00e8glement int\u00e9rieur de l\u2019association LOCUPALI et en accepter le contenu.\"  id='checkbox_2_1013827c9daad8d756b4c70f5b1b45b3' aria-label='Je d\u00e9clare avoir pris connaissance du r\u00e8glement int\u00e9rieur de l\u2019association LOCUPALI et en accepter le contenu.' aria-invalid='false' aria-required=true> <span>Je d\u00e9clare avoir pris connaissance du r\u00e8glement int\u00e9rieur de l\u2019association LOCUPALI et en accepter le contenu.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Je consens \u00e0 ce que ce site stocke les informations que j\u2019ai envoy\u00e9es afin de pouvoir r\u00e9pondre \u00e0 ma demande.' class='ff-el-form-check-label ff_tc_label' for=gdpr-agreement_330a4838da3e2f44b5231ff786146622><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"gdpr-agreement\" class=\"ff-el-form-check-input ff_gdpr_field\" data-name=\"gdpr-agreement\" id=\"gdpr-agreement_330a4838da3e2f44b5231ff786146622\" tabindex=\"21\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'>Je consens \u00e0 ce que ce site stocke les informations que j\u2019ai envoy\u00e9es afin de pouvoir r\u00e9pondre \u00e0 ma demande.<\/div><\/label><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper ff_submit_btn_wrapper_custom'><button class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style wpf_has_custom_css\" type=\"submit\" name=\"custom_submit_button-21_5\" data-name=\"custom_submit_button-21_5\" tabindex=\"22\"  aria-label=\"Envoyer\">Envoyer<\/button><style>form.fluent_form_21 .wpf_has_custom_css.ff-btn-submit { background-color:#409EFF;border-color:#409EFF;color:#ffffff;min-width:100%; }form.fluent_form_21 .wpf_has_custom_css.ff-btn-submit:hover { background-color:#ffffff;border-color:#409EFF;color:#409EFF;min-width:100%; } <\/style><\/div><\/fieldset><\/form><div id='fluentform_21_errors' class='ff-errors-in-stack ff_form_instance_21_1 ff-form-loading_errors ff_form_instance_21_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_21_1 = {\"id\":\"21\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_21_1\",\"form_id_selector\":\"fluentform_21\",\"rules\":{\"names_1[first_name]\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global\":false,\"global_message\":\"Ce champ est obligatoire\"}},\"names_1[middle_name]\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global\":false,\"global_message\":\"Ce champ est obligatoire\"}},\"names_1[last_name]\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global\":false,\"global_message\":\"Ce champ est 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obligatoire\"}}},\"debounce_time\":300,\"conditionals\":{\"custom_html-21_2\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_2\",\"value\":\"Virement\",\"operator\":\"=\"}],\"condition_groups\":[{\"rules\":[{\"field\":\"\",\"value\":\"\",\"operator\":\"\"}],\"title\":\"\",\"isEditingTitle\":false,\"isPreviewOpen\":false,\"isGroupOpen\":true}]}}};\n                            <\/script>\n            \n\n\n<p><\/p>\n<div class=\"pvc_clear\"><\/div><p id=\"pvc_stats_2877\" class=\"pvc_stats total_only  \" data-element-id=\"2877\" style=\"\"><i class=\"pvc-stats-icon medium\" aria-hidden=\"true\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" version=\"1.0\" viewBox=\"0 0 502 315\" preserveAspectRatio=\"xMidYMid meet\"><g transform=\"translate(0,332) scale(0.1,-0.1)\" fill=\"\" stroke=\"none\"><path d=\"M2394 3279 l-29 -30 -3 -207 c-2 -182 0 -211 15 -242 39 -76 157 -76 196 0 15 31 17 60 15 243 l-3 209 -33 29 c-26 23 -41 29 -80 29 -41 0 -53 -5 -78 -31z\"\/><path 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pla\u00eet)<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2877","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/pages\/2877","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/comments?post=2877"}],"version-history":[{"count":9,"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/pages\/2877\/revisions"}],"predecessor-version":[{"id":3311,"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/pages\/2877\/revisions\/3311"}],"wp:attachment":[{"href":"https:\/\/locupali.com\/WordPress\/index.php\/wp-json\/wp\/v2\/media?parent=2877"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}