{"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":"2026-08-19T18:00:13","modified_gmt":"2026-08-19T16:00:13","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":"\r\n<h2 class=\"wp-block-heading has-text-align-center has-black-color has-text-color has-link-color wp-elements-1\"><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>\r\n\r\n\r\n<div class='fluentform ff-default fluentform_wrapper_23  ff_guten_block ff_guten_block-23 ffs_custom_wrap'><form data-form_id=\"23\" id=\"fluentform_23\" class=\"frm-fluent-form fluent_form_23 ff-el-form-top ff_form_instance_23_1 ff-form-loading ffs_custom\" data-form_instance=\"ff_form_instance_23_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&#039;INSCRIPTION (#7) (#21) (#23)<\/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=\"221\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/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_23_item_sf\" aria-label=\"Subscribe\">\n                    Subscribe                <\/label>\n            <\/div>\n            <div class=\"ff-el-input--content\">\n                <input type=\"text\"\n                       name=\"item_23__fluent_sf\"\n                       class=\"ff-el-form-control\"\n                       id=\"ff_23_item_sf\"\n                \/>\n            <\/div>\n        <\/div>\n        <input type='hidden' name='__fluent_form_embded_post_id' value='2877' \/><input type=\"hidden\" id=\"_fluentform_23_fluentformnonce\" name=\"_fluentform_23_fluentformnonce\" value=\"e1cad64272\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/WordPress\/index.php\/wp-json\/wp\/v2\/pages\/2877\" \/><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_23_names_1_first_name_' id='label_ff_23_names_1_first_name_' >Nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_23_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_23_names_1_last_name_' id='label_ff_23_names_1_last_name_' >Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_23_names_1_last_name_\" class=\"ff-el-form-control\" placeholder=\"pr\u00e9nom\" 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_23_input_text_1' id='label_ff_23_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_23_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_23_email_adherent' id='label_ff_23_email_adherent' aria-label=\"E-mail\">E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_adherent\" id=\"ff_23_email_adherent\" class=\"ff-el-form-control\" placeholder=\"mel\" 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 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_601b0a9f02e11f259855cbf821c636a7'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"5\" value=\"Ch\u00e8que\"  id='input_radio_2_601b0a9f02e11f259855cbf821c636a7' 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_7f207f6209648fd6b2bc8ca1f237f384'><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_7f207f6209648fd6b2bc8ca1f237f384' aria-label='Virement' aria-invalid='false' aria-required=true> <span>Virement<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 37.51%;'><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-23_1\" ><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 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   aria-label=\"Nouvel adh\u00e9rent ou changement :\">Nouvel adh\u00e9rent ou changement :<\/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_ba64377d26e616219a41450f1b983bf3'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"6\" value=\"Oui\"  id='input_radio_ba64377d26e616219a41450f1b983bf3' aria-label='Oui' aria-invalid='false' aria-required=true> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_f4b24a06a577f192606c12c8edf8eaab'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Non\"  id='input_radio_f4b24a06a577f192606c12c8edf8eaab' aria-label='Non' aria-invalid='false' aria-required=true> <span>Non<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-23_2\" ><h3 style=\"text-align: center\"><span class=\"Aucun\"><i><span lang=\"EN-US\">Ne remplir la suite que pour une nouvelle adh\u00e9sion ou un changement<\/span><\/i><\/span><\/h3><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-23_3\" ><div>\n<p 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 un m\u00e9l<\/u><\/i><\/b><\/span><u><\/u><\/p>\n<\/div>\n<div style=\"text-align: center\"><span class=\"Aucun\"><span lang=\"EN-US\">(A d\u00e9faut, vous pouvez donner le m\u00e9l d\u2019un autre adh\u00e9rent qui s\u2019engage \u00e0 vous communiquer les informations qu\u2019il recevra)<\/span><\/span><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address has-conditions\" 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_23_address_1_address_line_1_' id='label_ff_23_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_23_address_1_address_line_1_\" class=\"ff-el-form-control\" data-key_name=\"address_line_1\" tabindex=\"7\"  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_23_address_1_city_' id='label_ff_23_address_1_city_' aria-label=\"Ville\">Ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_23_address_1_city_\" class=\"ff-el-form-control\" data-key_name=\"city\" tabindex=\"8\"  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_23_address_1_state_' id='label_ff_23_address_1_state_' aria-label=\"Code postal\">Code postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_23_address_1_state_\" class=\"ff-el-form-control\" data-key_name=\"state\" tabindex=\"9\"  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_23_address_1_zip_' id='label_ff_23_address_1_zip_' aria-label=\"T\u00e9l\u00e9phone fixe\">T\u00e9l\u00e9phone fixe<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_23_address_1_zip_\" class=\"ff-el-form-control\" data-key_name=\"zip\" tabindex=\"10\"  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_23_address_1_country_' id='label_ff_23_address_1_country_' aria-label=\"T\u00e9l\u00e9phone mobile\">T\u00e9l\u00e9phone mobile<\/label><\/div><div class='ff-el-input--content'><select name=\"address_1[country]\" id=\"ff_23_address_1_country_\" class=\"ff-el-form-control\" data-key_name=\"country\" tabindex=\"11\" aria-invalid='false' aria-required=true><option value=''><\/option><option value='AF' >Afghanistan<\/option><option value='ZA' >Afrique du Sud<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='DE' >Allemagne<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua-et-Barbuda<\/option><option value='SA' >Arabie Saoudite<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbades<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BY' >Bi\u00e9lorussie<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie-Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BN' >Brunei<\/option><option value='BR' >Br\u00e9sil<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='BJ' >B\u00e9nin<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CY' >Chypre<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='KP' >Cor\u00e9e du Nord<\/option><option value='KR' >Cor\u00e9e du Sud<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CI' >C\u00f4te-d\u2019Ivoire<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='ER' >Erythr\u00e9e<\/option><option value='ES' >Espagne<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='US' >Etats-Unis (USA)<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenade<\/option><option value='GL' >Groenland<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernesey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GY' >Guyane<\/option><option value='GF' >Guyane Fran\u00e7aise<\/option><option value='GE' >G\u00e9orgie<\/option><option value='GS' >G\u00e9orgie du Sud \/ \u00eeles Sandwich<\/option><option value='HT' >Ha\u00efti<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Irlande<\/option><option value='IS' >Islande<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='XK' >Kosovo<\/option><option value='KW' >Kowe\u00eft<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Laos<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao S.A.R., Chine<\/option><option value='MK' >Mac\u00e9doine du Nord<\/option><option value='MG' >Madagascar<\/option><option value='MY' >Malaisie<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MA' >Maroc<\/option><option value='MQ' >Martinique<\/option><option value='MU' >Maurice<\/option><option value='MR' >Mauritanie<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niue<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='NC' >Nouvelle-Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='NP' >N\u00e9pal<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palaos<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='NL' >Pays-Bas<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Pologne<\/option><option value='PF' >Polyn\u00e9sie Fran\u00e7aise<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='PE' >P\u00e9rou<\/option><option value='QA' >Qatar<\/option><option value='RO' >Roumanie<\/option><option value='GB' >Royaume-Uni (UK)<\/option><option value='RU' >Russie<\/option><option value='RW' >Rwanda<\/option><option value='CF' >R\u00e9publique Centrafricaine<\/option><option value='DO' >R\u00e9publique Dominicaine<\/option><option value='CZ' >R\u00e9publique Tch\u00e8que<\/option><option value='CG' >R\u00e9publique du Congo (Brazzaville)<\/option><option value='CD' >R\u00e9publique d\u00e9mocratique du Congo (Kinshasa)<\/option><option value='RE' >R\u00e9union<\/option><option value='EH' >Sahara occidental<\/option><option value='BL' >Saint-Barth\u00e9lemy<\/option><option value='KN' >Saint-Kitts-et-Nevis<\/option><option value='MF' >Saint-Martin (partie fran\u00e7aise)<\/option><option value='SX' >Saint-Martin (partie n\u00e9erlandaise)<\/option><option value='PM' >Saint-Pierre-et-Miquelon<\/option><option value='VC' >Saint-Vincent-et-les-Grenadines<\/option><option value='SH' >Sainte-H\u00e9l\u00e8ne<\/option><option value='LC' >Sainte-Lucie<\/option><option value='SV' >Salvador<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9-et-Principe<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SO' >Somalie<\/option><option value='SD' >Soudan<\/option><option value='SS' >Soudan du Sud<\/option><option value='LK' >Sri Lanka<\/option><option value='CH' >Suisse<\/option><option value='SR' >Suriname<\/option><option value='SE' >Su\u00e8de<\/option><option value='SJ' >Svalbard et Jan Mayen<\/option><option value='SY' >Syrie<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzanie<\/option><option value='TD' >Tchad<\/option><option value='TF' >Terres australes et antarctiques fran\u00e7aises<\/option><option value='PS' >Territoire Palestinien<\/option><option value='IO' >Territoire britannique de l&rsquo;oc\u00e9an Indien<\/option><option value='TH' >Thailande<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9-et-Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TR' >Turquie<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vatican<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis et Futuna<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><option value='EG' >\u00c9gypte<\/option><option value='AE' >\u00c9mirats Arabes Unis<\/option><option value='EC' >\u00c9quateur<\/option><option value='ET' >\u00c9thiopie<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='CX' >\u00cele Christmas<\/option><option value='NF' >\u00cele Norfolk<\/option><option value='IM' >\u00cele de Man<\/option><option value='AX' >\u00celes Aland<\/option><option value='KY' >\u00celes Ca\u00efmans<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CK' >\u00celes Cook<\/option><option value='FK' >\u00celes Falkland<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='HM' >\u00celes Heard-et-MacDonald<\/option><option value='MP' >\u00celes Mariannes du Nord<\/option><option value='MH' >\u00celes Marshall<\/option><option value='UM' >\u00celes Mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><option value='SB' >\u00celes Salomon<\/option><option value='TC' >\u00celes Turques et Ca\u00efques<\/option><option value='VI' >\u00celes Vierges am\u00e9ricaines (US)<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><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_1409784c1eae846f3ee4648b31b4a5d6'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"12\" value=\"Par vos amis ou relations\"  id='input_radio_3_1409784c1eae846f3ee4648b31b4a5d6' 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_0725380fbf43f8180a49566f17339af4'><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_0725380fbf43f8180a49566f17339af4' 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_8b3da24d8fc5d8ef6e0cef0c9221ce2e'><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_8b3da24d8fc5d8ef6e0cef0c9221ce2e' aria-label='Autre' aria-invalid='false' aria-required=true> <span>Autre<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_23_input_text' id='label_ff_23_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=\"13\" id=\"ff_23_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 59.48%;'><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 40.52%;'><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-23_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=\"has-conditions  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_23_names_first_name_' id='label_ff_23_names_first_name_' >Nom_contact 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_23_names_first_name_\" class=\"ff-el-form-control\" tabindex=\"14\" 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_23_names_last_name_' id='label_ff_23_names_last_name_' >Pr\u00e9nom _contact 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_23_names_last_name_\" class=\"ff-el-form-control\" tabindex=\"15\" 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: 49.65%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_23_phone_2' id='label_ff_23_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_23_phone_2\" tabindex=\"16\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_23_phone_4' id='label_ff_23_phone_4' aria-label=\"T\u00e9l\u00e9phone contact 1\">T\u00e9l\u00e9phone contact 1<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_4\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" data-name=\"phone_4\" id=\"ff_23_phone_4\" tabindex=\"17\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/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=\"has-conditions  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_23_names_2_first_name_' id='label_ff_23_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_23_names_2_first_name_\" class=\"ff-el-form-control\" tabindex=\"18\" 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_23_names_2_last_name_' id='label_ff_23_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_23_names_2_last_name_\" class=\"ff-el-form-control\" tabindex=\"19\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_7\"  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 has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_23_phone_3' id='label_ff_23_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_23_phone_3\" tabindex=\"20\" 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_8\"  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_23_datetime_1' id='label_ff_23_datetime_1' 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_1\" value=\"03\/10\/2026\" id=\"ff_23_datetime_1\" class=\"ff-el-form-control ff-el-datepicker ff-read-only\" data-name=\"datetime_1\" tabindex=\"21\"  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_8aceb9a6bff4d6ed15cc967eeff0a3be'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"22\" value=\"Je d\u00e9clare avoir pris connaissance du r\u00e8glement int\u00e9rieur de l\u2019association LOCUPALI et en accepter le contenu.\"  id='checkbox_2_8aceb9a6bff4d6ed15cc967eeff0a3be' 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_90f691a0b452421b70580ce522a6ce1c><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_90f691a0b452421b70580ce522a6ce1c\" tabindex=\"23\"  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-23_5\" data-name=\"custom_submit_button-23_5\" tabindex=\"24\"  aria-label=\"Envoyer\">Envoyer<\/button><style>form.fluent_form_23 .wpf_has_custom_css.ff-btn-submit { background-color:#409EFF;border-color:#409EFF;color:#ffffff;min-width:100%; }form.fluent_form_23 .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_23_errors' class='ff-errors-in-stack ff_form_instance_23_1 ff-form-loading_errors ff_form_instance_23_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_23_1 = {\"id\":\"23\",\"ajaxUrl\":\"https:\\\/\\\/locupali.com\\\/WordPress\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_23_1\",\"form_id_selector\":\"fluentform_23\",\"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 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