{"id":568,"date":"2024-03-20T12:07:05","date_gmt":"2024-03-20T11:07:05","guid":{"rendered":"https:\/\/jama97.fr\/?page_id=568"},"modified":"2024-05-08T17:16:38","modified_gmt":"2024-05-08T15:16:38","slug":"inscription","status":"publish","type":"page","link":"https:\/\/jama97.fr\/guadeloupe\/inscription\/","title":{"rendered":"Inscription"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;3%&#8221; bottom_padding=&#8221;6%&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; 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row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; pointer_events=&#8221;all&#8221;][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; overflow=&#8221;visible&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/6&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][\/vc_column_inner][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; font_color=&#8221;#000000&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; overflow=&#8221;visible&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;2\/3&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221; column_padding_type=&#8221;default&#8221; gradient_type=&#8221;default&#8221;]<script>\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } );\n\n\tvar gform = {\n\t\tdomLoaded: false,\n\t\tscriptsLoaded: false,\n\t\tthemeScriptsLoaded: false,\n\t\tisFormEditor: () => typeof InitializeEditor === 'function',\n\n\t\t\/**\n\t\t * @deprecated 2.9 the use of initializeOnLoaded in the form editor context is deprecated.\n\t\t * @remove-in 4.0 this function will not check for gform.isFormEditor().\n\t\t *\/\n\t\tcallIfLoaded: function ( fn ) {\n\t\t\tif ( gform.domLoaded && gform.scriptsLoaded && ( gform.themeScriptsLoaded || gform.isFormEditor() ) ) {\n\t\t\t\tif ( gform.isFormEditor() ) {\n\t\t\t\t\tconsole.warn( 'The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.' );\n\t\t\t\t}\n\t\t\t\tfn();\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\treturn false;\n\t\t},\n\n\t\t\/**\n\t\t * Call a function when all scripts are loaded\n\t\t *\n\t\t * @param function fn the callback function to call when all scripts are loaded\n\t\t *\n\t\t * @returns void\n\t\t *\/\n\t\tinitializeOnLoaded: function( fn ) {\n\t\t\tif ( ! gform.callIfLoaded( fn ) ) {\n\t\t\t\tdocument.addEventListener( 'gform_main_scripts_loaded', () => { gform.scriptsLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', () => { gform.themeScriptsLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t\twindow.addEventListener( 'DOMContentLoaded', () => { gform.domLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t}\n\t\t},\n\n\t\thooks: { action: {}, filter: {} },\n\t\taddAction: function( action, callable, priority, tag ) {\n\t\t\tgform.addHook( 'action', action, callable, priority, tag );\n\t\t},\n\t\taddFilter: function( action, callable, priority, tag ) {\n\t\t\tgform.addHook( 'filter', action, callable, priority, tag );\n\t\t},\n\t\tdoAction: function( action ) {\n\t\t\tgform.doHook( 'action', action, arguments );\n\t\t},\n\t\tapplyFilters: function( action ) {\n\t\t\treturn gform.doHook( 'filter', action, arguments );\n\t\t},\n\t\tremoveAction: function( action, tag ) {\n\t\t\tgform.removeHook( 'action', action, tag );\n\t\t},\n\t\tremoveFilter: function( action, priority, tag ) {\n\t\t\tgform.removeHook( 'filter', action, priority, tag );\n\t\t},\n\t\taddHook: function( hookType, action, callable, priority, tag ) {\n\t\t\tif ( undefined == gform.hooks[hookType][action] ) {\n\t\t\t\tgform.hooks[hookType][action] = [];\n\t\t\t}\n\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\tif ( undefined == tag ) {\n\t\t\t\ttag = action + '_' + hooks.length;\n\t\t\t}\n\t\t\tif( priority == undefined ){\n\t\t\t\tpriority = 10;\n\t\t\t}\n\n\t\t\tgform.hooks[hookType][action].push( { tag:tag, callable:callable, priority:priority } );\n\t\t},\n\t\tdoHook: function( hookType, action, args ) {\n\n\t\t\t\/\/ splice args from object into array and remove first index which is the hook name\n\t\t\targs = Array.prototype.slice.call(args, 1);\n\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action], hook;\n\t\t\t\t\/\/sort by priority\n\t\t\t\thooks.sort(function(a,b){return a[\"priority\"]-b[\"priority\"]});\n\n\t\t\t\thooks.forEach( function( hookItem ) {\n\t\t\t\t\thook = hookItem.callable;\n\n\t\t\t\t\tif(typeof hook != 'function')\n\t\t\t\t\t\thook = window[hook];\n\t\t\t\t\tif ( 'action' == hookType ) {\n\t\t\t\t\t\thook.apply(null, args);\n\t\t\t\t\t} else {\n\t\t\t\t\t\targs[0] = hook.apply(null, args);\n\t\t\t\t\t}\n\t\t\t\t} );\n\t\t\t}\n\t\t\tif ( 'filter'==hookType ) {\n\t\t\t\treturn args[0];\n\t\t\t}\n\t\t},\n\t\tremoveHook: function( hookType, action, priority, tag ) {\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\t\thooks = hooks.filter( function(hook, index, arr) {\n\t\t\t\t\tvar removeHook = (undefined==tag||tag==hook.tag) && (undefined==priority||priority==hook.priority);\n\t\t\t\t\treturn !removeHook;\n\t\t\t\t} );\n\t\t\t\tgform.hooks[hookType][action] = hooks;\n\t\t\t}\n\t\t}\n\t};\n}\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_2' style='display:none'><style>#gform_wrapper_2[data-form-index=\"0\"].gform-theme,[data-parent-form=\"2_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' 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var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/guadeloupe\/wp-json\/wp\/v2\/pages\/568#gf_2' data-formid='2' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>3<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_67\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_67'>Facebook<\/label><div class='gfield_description' id='gfield_description_2_67'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><div class='ginput_container'><input name='input_67' id='input_2_67' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_2_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Inscrivez-vous  pour profiter de nos offres<\/h3><\/div><div id=\"field_2_32\" class=\"gfield gfield--type-username gfield--input-type-username gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_32'>Identifiant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_2_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_2'>Adresse mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_2_2' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_2_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_2_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_2_1_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_37'>Code postal<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_2_37' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='97001' >97001<\/option><option value='97110' >97110<\/option><option value='97111' >97111<\/option><option value='97112' >97112<\/option><option value='97113' >97113<\/option><option value='97114' >97114<\/option><option value='97115' >97115<\/option><option value='97116' >97116<\/option><option value='97117' >97117<\/option><option value='97118' >97118<\/option><option value='97119' >97119<\/option><option value='97120' >97120<\/option><option value='97121' >97121<\/option><option value='97122' >97122<\/option><option value='97123' >97123<\/option><option value='97125' >97125<\/option><option value='97126' >97126<\/option><option value='97127' >97127<\/option><option value='97128' >97128<\/option><option value='97129' >97129<\/option><option value='97130' >97130<\/option><option value='97131' >97131<\/option><option value='97133' >97133<\/option><option value='97134' >97134<\/option><option value='97136' >97136<\/option><option value='97137' >97137<\/option><option value='97139' >97139<\/option><option value='97140' >97140<\/option><option value='97141' >97141<\/option><option value='97142' >97142<\/option><option value='97160' >97160<\/option><option value='97170' >97170<\/option><option value='97180' >97180<\/option><option value='97190' >97190<\/option><\/select><\/div><\/div><div id=\"field_2_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_38'>ville<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_2_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_39'>pays<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_2_39' type='text' value='Guadeloupe' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_4\" class=\"gfield gfield--type-password gfield--input-type-password gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mot de passe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_password gform-grid-row' id='input_2_4_container'>\n\t\t\t\t\t\t<span id='input_2_4_1_container' class='ginput_password ginput_left gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<label for='input_2_4' class='gform-field-label gform-field-label--type-sub '>Saisir le mot de passe<\/label>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_4' id='input_2_4' onkeyup='gformShowPasswordStrength(\"input_2_4\");' onchange='gformShowPasswordStrength(\"input_2_4\");' aria-describedby=\"input_2_4_strength_indicator\" value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t<button type='button' class='gform_show_password gform-theme-button gform-theme-button--simple' onclick='javascript:gformToggleShowPassword(\"input_2_4\");' aria-live='polite' aria-label='Afficher le mot de passe' data-label-show='Afficher le mot de passe' data-label-hide='Masquer le mot de passe'><span class='dashicons dashicons-hidden' aria-hidden='true'><\/span><\/button>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<span id='input_2_4_2_container' class='ginput_password ginput_right gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<label for='input_2_4_2' class='gform-field-label gform-field-label--type-sub '>Confirmer le mot de passe<\/label>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_4_2' id='input_2_4_2' onkeyup='gformShowPasswordStrength(\"input_2_4\");' onchange='gformShowPasswordStrength(\"input_2_4\");' value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t<button type='button' class='gform_show_password gform-theme-button gform-theme-button--simple' onclick='javascript:gformToggleShowPassword(\"input_2_4_2\");' aria-live='polite' aria-label='Afficher le mot de passe' data-label-show='Afficher le mot de passe' data-label-hide='Masquer le mot de passe'><span class='dashicons dashicons-hidden' aria-hidden='true'><\/span><\/button>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><div id='input_2_4_strength_indicator' class='gfield_password_strength'  aria-live='assertive' aria-atomic='true'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tIndicateur de degr\u00e9 de s\u00fbret\u00e9\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type='hidden' class='gform_hidden' id='input_2_4_strength' name='input_4_strength' \/><\/fieldset><fieldset id=\"field_2_6\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >RGPD<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_6.1' id='input_2_6_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_6_1' >J\u2019accepte les  <a href=\"\/guadeloupe\/conditions-generales-dutilisations\/\">conditions g\u00e9n\u00e9rales d'utilisations<a\/><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_6.2' value='J\u2019accepte les  &lt;a href=&quot;\/guadeloupe\/conditions-generales-dutilisations\/&quot;&gt;conditions g\u00e9n\u00e9rales d&#039;utilisations&lt;a\/&gt;' class='gform_hidden' \/><input type='hidden' name='input_6.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_17\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >newsletter<\/legend><div class='ginput_container ginput_container_consent'><input name='input_17.1' id='input_2_17_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_17_1' >J\u2019accepte de recevoir la newsletter<\/label><input type='hidden' name='input_17.2' value='J\u2019accepte de recevoir la newsletter' class='gform_hidden' \/><input type='hidden' name='input_17.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_9' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-9' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_29\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Quels sont vos rayons pr\u00e9f\u00e9r\u00e9s ?<\/h3><\/div><fieldset id=\"field_2_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full border-input field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Alimentaire<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_55'><div class='gchoice gchoice_2_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Alimentaire'  id='choice_2_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_1' id='label_2_55_1' class='gform-field-label gform-field-label--type-inline'>Alimentaire<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full border-input field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Boissons<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_56'><div class='gchoice gchoice_2_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='Boissons'  id='choice_2_56_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_1' id='label_2_56_1' class='gform-field-label gform-field-label--type-inline'>Boissons<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_57\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full border-input field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Frais et surgel\u00e9<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_57'><div class='gchoice gchoice_2_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='Frais et surgel\u00e9'  id='choice_2_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_57_1' id='label_2_57_1' class='gform-field-label gform-field-label--type-inline'>Frais et surgel\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_58\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full border-input field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Hygi\u00e8ne et Parfumerie<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_58'><div class='gchoice gchoice_2_58_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.1' type='checkbox'  value='Hygi\u00e8ne et Parfumerie'  id='choice_2_58_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_58_1' id='label_2_58_1' class='gform-field-label gform-field-label--type-inline'>Hygi\u00e8ne et Parfumerie<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_59\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full border-input field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Sant\u00e9 &amp; Bien-\u00eatre<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_59'><div class='gchoice gchoice_2_59_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.1' type='checkbox'  value='Sant\u00e9 &amp; Bien-\u00eatre'  id='choice_2_59_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_59_1' id='label_2_59_1' class='gform-field-label gform-field-label--type-inline'>Sant\u00e9 &amp; Bien-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_66\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full form-skip-etap field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >R\u00e9pondre plus tard<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_66'><div class='gchoice gchoice_2_66_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='R\u00e9pondre plus tard'  id='choice_2_66_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_66_1' id='label_2_66_1' class='gform-field-label gform-field-label--type-inline'>R\u00e9pondre plus tard<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_51' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_2_51' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-51' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_2_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Quels sont vos points de ventes pr\u00e9f\u00e9r\u00e9s ?<\/h3><\/div><fieldset id=\"field_2_61\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half border-input-groupe field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >\t<div class=\"gf-group-items\"><div class=\"gf-items-title \">Grande-Terre<i class=\"fa-solid fa-angle-down\"><\/i><\/div><div class=\"gf-items-content \"><legend class='gfield_label gform-field-label gfield_label_before_complex' >Grande-Terre<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_61'><div class='gchoice gchoice_2_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='Carrefour Contact GRAND CAMP'  id='choice_2_61_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_1' id='label_2_61_1' class='gform-field-label gform-field-label--type-inline'>Carrefour Contact GRAND CAMP<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='Carrefour Contact St-FRANCOIS'  id='choice_2_61_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_2' id='label_2_61_2' class='gform-field-label gform-field-label--type-inline'>Carrefour Contact St-FRANCOIS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Carrefour EXPRESS MAE GRIPPON'  id='choice_2_61_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_3' id='label_2_61_3' class='gform-field-label gform-field-label--type-inline'>Carrefour EXPRESS MAE GRIPPON<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.4' type='checkbox'  value='Carrefour EXPRESS MAE LASSERRE'  id='choice_2_61_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_4' id='label_2_61_4' class='gform-field-label gform-field-label--type-inline'>Carrefour EXPRESS MAE LASSERRE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.5' type='checkbox'  value='Carrefour EXPRESS MARINA'  id='choice_2_61_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_5' id='label_2_61_5' class='gform-field-label gform-field-label--type-inline'>Carrefour EXPRESS MARINA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.6' type='checkbox'  value='Carrefour Express RAIZET'  id='choice_2_61_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_6' id='label_2_61_6' class='gform-field-label gform-field-label--type-inline'>Carrefour Express RAIZET<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.7' type='checkbox'  value='Carrefour Market ABYMES'  id='choice_2_61_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_7' id='label_2_61_7' class='gform-field-label gform-field-label--type-inline'>Carrefour Market ABYMES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.8' type='checkbox'  value='Carrefour Market MOULE'  id='choice_2_61_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_8' id='label_2_61_8' class='gform-field-label gform-field-label--type-inline'>Carrefour Market MOULE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.9' type='checkbox'  value='Carrefour MILENIS'  id='choice_2_61_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_9' id='label_2_61_9' class='gform-field-label gform-field-label--type-inline'>Carrefour MILENIS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.11' type='checkbox'  value='CASH SERGENT MOULE'  id='choice_2_61_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_11' id='label_2_61_11' class='gform-field-label gform-field-label--type-inline'>CASH SERGENT MOULE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.12' type='checkbox'  value='DISCOUNT CENTER ABYMES'  id='choice_2_61_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_12' id='label_2_61_12' class='gform-field-label gform-field-label--type-inline'>DISCOUNT CENTER ABYMES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.13' type='checkbox'  value='Hidis'  id='choice_2_61_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_13' id='label_2_61_13' class='gform-field-label gform-field-label--type-inline'>Hidis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.14' type='checkbox'  value='LECLERC GOSIER'  id='choice_2_61_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_14' id='label_2_61_14' class='gform-field-label gform-field-label--type-inline'>LECLERC GOSIER<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.15' type='checkbox'  value='MR BRICOLAGE ABYMES'  id='choice_2_61_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_15' id='label_2_61_15' class='gform-field-label gform-field-label--type-inline'>MR BRICOLAGE ABYMES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.16' type='checkbox'  value='Super U BERGEVIN'  id='choice_2_61_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_16' id='label_2_61_16' class='gform-field-label gform-field-label--type-inline'>Super U BERGEVIN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.17' type='checkbox'  value='Super U PLIANE'  id='choice_2_61_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_17' id='label_2_61_17' class='gform-field-label gform-field-label--type-inline'>Super U PLIANE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.18' type='checkbox'  value='Super U PT-CANAL'  id='choice_2_61_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_18' id='label_2_61_18' class='gform-field-label gform-field-label--type-inline'>Super U PT-CANAL<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.19' type='checkbox'  value='Super U ROCADE'  id='choice_2_61_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_19' id='label_2_61_19' class='gform-field-label gform-field-label--type-inline'>Super U ROCADE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.21' type='checkbox'  value='Super U ST-FRANCOIS'  id='choice_2_61_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_21' id='label_2_61_21' class='gform-field-label gform-field-label--type-inline'>Super U ST-FRANCOIS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_61_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.22' type='checkbox'  value='Super U St-JULES'  id='choice_2_61_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_61_22' id='label_2_61_22' class='gform-field-label gform-field-label--type-inline'>Super U St-JULES<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><\/div><pre><\/pre><\/fieldset><fieldset id=\"field_2_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half border-input-groupe field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >\t<div class=\"gf-group-items\"><div class=\"gf-items-title \">Basse-Terre<i class=\"fa-solid fa-angle-down\"><\/i><\/div><div class=\"gf-items-content \"><legend class='gfield_label gform-field-label gfield_label_before_complex' >Basse-Terre<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_62'><div class='gchoice gchoice_2_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='8 A 8 LAMENTIN'  id='choice_2_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_1' id='label_2_62_1' class='gform-field-label gform-field-label--type-inline'>8 A 8 LAMENTIN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.2' type='checkbox'  value='Carrefour DESTRELAND'  id='choice_2_62_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_2' id='label_2_62_2' class='gform-field-label gform-field-label--type-inline'>Carrefour DESTRELAND<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.3' type='checkbox'  value='Carrefour EXPRESS BELCOURT'  id='choice_2_62_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_3' id='label_2_62_3' class='gform-field-label gform-field-label--type-inline'>Carrefour EXPRESS BELCOURT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.4' type='checkbox'  value='Carrefour EXPRESS LA BOUCAN'  id='choice_2_62_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_4' id='label_2_62_4' class='gform-field-label gform-field-label--type-inline'>Carrefour EXPRESS LA BOUCAN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.5' type='checkbox'  value='Carrefour EXPRESS LAMENTIN'  id='choice_2_62_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_5' id='label_2_62_5' class='gform-field-label gform-field-label--type-inline'>Carrefour EXPRESS LAMENTIN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.6' type='checkbox'  value='Carrefour Market BAILLIF'  id='choice_2_62_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_6' id='label_2_62_6' class='gform-field-label gform-field-label--type-inline'>Carrefour Market BAILLIF<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.7' type='checkbox'  value='Carrefour Market BOUILLANTE'  id='choice_2_62_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_7' id='label_2_62_7' class='gform-field-label gform-field-label--type-inline'>Carrefour Market BOUILLANTE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.8' type='checkbox'  value='Carrefour Market COLIN'  id='choice_2_62_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_8' id='label_2_62_8' class='gform-field-label gform-field-label--type-inline'>Carrefour Market COLIN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.9' type='checkbox'  value='Carrefour Market LAMENTIN'  id='choice_2_62_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_9' id='label_2_62_9' class='gform-field-label gform-field-label--type-inline'>Carrefour Market LAMENTIN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.11' type='checkbox'  value='Carrefour Market STE-ROSE'  id='choice_2_62_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_11' id='label_2_62_11' class='gform-field-label gform-field-label--type-inline'>Carrefour Market STE-ROSE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.12' type='checkbox'  value='CASINO JARDISUP'  id='choice_2_62_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_12' id='label_2_62_12' class='gform-field-label gform-field-label--type-inline'>CASINO JARDISUP<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.13' type='checkbox'  value='HOME ANIMAL JARRY'  id='choice_2_62_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_13' id='label_2_62_13' class='gform-field-label gform-field-label--type-inline'>HOME ANIMAL JARRY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.14' type='checkbox'  value='JARDILAND'  id='choice_2_62_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_14' id='label_2_62_14' class='gform-field-label gform-field-label--type-inline'>JARDILAND<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.15' type='checkbox'  value='LECLERC STE-ROSE'  id='choice_2_62_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_15' id='label_2_62_15' class='gform-field-label gform-field-label--type-inline'>LECLERC STE-ROSE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.16' type='checkbox'  value='MR BRICOLAGE DESTRELAND'  id='choice_2_62_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_16' id='label_2_62_16' class='gform-field-label gform-field-label--type-inline'>MR BRICOLAGE DESTRELAND<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.17' type='checkbox'  value='Petit CASINO DORVILLE'  id='choice_2_62_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_17' id='label_2_62_17' class='gform-field-label gform-field-label--type-inline'>Petit CASINO DORVILLE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.18' type='checkbox'  value='Super U BAILLIF'  id='choice_2_62_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_18' id='label_2_62_18' class='gform-field-label gform-field-label--type-inline'>Super U BAILLIF<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.19' type='checkbox'  value='Super U COLIN'  id='choice_2_62_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_19' id='label_2_62_19' class='gform-field-label gform-field-label--type-inline'>Super U COLIN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_62_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.21' type='checkbox'  value='Super U DESMARAIS'  id='choice_2_62_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_62_21' id='label_2_62_21' class='gform-field-label gform-field-label--type-inline'>Super U DESMARAIS<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><\/div><pre><\/pre><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Envoyer'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' 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