{"id":371406,"date":"2024-07-17T09:14:20","date_gmt":"2024-07-17T09:14:20","guid":{"rendered":"https:\/\/centromedicomanzanera.com\/formulario-es\/"},"modified":"2024-10-09T09:34:34","modified_gmt":"2024-10-09T09:34:34","slug":"formulario-fr","status":"publish","type":"page","link":"https:\/\/centromedicomanzanera.com\/fr\/formulario-fr\/","title":{"rendered":"Formulario FR"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;800px&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.26.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][wpforms_selector form_id=&#8221;371613&#8243; show_title=&#8221;off&#8221; _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/wpforms_selector][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"et_pb_module wpforms_selector wpforms_selector_0\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_module_inner\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-371613\">\n\t\t\t\t#wpforms-371613 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-371613\"><form id=\"wpforms-form-371613\" class=\"wpforms-validate wpforms-form\" data-formid=\"371613\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/371406\" data-token=\"ad43e132aef5a95bcdcf66329cc4f028\" data-token-time=\"1775830832\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-371613-field_47-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"47\"><input type=\"hidden\" id=\"wpforms-371613-field_47\" name=\"wpforms[fields][47]\" value=\"10\/04\/2026\"><\/div><div id=\"wpforms-371613-field_56-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"56\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-371613-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-371613-field_0\">PR\u00c9NOM <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-371613-field_0\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][0]\" aria-errormessage=\"wpforms-371613-field_0-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-371613-field_43-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-371613-field_43\">NOM<\/label><input type=\"text\" id=\"wpforms-371613-field_43\" class=\"wpforms-field-large\" name=\"wpforms[fields][43]\" aria-errormessage=\"wpforms-371613-field_43-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-371613-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-371613-field_1\">E-MAIL <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-371613-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-371613-field_1-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-371613-field_19-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-371613-field_19\">NUM\u00c9RO DE T\u00c9L\u00c9PHONE<\/label><input type=\"tel\" id=\"wpforms-371613-field_19\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][19]\" aria-label=\"NUM\u00c9RO DE T\u00c9L\u00c9PHONE\" aria-errormessage=\"wpforms-371613-field_19-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-371613-field_14-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"14\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-371613-field_18-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-371613-field_18\">PAYS <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-371613-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required=\"required\"><option value=\"FR France\" >FR France<\/option><option value=\"AF Afghanistan\" >AF Afghanistan<\/option><option value=\"ZA Afrique du Sud\" >ZA Afrique du Sud<\/option><option value=\"AL Albanie\" >AL Albanie<\/option><option value=\"DZ Alg\u00e9rie\" >DZ Alg\u00e9rie<\/option><option value=\"DE Allemagne\" >DE Allemagne<\/option><option value=\"AD Andorre\" >AD Andorre<\/option><option value=\"AO Angola\" >AO Angola<\/option><option value=\"AI Anguilla\" >AI Anguilla<\/option><option value=\"AQ Antarctique\" >AQ Antarctique<\/option><option value=\"AG Antigua-et-Barbuda\" >AG Antigua-et-Barbuda<\/option><option value=\"SA Arabie saoudite\" >SA Arabie saoudite<\/option><option value=\"AR Argentine\" >AR Argentine<\/option><option value=\"AM Arm\u00e9nie\" >AM Arm\u00e9nie<\/option><option value=\"AW Aruba\" >AW Aruba<\/option><option value=\"AU Australie\" >AU Australie<\/option><option value=\"AT Autriche\" >AT Autriche<\/option><option value=\"AZ Azerba\u00efdjan\" >AZ Azerba\u00efdjan<\/option><option value=\"BS Bahamas\" >BS Bahamas<\/option><option value=\"BH Bahre\u00efn\" >BH Bahre\u00efn<\/option><option value=\"BD Bangladesh\" >BD Bangladesh<\/option><option value=\"BB Barbade\" >BB Barbade<\/option><option value=\"BE Belgique\" >BE Belgique<\/option><option value=\"BZ Belize\" >BZ Belize<\/option><option value=\"BJ B\u00e9nin\" >BJ B\u00e9nin<\/option><option value=\"BM Bermudes\" >BM Bermudes<\/option><option value=\"BT Bhoutan\" >BT Bhoutan<\/option><option value=\"BY Bi\u00e9lorussie\" >BY Bi\u00e9lorussie<\/option><option value=\"BO Bolivie\" >BO Bolivie<\/option><option value=\"BA Bosnie-Herz\u00e9govine\" >BA Bosnie-Herz\u00e9govine<\/option><option value=\"BW Botswana\" >BW Botswana<\/option><option value=\"BR Br\u00e9sil\" >BR Br\u00e9sil<\/option><option value=\"BN Brunei\" >BN Brunei<\/option><option value=\"BG Bulgarie\" >BG Bulgarie<\/option><option value=\"BF Burkina Faso\" >BF Burkina Faso<\/option><option value=\"BI Burundi\" >BI Burundi<\/option><option value=\"KH Cambodge\" >KH Cambodge<\/option><option value=\"CM Cameroun\" >CM Cameroun<\/option><option value=\"CA Canada\" >CA Canada<\/option><option value=\"CV Cap-Vert\" >CV Cap-Vert<\/option><option value=\"CL Chili\" >CL Chili<\/option><option value=\"CN Chine\" >CN Chine<\/option><option value=\"CY Chypre\" >CY Chypre<\/option><option value=\"CO Colombie\" >CO Colombie<\/option><option value=\"KM Comores\" >KM Comores<\/option><option value=\"CG Congo-Brazzaville\" >CG Congo-Brazzaville<\/option><option value=\"CD Congo-Kinshasa\" >CD Congo-Kinshasa<\/option><option value=\"KP Cor\u00e9e du Nord\" >KP Cor\u00e9e du Nord<\/option><option value=\"KR Cor\u00e9e du Sud\" >KR Cor\u00e9e du Sud<\/option><option value=\"CR Costa Rica\" >CR Costa Rica<\/option><option value=\"CI C\u00f4te d\u2019Ivoire\" >CI C\u00f4te d\u2019Ivoire<\/option><option value=\"HR Croatie\" >HR Croatie<\/option><option value=\"CU Cuba\" >CU Cuba<\/option><option value=\"CW Cura\u00e7ao\" >CW Cura\u00e7ao<\/option><option value=\"DK Danemark\" >DK Danemark<\/option><option value=\"DJ Djibouti\" >DJ Djibouti<\/option><option value=\"DM Dominique\" >DM Dominique<\/option><option value=\"EG \u00c9gypte\" >EG \u00c9gypte<\/option><option value=\"AE \u00c9mirats arabes unis\" >AE \u00c9mirats arabes unis<\/option><option value=\"EC \u00c9quateur\" >EC \u00c9quateur<\/option><option value=\"ER \u00c9rythr\u00e9e\" >ER \u00c9rythr\u00e9e<\/option><option value=\"ES Espagne\" >ES Espagne<\/option><option value=\"EE Estonie\" >EE Estonie<\/option><option value=\"SZ Eswatini\" >SZ Eswatini<\/option><option value=\"VA \u00c9tat de la Cit\u00e9 du Vatican\" >VA \u00c9tat de la Cit\u00e9 du Vatican<\/option><option value=\"US \u00c9tats-Unis\" >US \u00c9tats-Unis<\/option><option value=\"ET \u00c9thiopie\" >ET \u00c9thiopie<\/option><option value=\"FJ Fidji\" >FJ Fidji<\/option><option value=\"FI Finlande\" >FI Finlande<\/option><option value=\"GA Gabon\" >GA Gabon<\/option><option value=\"GM Gambie\" >GM Gambie<\/option><option value=\"GE G\u00e9orgie\" >GE G\u00e9orgie<\/option><option value=\"GS G\u00e9orgie du Sud-et-les \u00celes Sandwich du Sud\" >GS G\u00e9orgie du Sud-et-les \u00celes Sandwich du Sud<\/option><option value=\"GH Ghana\" >GH Ghana<\/option><option value=\"GI Gibraltar\" >GI Gibraltar<\/option><option value=\"GR Gr\u00e8ce\" >GR Gr\u00e8ce<\/option><option value=\"GD Grenade\" >GD Grenade<\/option><option value=\"GL Groenland\" >GL Groenland<\/option><option value=\"GP Guadeloupe\" >GP Guadeloupe<\/option><option value=\"GU Guam\" >GU Guam<\/option><option value=\"GT Guatemala\" >GT Guatemala<\/option><option value=\"GG Guernesey\" >GG Guernesey<\/option><option value=\"GN Guin\u00e9e\" >GN Guin\u00e9e<\/option><option value=\"GQ Guin\u00e9e \u00e9quatoriale\" >GQ Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW Guin\u00e9e-Bissau\" >GW Guin\u00e9e-Bissau<\/option><option value=\"GY Guyana\" >GY Guyana<\/option><option value=\"GF Guyane fran\u00e7aise\" >GF Guyane fran\u00e7aise<\/option><option value=\"HT Ha\u00efti\" >HT Ha\u00efti<\/option><option value=\"HN Honduras\" >HN Honduras<\/option><option value=\"HU Hongrie\" >HU Hongrie<\/option><option value=\"BV \u00cele Bouvet\" >BV \u00cele Bouvet<\/option><option value=\"CX \u00cele Christmas\" >CX \u00cele Christmas<\/option><option value=\"IM \u00cele de Man\" >IM \u00cele de Man<\/option><option value=\"NF \u00cele Norfolk\" >NF \u00cele Norfolk<\/option><option value=\"AX \u00celes \u00c5land\" >AX \u00celes \u00c5land<\/option><option value=\"KY \u00celes Ca\u00efmans\" >KY \u00celes Ca\u00efmans<\/option><option value=\"CC \u00celes Cocos\" >CC \u00celes Cocos<\/option><option value=\"CK \u00celes Cook\" >CK \u00celes Cook<\/option><option value=\"FO \u00celes F\u00e9ro\u00e9\" >FO \u00celes F\u00e9ro\u00e9<\/option><option value=\"HM \u00celes Heard-et-MacDonald\" >HM \u00celes Heard-et-MacDonald<\/option><option value=\"FK \u00celes Malouines\" >FK \u00celes Malouines<\/option><option value=\"MP \u00celes Mariannes du Nord\" >MP \u00celes Mariannes du Nord<\/option><option value=\"MH \u00celes Marshall\" >MH \u00celes Marshall<\/option><option value=\"UM \u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" >UM \u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><option value=\"PN \u00celes Pitcairn\" >PN \u00celes Pitcairn<\/option><option value=\"SB \u00celes Salomon\" >SB \u00celes Salomon<\/option><option value=\"TC \u00celes Turques-et-Ca\u00efques\" >TC \u00celes Turques-et-Ca\u00efques<\/option><option value=\"VG \u00celes Vierges britanniques\" >VG \u00celes Vierges britanniques<\/option><option value=\"VI \u00celes Vierges des \u00c9tats-Unis\" >VI \u00celes Vierges des \u00c9tats-Unis<\/option><option value=\"IN Inde\" >IN Inde<\/option><option value=\"ID Indon\u00e9sie\" >ID Indon\u00e9sie<\/option><option value=\"IQ Irak\" >IQ Irak<\/option><option value=\"IR Iran\" >IR Iran<\/option><option value=\"IE Irlande\" >IE Irlande<\/option><option value=\"IS Islande\" >IS Islande<\/option><option value=\"IL Isra\u00ebl\" >IL Isra\u00ebl<\/option><option value=\"IT Italie\" >IT Italie<\/option><option value=\"JM Jama\u00efque\" >JM Jama\u00efque<\/option><option value=\"JP Japon\" >JP Japon<\/option><option value=\"JE Jersey\" >JE Jersey<\/option><option value=\"JO Jordanie\" >JO Jordanie<\/option><option value=\"KZ Kazakhstan\" >KZ Kazakhstan<\/option><option value=\"KE Kenya\" >KE Kenya<\/option><option value=\"KG Kirghizstan\" >KG Kirghizstan<\/option><option value=\"KI Kiribati\" >KI Kiribati<\/option><option value=\"KW Kowe\u00eft\" >KW Kowe\u00eft<\/option><option value=\"RE La R\u00e9union\" >RE La R\u00e9union<\/option><option value=\"LA Laos\" >LA Laos<\/option><option value=\"LS Lesotho\" >LS Lesotho<\/option><option value=\"LV Lettonie\" >LV Lettonie<\/option><option value=\"LB Liban\" >LB Liban<\/option><option value=\"LR Liberia\" >LR Liberia<\/option><option value=\"LY Libye\" >LY Libye<\/option><option value=\"LI Liechtenstein\" >LI Liechtenstein<\/option><option value=\"LT Lituanie\" >LT Lituanie<\/option><option value=\"LU Luxembourg\" >LU Luxembourg<\/option><option value=\"MK Mac\u00e9doine du Nord\" >MK Mac\u00e9doine du Nord<\/option><option value=\"MG Madagascar\" >MG Madagascar<\/option><option value=\"MY Malaisie\" >MY Malaisie<\/option><option value=\"MW Malawi\" >MW Malawi<\/option><option value=\"MV Maldives\" >MV Maldives<\/option><option value=\"ML Mali\" >ML Mali<\/option><option value=\"MT Malte\" >MT Malte<\/option><option value=\"MA Maroc\" >MA Maroc<\/option><option value=\"MQ Martinique\" >MQ Martinique<\/option><option value=\"MU Maurice\" >MU Maurice<\/option><option value=\"MR Mauritanie\" >MR Mauritanie<\/option><option value=\"YT Mayotte\" >YT Mayotte<\/option><option value=\"MX Mexique\" >MX Mexique<\/option><option value=\"FM Micron\u00e9sie\" >FM Micron\u00e9sie<\/option><option value=\"MD Moldavie\" >MD Moldavie<\/option><option value=\"MC Monaco\" >MC Monaco<\/option><option value=\"MN Mongolie\" >MN Mongolie<\/option><option value=\"ME Mont\u00e9n\u00e9gro\" >ME Mont\u00e9n\u00e9gro<\/option><option value=\"MS Montserrat\" >MS Montserrat<\/option><option value=\"MZ Mozambique\" >MZ Mozambique<\/option><option value=\"MM Myanmar (Birmanie)\" >MM Myanmar (Birmanie)<\/option><option value=\"NA Namibie\" >NA Namibie<\/option><option value=\"NR Nauru\" >NR Nauru<\/option><option value=\"NP N\u00e9pal\" >NP N\u00e9pal<\/option><option value=\"NI Nicaragua\" >NI Nicaragua<\/option><option value=\"NE Niger\" >NE Niger<\/option><option value=\"NG Nigeria\" >NG Nigeria<\/option><option value=\"NU Niue\" >NU Niue<\/option><option value=\"NO Norv\u00e8ge\" >NO Norv\u00e8ge<\/option><option value=\"NC Nouvelle-Cal\u00e9donie\" >NC Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ Nouvelle-Z\u00e9lande\" >NZ Nouvelle-Z\u00e9lande<\/option><option value=\"OM Oman\" >OM Oman<\/option><option value=\"UG Ouganda\" >UG Ouganda<\/option><option value=\"UZ Ouzb\u00e9kistan\" >UZ Ouzb\u00e9kistan<\/option><option value=\"PK Pakistan\" >PK Pakistan<\/option><option value=\"PW Palaos\" >PW Palaos<\/option><option value=\"PA Panama\" >PA Panama<\/option><option value=\"PG Papouasie-Nouvelle-Guin\u00e9e\" >PG Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY Paraguay\" >PY Paraguay<\/option><option value=\"NL Pays-Bas\" >NL Pays-Bas<\/option><option value=\"BQ Pays-Bas carib\u00e9ens\" >BQ Pays-Bas carib\u00e9ens<\/option><option value=\"PE P\u00e9rou\" >PE P\u00e9rou<\/option><option value=\"PH Philippines\" >PH Philippines<\/option><option value=\"PL Pologne\" >PL Pologne<\/option><option value=\"PF Polyn\u00e9sie fran\u00e7aise\" >PF Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR Porto Rico\" >PR Porto Rico<\/option><option value=\"PT Portugal\" >PT Portugal<\/option><option value=\"QA Qatar\" >QA Qatar<\/option><option value=\"HK R.A.S. chinoise de Hong Kong\" >HK R.A.S. chinoise de Hong Kong<\/option><option value=\"MO R.A.S. chinoise de Macao\" >MO R.A.S. chinoise de Macao<\/option><option value=\"CF R\u00e9publique centrafricaine\" >CF R\u00e9publique centrafricaine<\/option><option value=\"DO R\u00e9publique dominicaine\" >DO R\u00e9publique dominicaine<\/option><option value=\"RO Roumanie\" >RO Roumanie<\/option><option value=\"GB Royaume-Uni\" >GB Royaume-Uni<\/option><option value=\"RU Russie\" >RU Russie<\/option><option value=\"RW Rwanda\" >RW Rwanda<\/option><option value=\"EH Sahara occidental\" >EH Sahara occidental<\/option><option value=\"BL Saint-Barth\u00e9lemy\" >BL Saint-Barth\u00e9lemy<\/option><option value=\"KN Saint-Christophe-et-Ni\u00e9v\u00e8s\" >KN Saint-Christophe-et-Ni\u00e9v\u00e8s<\/option><option value=\"SM Saint-Marin\" >SM Saint-Marin<\/option><option value=\"MF Saint-Martin\" >MF Saint-Martin<\/option><option value=\"SX Saint-Martin (partie n\u00e9erlandaise)\" >SX Saint-Martin (partie n\u00e9erlandaise)<\/option><option value=\"PM Saint-Pierre-et-Miquelon\" >PM Saint-Pierre-et-Miquelon<\/option><option value=\"VC Saint-Vincent-et-les Grenadines\" >VC Saint-Vincent-et-les Grenadines<\/option><option value=\"SH Sainte-H\u00e9l\u00e8ne\" >SH Sainte-H\u00e9l\u00e8ne<\/option><option value=\"LC Sainte-Lucie\" >LC Sainte-Lucie<\/option><option value=\"SV Salvador\" >SV Salvador<\/option><option value=\"WS Samoa\" >WS Samoa<\/option><option value=\"AS Samoa am\u00e9ricaines\" >AS Samoa am\u00e9ricaines<\/option><option value=\"ST Sao Tom\u00e9-et-Principe\" >ST Sao Tom\u00e9-et-Principe<\/option><option value=\"SN S\u00e9n\u00e9gal\" >SN S\u00e9n\u00e9gal<\/option><option value=\"RS Serbie\" >RS Serbie<\/option><option value=\"SC Seychelles\" >SC Seychelles<\/option><option value=\"SL Sierra Leone\" >SL Sierra Leone<\/option><option value=\"SG Singapour\" >SG Singapour<\/option><option value=\"SK Slovaquie\" >SK Slovaquie<\/option><option value=\"SI Slov\u00e9nie\" >SI Slov\u00e9nie<\/option><option value=\"SO Somalie\" >SO Somalie<\/option><option value=\"SD Soudan\" >SD Soudan<\/option><option value=\"SS Soudan du Sud\" >SS Soudan du Sud<\/option><option value=\"LK Sri Lanka\" >LK Sri Lanka<\/option><option value=\"SE Su\u00e8de\" >SE Su\u00e8de<\/option><option value=\"CH Suisse\" >CH Suisse<\/option><option value=\"SR Suriname\" >SR Suriname<\/option><option value=\"SJ Svalbard et Jan Mayen\" >SJ Svalbard et Jan Mayen<\/option><option value=\"SY Syrie\" >SY Syrie<\/option><option value=\"TJ Tadjikistan\" >TJ Tadjikistan<\/option><option value=\"TW Ta\u00efwan\" >TW Ta\u00efwan<\/option><option value=\"TZ Tanzanie\" >TZ Tanzanie<\/option><option value=\"TD Tchad\" >TD Tchad<\/option><option value=\"CZ Tch\u00e9quie\" >CZ Tch\u00e9quie<\/option><option value=\"TF Terres australes fran\u00e7aises\" >TF Terres australes fran\u00e7aises<\/option><option value=\"IO Territoire britannique de l\u2019oc\u00e9an Indien\" >IO Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"PS Territoires palestiniens\" >PS Territoires palestiniens<\/option><option value=\"TH Tha\u00eflande\" >TH Tha\u00eflande<\/option><option value=\"TL Timor oriental\" >TL Timor oriental<\/option><option value=\"TG Togo\" >TG Togo<\/option><option value=\"TK Tokelau\" >TK Tokelau<\/option><option value=\"TO Tonga\" >TO Tonga<\/option><option value=\"TT Trinit\u00e9-et-Tobago\" >TT Trinit\u00e9-et-Tobago<\/option><option value=\"TN Tunisie\" >TN Tunisie<\/option><option value=\"TM Turkm\u00e9nistan\" >TM Turkm\u00e9nistan<\/option><option value=\"TR Turquie\" >TR Turquie<\/option><option value=\"TV Tuvalu\" >TV Tuvalu<\/option><option value=\"UA Ukraine\" >UA Ukraine<\/option><option value=\"UY Uruguay\" >UY Uruguay<\/option><option value=\"VU Vanuatu\" >VU Vanuatu<\/option><option value=\"VE Venezuela\" >VE Venezuela<\/option><option value=\"VN Vi\u00eat Nam\" >VN Vi\u00eat Nam<\/option><option value=\"WF Wallis-et-Futuna\" >WF Wallis-et-Futuna<\/option><option value=\"YE Y\u00e9men\" >YE Y\u00e9men<\/option><option value=\"ZM Zambie\" >ZM Zambie<\/option><option value=\"ZW Zimbabwe\" >ZW Zimbabwe<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-371613-field_20-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-371613-field_20\">SITUATION <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-371613-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" required=\"required\"><option value=\"Choisissez une option\" >Choisissez une option<\/option><option value=\"En couple\" >En couple<\/option><option value=\"En couple homosexuel\" >En couple homosexuel<\/option><option value=\"Celibataire\" 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