{"id":819,"date":"2023-02-21T13:48:15","date_gmt":"2023-02-21T13:48:15","guid":{"rendered":"https:\/\/cdf-formations.fr\/?page_id=819"},"modified":"2023-02-21T13:48:17","modified_gmt":"2023-02-21T13:48:17","slug":"inscription-afgsu-niveau-2-recyclage-7h-saint-quentin","status":"publish","type":"page","link":"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/","title":{"rendered":"Inscription AFGSU niveau 2 &#8211; Recyclage 7h &#8211; Saint-Quentin"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-638 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-638\" data-uid=\"67d01c29c92c0\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-638\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-638 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"638\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"default\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"67d01c29c92c0\"\r\n\t\t\t><div class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-638--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-638--page-0-label\" data-step=\"0\" data-label=\"Paiement\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">Autres moyens de paiement<\/label><p>Vous pr\u00e9f\u00e9rez payer par virement bancaire ou par ch\u00e8que ?<\/p>\n<p>N\u2019h\u00e9sitez pas \u00e0 nous contacter via l\u2019adresse \u00e9lectronique : formations@lescdf.fr<\/p>\n<p>Ou, par t\u00e9l\u00e9phone : 01 56 79 20 64 - 06 08&nbsp; 80 72 33<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-26\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-26_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-26_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-26\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-26_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_67d01c29c92c0\" class=\"forminator-label\">Nom du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-24\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-24_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-24\" value=\"\" placeholder=\"\" id=\"forminator-field-name-24_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-4_67d01c29c92c0-label\" class=\"forminator-label\">Profession du stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-4_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-4_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-6\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS<\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"\" id=\"forminator-field-name-6_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" aria-describedby=\"forminator-field-name-6_67d01c29c92c0-description\" \/><span id=\"forminator-field-name-6_67d01c29c92c0-description\" class=\"forminator-description\">n\u00e9cessaire pour le dipl\u00f4me d\u00e9livr\u00e9 par le CESU<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-1_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du stagiaire<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-1_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-1_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-1_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-1_67d01c29c92c0\" class=\"forminator-label\">Ville du stagiaire<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-1_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-1_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-1_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de la ville de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-1_67d01c29c92c0\" class=\"forminator-label\">Code postal du stagiaire<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-1_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-1_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-1_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rent du code postal de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-1-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_67d01c29c92c0-description\" \/><span id=\"forminator-field-date-1-picker_67d01c29c92c0-description\" class=\"forminator-description\">n\u00e9cessaire pour le dipl\u00f4me d\u00e9livr\u00e9 par le CESU<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-26\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-26_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-26\" value=\"\" placeholder=\"\" id=\"forminator-field-name-26_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" aria-describedby=\"forminator-field-name-26_67d01c29c92c0-description\" \/><span id=\"forminator-field-name-26_67d01c29c92c0-description\" class=\"forminator-description\">n\u00e9cessaire pour le dipl\u00f4me d\u00e9livr\u00e9 par le CESU<\/span><\/div><\/div><div id=\"name-27\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-27_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-27\" value=\"\" placeholder=\"\" id=\"forminator-field-name-27_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" aria-describedby=\"forminator-field-name-27_67d01c29c92c0-description\" \/><span id=\"forminator-field-name-27_67d01c29c92c0-description\" class=\"forminator-description\">n\u00e9cessaire pour le dipl\u00f4me d\u00e9livr\u00e9 par le CESU<\/span><\/div><\/div><div id=\"name-5\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-5_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"\" id=\"forminator-field-name-5_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" aria-describedby=\"forminator-field-name-5_67d01c29c92c0-description\" \/><span id=\"forminator-field-name-5_67d01c29c92c0-description\" class=\"forminator-description\">n\u00e9cessaire pour le dipl\u00f4me d\u00e9livr\u00e9 par le CESU<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-5_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-5_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-5\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-5_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-5_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-27\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-27_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 2e stagiaire<\/label><select id=\"forminator-form-638__field--select-27_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-27\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-27_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-28\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-28_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 2e stagiaire<\/label><input type=\"text\" name=\"name-28\" value=\"\" placeholder=\"\" id=\"forminator-field-name-28_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-25\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-25_67d01c29c92c0\" class=\"forminator-label\">NOM de naissance du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-25\" value=\"\" placeholder=\"\" id=\"forminator-field-name-25_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-6_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-6_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-6\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-6_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-29\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-29_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 2e stagiaire<\/label><input type=\"text\" name=\"name-29\" value=\"\" placeholder=\"\" id=\"forminator-field-name-29_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-10\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-10-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-10_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 2e stagiaire<\/label><input type=\"text\" name=\"address-10-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-10_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-10_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-10_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-10-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-10_67d01c29c92c0\" class=\"forminator-label\">Ville du 2e stagiaire<\/label><input type=\"text\" name=\"address-10-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-10_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-10_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-10_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-10-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-10_67d01c29c92c0\" class=\"forminator-label\">Code postal du 2e stagiaire<\/label><input type=\"text\" name=\"address-10-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-10_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-10_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-10_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-3_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-3\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-3_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-3\" value=\"\" placeholder=\"\" id=\"forminator-field-email-3_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-2-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-31\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-31_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-31\" value=\"\" placeholder=\"\" id=\"forminator-field-name-31_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-30\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-30_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-30\" value=\"\" placeholder=\"\" id=\"forminator-field-name-30_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-15\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-15_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 2e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-15\" value=\"\" placeholder=\"\" id=\"forminator-field-name-15_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-15\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-15_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-15_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-15\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-15_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-15_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-28\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-28_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 3e stagiaire<\/label><select id=\"forminator-form-638__field--select-28_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-28\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-28_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-14\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-14_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 3e stagiaire<\/label><input type=\"text\" name=\"name-14\" value=\"\" placeholder=\"\" id=\"forminator-field-name-14_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-32\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-32_67d01c29c92c0\" class=\"forminator-label\">NOM de naissance du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-32\" value=\"\" placeholder=\"\" id=\"forminator-field-name-32_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-14\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-14_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-14_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-14\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-14_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-33\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-33_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 3e stagiaire<\/label><input type=\"text\" name=\"name-33\" value=\"\" placeholder=\"\" id=\"forminator-field-name-33_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-9\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-9-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-9_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 3e stagiaire<\/label><input type=\"text\" name=\"address-9-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-9_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-9_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-9_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-9-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-9_67d01c29c92c0\" class=\"forminator-label\">Ville du 3e stagiaire<\/label><input type=\"text\" name=\"address-9-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-9_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-9_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-9_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-9-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-9_67d01c29c92c0\" class=\"forminator-label\">Code postal du 3e stagiaire<\/label><input type=\"text\" name=\"address-9-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-9_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-9_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-9_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-11\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-11_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-11\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-11_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-9\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-9_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-9\" value=\"\" placeholder=\"\" id=\"forminator-field-email-9_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-3-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-35\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-35_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-35\" value=\"\" placeholder=\"\" id=\"forminator-field-name-35_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-34\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-34_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-34\" value=\"\" placeholder=\"\" id=\"forminator-field-name-34_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-23\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-23_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 3e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-23\" value=\"\" placeholder=\"\" id=\"forminator-field-name-23_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-16\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-16_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-16_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-16\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-16_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-16_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-29\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-29_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 4e stagiaire<\/label><select id=\"forminator-form-638__field--select-29_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-29\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-29_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-13\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-13_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 4e stagiaire<\/label><input type=\"text\" name=\"name-13\" value=\"\" placeholder=\"\" id=\"forminator-field-name-13_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-36\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-36_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-36\" value=\"\" placeholder=\"\" id=\"forminator-field-name-36_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-13_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-13_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-13\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-13_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-37\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-37_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 4e stagiaire<\/label><input type=\"text\" name=\"name-37\" value=\"\" placeholder=\"\" id=\"forminator-field-name-37_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-8-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-8_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 4e stagiaire<\/label><input type=\"text\" name=\"address-8-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-8_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-8_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-8_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-8-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-8_67d01c29c92c0\" class=\"forminator-label\">Ville du 4e stagiaire<\/label><input type=\"text\" name=\"address-8-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-8_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-8_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-8_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-8-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-8_67d01c29c92c0\" class=\"forminator-label\">Code postal du 4e stagiaire<\/label><input type=\"text\" name=\"address-8-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-8_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-8_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-8_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-10\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-10_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-10\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-10_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-10\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-10_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-10\" value=\"\" placeholder=\"\" id=\"forminator-field-email-10_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-10\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-10-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-10\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-10-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-39\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-39_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-39\" value=\"\" placeholder=\"\" id=\"forminator-field-name-39_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-38\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-38_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-38\" value=\"\" placeholder=\"\" id=\"forminator-field-name-38_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-22\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-22_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 4e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-22\" value=\"\" placeholder=\"\" id=\"forminator-field-name-22_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-17\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-17_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-17_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-17\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-17_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-17_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-30\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-30_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 5e stagiaire<\/label><select id=\"forminator-form-638__field--select-30_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-30\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-30_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-12\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-12_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 5e stagiaire<\/label><input type=\"text\" name=\"name-12\" value=\"\" placeholder=\"\" id=\"forminator-field-name-12_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-40\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-40_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-40\" value=\"\" placeholder=\"\" id=\"forminator-field-name-40_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-12\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-12_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-12_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-12\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-12_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-41\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-41_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 5e stagiaire<\/label><input type=\"text\" name=\"name-41\" value=\"\" placeholder=\"\" id=\"forminator-field-name-41_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-7-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-7_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 5e stagiaire<\/label><input type=\"text\" name=\"address-7-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-7_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-7_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-7_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-7-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-7_67d01c29c92c0\" class=\"forminator-label\">Ville du 5e stagiaire<\/label><input type=\"text\" name=\"address-7-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-7_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-7_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-7_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-7-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-7_67d01c29c92c0\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-7-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-7_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-7_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-7_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-9\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-9_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-9\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-9_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-8\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-8_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-8\" value=\"\" placeholder=\"\" id=\"forminator-field-email-8_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-9\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-9\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-9-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-43\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-43_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-43\" value=\"\" placeholder=\"\" id=\"forminator-field-name-43_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-42\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-42_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-42\" value=\"\" placeholder=\"\" id=\"forminator-field-name-42_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-21\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-21_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 5e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-21\" value=\"\" placeholder=\"\" id=\"forminator-field-name-21_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-18\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-18_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-18_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-18\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-18_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-18_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-31\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-31_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 6e stagiaire<\/label><select id=\"forminator-form-638__field--select-31_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-31\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-31_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-11\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-11_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 6e stagiaire<\/label><input type=\"text\" name=\"name-11\" value=\"\" placeholder=\"\" id=\"forminator-field-name-11_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-44\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-44_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-44\" value=\"\" placeholder=\"\" id=\"forminator-field-name-44_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-11\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-11_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-11_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-11\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-11_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-45\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-45_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 6e stagiaire<\/label><input type=\"text\" name=\"name-45\" value=\"\" placeholder=\"\" id=\"forminator-field-name-45_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-6-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-6_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 6e stagiaire<\/label><input type=\"text\" name=\"address-6-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-6_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-6_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-6_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-6-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-6_67d01c29c92c0\" class=\"forminator-label\">Ville du 6e stagiaire<\/label><input type=\"text\" name=\"address-6-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-6_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-6_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-6_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-6-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-6_67d01c29c92c0\" class=\"forminator-label\">Code postal du 6e stagiaire<\/label><input type=\"text\" name=\"address-6-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-6_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-6_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-6_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-8\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-8_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-8\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-8_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-7\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-7_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-7\" value=\"\" placeholder=\"\" id=\"forminator-field-email-7_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-8\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-8-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-46\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-46_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-46\" value=\"\" placeholder=\"\" id=\"forminator-field-name-46_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-47\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-47_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-47\" value=\"\" placeholder=\"\" id=\"forminator-field-name-47_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-20\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-20_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 6e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-20\" value=\"\" placeholder=\"\" id=\"forminator-field-name-20_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-19\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-19_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-19_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-19\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-19_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-19_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-32\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-32_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 7e stagiaire<\/label><select id=\"forminator-form-638__field--select-32_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-32\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-32_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-10\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-10_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 7e stagiaire<\/label><input type=\"text\" name=\"name-10\" value=\"\" placeholder=\"\" id=\"forminator-field-name-10_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-48\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-48_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-48\" value=\"\" placeholder=\"\" id=\"forminator-field-name-48_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-10_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-10_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-10\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-10_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-49\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-49_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 7e stagiaire<\/label><input type=\"text\" name=\"name-49\" value=\"\" placeholder=\"\" id=\"forminator-field-name-49_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-5-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-5_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 7e stagiaire<\/label><input type=\"text\" name=\"address-5-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-5_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-5_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-5_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-5-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-5_67d01c29c92c0\" class=\"forminator-label\">Ville du 7e stagiaire<\/label><input type=\"text\" name=\"address-5-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-5_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-5-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-5_67d01c29c92c0\" class=\"forminator-label\">Code postal du 7e stagiaire<\/label><input type=\"text\" name=\"address-5-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-5_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-5_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-5_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-7\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-7_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-7\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-7_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-6\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-6_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-6\" value=\"\" placeholder=\"\" id=\"forminator-field-email-6_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-7\" class=\"forminator-col forminator-col-12 \"><label for=\"forminator-field-date-7\" class=\"forminator-label\">Date de naissance du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-7-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-day_67d01c29c92c0\" class=\"forminator-label\">Jour <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-7-day\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-7-day_67d01c29c92c0\" class=\"forminator-input\" data-field=\"day\" data-format=\"dd\/mm\/yy\" data-parent=\"date-7\" aria-describedby=\"forminator-field-date-7_67d01c29c92c0-description\" \/><\/div><\/div><div id=\"date-7-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-month_67d01c29c92c0\" class=\"forminator-label\">Mois <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-7-month\" value=\"\" placeholder=\"Par exemple\u00a0: 01\" id=\"forminator-field-date-7-month_67d01c29c92c0\" class=\"forminator-input\" data-field=\"month\" data-format=\"dd\/mm\/yy\" data-parent=\"date-7\" aria-describedby=\"forminator-field-date-7_67d01c29c92c0-description\" \/><\/div><\/div><div id=\"date-7-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-year_67d01c29c92c0\" class=\"forminator-label\">Ann\u00e9e <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" name=\"date-7-year\" placeholder=\"Par exemple\u00a0: 2000\" id=\"forminator-field-date-7-year_67d01c29c92c0\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"dd\/mm\/yy\" data-parent=\"date-7\" aria-describedby=\"forminator-field-date-7_67d01c29c92c0-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-50\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-50_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-50\" value=\"\" placeholder=\"\" id=\"forminator-field-name-50_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-51\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-51_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-51\" value=\"\" placeholder=\"\" id=\"forminator-field-name-51_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-19\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-19_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 7e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-19\" value=\"\" placeholder=\"\" id=\"forminator-field-name-19_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-20\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-20_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-20_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-20\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-20_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-20_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-33\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-33_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 8e stagiaire<\/label><select id=\"forminator-form-638__field--select-33_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-33\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-33_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-9\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-9_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 8e stagiaire<\/label><input type=\"text\" name=\"name-9\" value=\"\" placeholder=\"\" id=\"forminator-field-name-9_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-52\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-52_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-52\" value=\"\" placeholder=\"\" id=\"forminator-field-name-52_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-9_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-9_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-9\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-9_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-53\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-53_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 8e stagiaire<\/label><input type=\"text\" name=\"name-53\" value=\"\" placeholder=\"\" id=\"forminator-field-name-53_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-2-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-2_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 8e stagiaire<\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-2_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-2_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-2_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-2_67d01c29c92c0\" class=\"forminator-label\">Ville du 8e stagiaire<\/label><input type=\"text\" name=\"address-2-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-2_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-2_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-2_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-2_67d01c29c92c0\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-2-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-2_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-2_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-2_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-6\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-6_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-6\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-6_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-11\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-11_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-11\" value=\"\" placeholder=\"\" id=\"forminator-field-email-11_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-6-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-6\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-6-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-18\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-18_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-18\" value=\"\" placeholder=\"\" id=\"forminator-field-name-18_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-54\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-54_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-54\" value=\"\" placeholder=\"\" id=\"forminator-field-name-54_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-55\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-55_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 8e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-55\" value=\"\" placeholder=\"\" id=\"forminator-field-name-55_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-21\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-21_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-21_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-21\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-21_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-21_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-34\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-34_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 9e stagiaire<\/label><select id=\"forminator-form-638__field--select-34_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-34\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-34_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-8\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-8_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 9e stagiaire<\/label><input type=\"text\" name=\"name-8\" value=\"\" placeholder=\"\" id=\"forminator-field-name-8_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-56\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-56_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-56\" value=\"\" placeholder=\"\" id=\"forminator-field-name-56_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-8_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-8_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-8\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-8_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-57\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-57_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 9e stagiaire<\/label><input type=\"text\" name=\"name-57\" value=\"\" placeholder=\"\" id=\"forminator-field-name-57_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-4-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-4_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 9e stagiaire<\/label><input type=\"text\" name=\"address-4-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-4_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-4_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-4_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-4-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-4_67d01c29c92c0\" class=\"forminator-label\">Ville du 9e stagiaire<\/label><input type=\"text\" name=\"address-4-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-4_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-4_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-4_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-4-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-4_67d01c29c92c0\" class=\"forminator-label\">Code postal du 9e stagiaire<\/label><input type=\"text\" name=\"address-4-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-4_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-4_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-4_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-5\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-5_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-5\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-5_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-5\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-5_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-5\" value=\"\" placeholder=\"\" id=\"forminator-field-email-5_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-5\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-5-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-17\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-17_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-17\" value=\"\" placeholder=\"\" id=\"forminator-field-name-17_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-58\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-58_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-58\" value=\"\" placeholder=\"\" id=\"forminator-field-name-58_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-59\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-59_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 9e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-59\" value=\"\" placeholder=\"\" id=\"forminator-field-name-59_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-22\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-22_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-22_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-22\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-22_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-22_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-35\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-35_67d01c29c92c0-label\" class=\"forminator-label\">Civilit\u00e9 du 10e stagiaire<\/label><select id=\"forminator-form-638__field--select-35_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-35\" data-default-value=\"\" data-placeholder=\"-- Civilit\u00e9 --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-35_67d01c29c92c0-description\"><option value=\"\">-- Civilit\u00e9 --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Madame<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Monsieur<\/option><\/select><\/div><\/div><div id=\"name-7\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-7_67d01c29c92c0\" class=\"forminator-label\">Pr\u00e9nom et NOM du 10e stagiaire<\/label><input type=\"text\" name=\"name-7\" value=\"\" placeholder=\"\" id=\"forminator-field-name-7_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-60\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-60_67d01c29c92c0\" class=\"forminator-label\">Nom de naissance du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-60\" value=\"\" placeholder=\"\" id=\"forminator-field-name-60_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-7_67d01c29c92c0-label\" class=\"forminator-label\">Profession du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-7_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-7\" data-default-value=\"\" data-placeholder=\"-- Profession --\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-7_67d01c29c92c0-description\"><option value=\"\">-- Profession --<\/option><option value=\"Chirurgien-dentiste-lib\u00e9ral\"  data-calculation=\"0\">Chirurgien-dentiste lib\u00e9ral<\/option><option value=\"Chirurgien-dentiste-salari\u00e9\"  data-calculation=\"0\">Chirurgien-dentiste salari\u00e9<\/option><option value=\"Assistant(e)-dentaire\"  data-calculation=\"0\">Assistant(e) dentaire<\/option><option value=\"Autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><div id=\"name-61\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-61_67d01c29c92c0\" class=\"forminator-label\">Num\u00e9ro Adeli ou RPPS du 10e stagiaire<\/label><input type=\"text\" name=\"name-61\" value=\"\" placeholder=\"\" id=\"forminator-field-name-61_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-3-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-3_67d01c29c92c0\" class=\"forminator-label\">Adresse postale du 10e stagiaire<\/label><input type=\"text\" name=\"address-3-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-3_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-street_address-address-3_67d01c29c92c0-description\" \/><span id=\"forminator-field-street_address-address-3_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-3-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-3_67d01c29c92c0\" class=\"forminator-label\">Ville du 10e stagiaire<\/label><input type=\"text\" name=\"address-3-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-3_67d01c29c92c0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" aria-describedby=\"forminator-field-city-address-3_67d01c29c92c0-description\" \/><span id=\"forminator-field-city-address-3_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-3-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-3_67d01c29c92c0\" class=\"forminator-label\">Code postal du 10e stagiaire<\/label><input type=\"text\" name=\"address-3-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-3_67d01c29c92c0\" class=\"forminator-input\" value=\"\" aria-describedby=\"forminator-field-zip-address-3_67d01c29c92c0-description\" \/><span id=\"forminator-field-zip-address-3_67d01c29c92c0-description\" class=\"forminator-description\">Si diff\u00e9rente de l'adresse de facturation<\/span><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-4_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-4_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-4\" value=\"\" placeholder=\"\" id=\"forminator-field-email-4_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_67d01c29c92c0\" class=\"forminator-label\">Date de naissance du 10e stagiaire<\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"14\/06\/1983\" id=\"forminator-field-date-4-picker_67d01c29c92c0\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1925\" data-end-year=\"2125\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-16\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-16_67d01c29c92c0\" class=\"forminator-label\">Pays de naissance du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-16\" value=\"\" placeholder=\"\" id=\"forminator-field-name-16_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-62\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-62_67d01c29c92c0\" class=\"forminator-label\">D\u00e9partement de naissance du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-62\" value=\"\" placeholder=\"\" id=\"forminator-field-name-62_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-63\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-63_67d01c29c92c0\" class=\"forminator-label\">Ville de naissance du 10e stagiaire <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-63\" value=\"\" placeholder=\"\" id=\"forminator-field-name-63_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-23\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-23_67d01c29c92c0-label\" class=\"forminator-label\">J&#039;autorise CDF Formations \u00e0 me photographier, me filmer, et utiliser mon image. <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-638__field--select-23_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-23\" data-default-value=\"\" data-placeholder=\"Droit \u00e0 l&#039;image\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-23_67d01c29c92c0-description\"><option value=\"\">Droit \u00e0 l&#039;image<\/option><option value=\"OUI\"  data-calculation=\"0\">OUI<\/option><option value=\"NON\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-638__field--select-23_67d01c29c92c0-description\" class=\"forminator-description\">Les photos et vid\u00e9os pourront \u00eatre exploit\u00e9es et utilis\u00e9es directement par CDF Formations sous toutes formes et tous supports connus, pour une dur\u00e9e de 30 ans, dans le monde entier, int\u00e9gralement ou par extraits \u00e0 des fins de communication. CDF Formations s'engagent \u00e0 respecter la vie priv\u00e9e et la r\u00e9putation des personnes concern\u00e9es.<\/span><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-638--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-638--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"Coordonn\u00e9es des stagiaires\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_67d01c29c92c0\" class=\"forminator-label\">Soci\u00e9t\u00e9 ou nom de facturation <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_67d01c29c92c0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-11\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-11-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-street_address-address-11_67d01c29c92c0\" class=\"forminator-label\">Adresse postale de facturation <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-11-street_address\" placeholder=\"Par exemple\u00a0: 54 rue Amp\u00e8re\" id=\"forminator-field-street_address-address-11_67d01c29c92c0\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-11-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-city-address-11_67d01c29c92c0\" class=\"forminator-label\">Ville de facturation <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-11-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-city-address-11_67d01c29c92c0\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-11-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-zip-address-11_67d01c29c92c0\" class=\"forminator-label\">Code postal de facturation <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-11-zip\" placeholder=\"Par exemple\u00a0: 75017\" id=\"forminator-field-zip-address-11_67d01c29c92c0\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_67d01c29c92c0\" class=\"forminator-label\">Adresse \u00e9lectronique de facturation <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"Par exemple\u00a0: formations@lescdf.fr\" id=\"forminator-field-email-2_67d01c29c92c0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_67d01c29c92c0\" class=\"forminator-label\">T\u00e9l\u00e9phone du payeur<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_67d01c29c92c0\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" aria-describedby=\"forminator-field-phone-2_67d01c29c92c0-description\" \/><span id=\"forminator-field-phone-2_67d01c29c92c0-description\" class=\"forminator-description\">si diff\u00e9rent du stagiaire<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-25\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-25_67d01c29c92c0-label\" class=\"forminator-label\">Date et ville choisies<\/label><select id=\"forminator-form-638__field--select-25_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-25\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Date et ville choisies\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-25_67d01c29c92c0-description\"><option value=\"\">Date et ville choisies<\/option><option value=\"18-mars-2025-\u00e0-Anglet-(64)\"  data-calculation=\"0\">18 mars 2025 \u00e0 Anglet (64)<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-67d01c29c92c0-label\"><h4 id=\"forminator-checkbox-group-67d01c29c92c0-label\" class=\"forminator-label\">Tarif chirurgien-dentiste syndiqu\u00e9 Les CDF\/assistant dentaire<\/h4><label for=\"forminator-field-checkbox-1-1-67d01c29c92c0\" class=\"forminator-checkbox\" title=\"290 \u20ac\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"275-\u20ac\" id=\"forminator-field-checkbox-1-1-67d01c29c92c0\" data-calculation=\"290\"   aria-describedby=\"forminator-field-checkbox-1-67d01c29c92c0-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">290 \u20ac<\/span><\/label><\/div><\/div><div id=\"select-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-2_67d01c29c92c0-label\" class=\"forminator-label\">Nombre de places<\/label><select id=\"forminator-form-638__field--select-2_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-2_67d01c29c92c0-description\"><option value=\"1\"  data-calculation=\"1\">1<\/option><option value=\"2\"  data-calculation=\"2\">2<\/option><option value=\"3\"  data-calculation=\"3\">3<\/option><option value=\"4\"  data-calculation=\"4\">4<\/option><option value=\"5\"  data-calculation=\"5\">5<\/option><option value=\"6\"  data-calculation=\"6\">6<\/option><option value=\"7\"  data-calculation=\"7\">7<\/option><option value=\"8\"  data-calculation=\"8\">8<\/option><option value=\"9\"  data-calculation=\"9\">9<\/option><option value=\"10\"  data-calculation=\"10\">10<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-67d01c29c92c0-label\"><h4 id=\"forminator-checkbox-group-67d01c29c92c0-label\" class=\"forminator-label\">Tarif chirurgien-dentiste non syndiqu\u00e9 Les CDF<\/h4><label for=\"forminator-field-checkbox-3-1-67d01c29c92c0\" class=\"forminator-checkbox\" title=\"350 \u20ac\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"350-\u20ac\" id=\"forminator-field-checkbox-3-1-67d01c29c92c0\" data-calculation=\"350\"   aria-describedby=\"forminator-field-checkbox-3-67d01c29c92c0-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">350 \u20ac<\/span><\/label><\/div><\/div><div id=\"select-3\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-3_67d01c29c92c0-label\" class=\"forminator-label\">Nombre de places<\/label><select id=\"forminator-form-638__field--select-3_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-3_67d01c29c92c0-description\"><option value=\"1\"  data-calculation=\"1\">1<\/option><option value=\"2\"  data-calculation=\"2\">2<\/option><option value=\"3\"  data-calculation=\"3\">3<\/option><option value=\"4\"  data-calculation=\"4\">4<\/option><option value=\"5\"  data-calculation=\"5\">5<\/option><option value=\"6\"  data-calculation=\"6\">6<\/option><option value=\"7\"  data-calculation=\"7\">7<\/option><option value=\"8\"  data-calculation=\"8\">8<\/option><option value=\"9\"  data-calculation=\"9\">9<\/option><option value=\"10\"  data-calculation=\"10\">10<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-67d01c29c92c0-label\"><h4 id=\"forminator-checkbox-group-67d01c29c92c0-label\" class=\"forminator-label\">Tarif autres professionnels de sant\u00e9<\/h4><label for=\"forminator-field-checkbox-4-1-67d01c29c92c0\" class=\"forminator-checkbox\" title=\"290 \u20ac\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"275-\u20ac\" id=\"forminator-field-checkbox-4-1-67d01c29c92c0\" data-calculation=\"290\"   aria-describedby=\"forminator-field-checkbox-4-67d01c29c92c0-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">290 \u20ac<\/span><\/label><\/div><\/div><div id=\"select-24\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-638__field--select-24_67d01c29c92c0-label\" class=\"forminator-label\">Nombre de places<\/label><select id=\"forminator-form-638__field--select-24_67d01c29c92c0\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-24\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-describedby=\"forminator-form-638__field--select-24_67d01c29c92c0-description\"><option value=\"1\"  data-calculation=\"1\">1<\/option><option value=\"2\"  data-calculation=\"2\">2<\/option><option value=\"3\"  data-calculation=\"3\">3<\/option><option value=\"4\"  data-calculation=\"4\">4<\/option><option value=\"5\"  data-calculation=\"5\">5<\/option><option value=\"6\"  data-calculation=\"6\">6<\/option><option value=\"7\"  data-calculation=\"7\">7<\/option><option value=\"8\"  data-calculation=\"8\">8<\/option><option value=\"9\"  data-calculation=\"9\">9<\/option><option value=\"10\"  data-calculation=\"10\">10<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"calculation-1-field_67d01c29c92c0\" class=\"forminator-label\">Sous total :<\/label><input name=\"calculation-1\" value=\"\" id=\"calculation-1-field_67d01c29c92c0\" class=\"forminator-calculation forminator-input\" data-formula=\"{checkbox-1}*{select-2}+{checkbox-4}*{select-24}+{checkbox-3}*{select-3}\" data-required=\"\" data-decimal-point=\".\" data-precision=\"2\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"stripe-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"stripe-1-field\" class=\"forminator-label\">Paiement de la formation <span class=\"forminator-required\">*<\/span><\/label><div id=\"card-element-67d01c29c92c0\" data-field-id=\"67d01c29c92c0\" data-is-payment=\"true\" data-payment-type=\"stripe\" data-secret=\"\" data-paymentid=\"\" data-key=\"pk_live_51MAaeUAaVTi5v1m9W3Ki8Y3Q7HNOYFSZ3I8XahFenevD5hrNbBDtFmwbGwcGxpIcH0WYfpTdUcGQXjaq7N8z5kWw00r8SwCisD\" data-card-icon=\"\" data-veify-zip=\"\" data-zip-field=\"\" data-language=\"fr\" data-base-class=\"StripeElement\" data-complete-class=\"StripeElement--complete\" data-empty-class=\"StripeElement--empty\" data-focused-class=\"StripeElement--focus\" data-invalid-class=\"StripeElement--invalid\" data-autofilled-class=\"StripeElement--webkit-autofill\" data-billing=\"1\" data-billing-name=\"name-4\" data-billing-email=\"email-2\" data-billing-address=\"address-11\" data-receipt=\"\" data-receipt-email=\"\" data-custom-fonts=\"1\" data-placeholder=\"#888888\" data-font-color=\"#000000\" data-font-color-focus=\"#000000\" data-font-color-error=\"#000000\" data-font-size=\"16px\" data-font-family=\"Roboto\" data-font-weight=\"normal\" data-icon-color=\"#777771\" data-icon-color-hover=\"#17A8E3\" data-icon-color-focus=\"#17A8E3\" data-icon-color-error=\"#E04562\" aria-describedby=\"card-element-67d01c29c92c0-description\" class=\"forminator-stripe-element\"><\/div><input type=\"hidden\" name=\"paymentid\" value=\"\" id=\"forminator-stripe-paymentid\"\/><input type=\"hidden\" name=\"paymentmethod\" value=\"\" id=\"forminator-stripe-paymentmethod\"\/><input type=\"hidden\" name=\"subscriptionid\" value=\"\" id=\"forminator-stripe-subscriptionid\"\/><span class=\"forminator-card-message\"><span class=\"forminator-error-message\" aria-hidden=\"true\"><\/span><\/span><span id=\"card-element-67d01c29c92c0-description\" class=\"forminator-description\">Paiement s\u00e9curis\u00e9 avec notre partenaire Stripe<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_67d01c29c92c0\" class=\"forminator-label\">Consentement <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label for=\"forminator-field-consent-1_67d01c29c92c0\" class=\"forminator-checkbox\" style=\"margin: 0;\" aria-labelledby=\"forminator-field-consent-1_67d01c29c92c0__label\"><input type=\"checkbox\" name=\"consent-1\" value=\"checked\" id=\"forminator-field-consent-1_67d01c29c92c0\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_67d01c29c92c0__label\" class=\"forminator-checkbox__label\"><ul>\n<li>J\u2019atteste correspondre au public vis\u00e9 par la formation, \u00e0 savoir \u00eatre chirurgien-dentiste, ou assistant dentaire.<\/li>\n<li>Je d\u00e9clare avoir pris connaissance des Conditions G\u00e9n\u00e9rales de Vente et du R\u00e8glement Int\u00e9rieur de CDF Formations.<\/li>\n<li>J\u2019atteste avoir pris connaissance des objectifs et des pr\u00e9requis de la formation et qu\u2019ils sont en accord avec mes besoins.<\/li>\n<\/ul><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-2_67d01c29c92c0\" class=\"forminator-label\">Traitement des donn\u00e9es personnelles <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label for=\"forminator-field-consent-2_67d01c29c92c0\" class=\"forminator-checkbox\" style=\"margin: 0;\" aria-labelledby=\"forminator-field-consent-2_67d01c29c92c0__label\"><input type=\"checkbox\" name=\"consent-2\" value=\"checked\" id=\"forminator-field-consent-2_67d01c29c92c0\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-2_67d01c29c92c0__label\" class=\"forminator-checkbox__label\"><p>En soumettant ce formulaire, vous acceptez que les donn\u00e9es personnelles recueillies soient utilis\u00e9es et trait\u00e9es par CDF Formations pour permettre de vous recontacter.<\/p>\n<p>CDF Formations a pris toutes les mesures n\u00e9cessaires pour assurer la protection de vos donn\u00e9es personnelles, il s\u2019engage \u00e0 ne les utiliser que pour son seul usage interne et \u00e0 ne pas les divulguer \u00e0 des tiers. Vous b\u00e9n\u00e9ficiez des droits d'acc\u00e8s, de rectification, de portabilit\u00e9 (transfert) et de suppression de vos donn\u00e9es personnelles en nous contactant : <a href=\"mailto:formations@lescdf.fr\">formations@lescdf.fr<\/a> &nbsp;ou CDF Formations 54 rue Amp\u00e8re 75849 PARIS cedex 17.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><label class=\"forminator-label\">Remarques<\/label><p>Si vous avez besoin d\u2019une adaptation quelconque sur le d\u00e9roul\u00e9 de la journ\u00e9e, n\u2019h\u00e9sitez pas \u00e0 nous contacter par t\u00e9l\u00e9phone au 01.56.79.20.64 ou par mail \u00e0 <a href=\"mailto:formations@lescdf.fr\">formations@lescdf.fr,<\/a> pour que l\u2019on fasse notre possible.<\/p><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>VALIDER LE PAIEMENT<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"660c3ae48f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/819\" \/><input type=\"hidden\" name=\"form_id\" value=\"638\"><input type=\"hidden\" name=\"page_id\" value=\"819\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>","protected":false},"excerpt":{"rendered":"","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/content-no-sidebar.php","meta":{"footnotes":""},"class_list":["post-819","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Inscription AFGSU niveau 2 - Recyclage 7h - Saint-Quentin - CDF Formations<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Inscription AFGSU niveau 2 - Recyclage 7h - Saint-Quentin - CDF Formations\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/\" \/>\n<meta property=\"og:site_name\" content=\"CDF Formations\" \/>\n<meta property=\"article:modified_time\" content=\"2023-02-21T13:48:17+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/\",\"url\":\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/\",\"name\":\"Inscription AFGSU niveau 2 - Recyclage 7h - Saint-Quentin - CDF Formations\",\"isPartOf\":{\"@id\":\"https:\/\/cdf-formations.fr\/#website\"},\"datePublished\":\"2023-02-21T13:48:15+00:00\",\"dateModified\":\"2023-02-21T13:48:17+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cdf-formations.fr\/inscription-afgsu-niveau-2-recyclage-7h-saint-quentin\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\/\/cdf-formations.fr\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Inscription AFGSU niveau 2 &#8211; 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