{"id":5858,"date":"2026-02-19T17:02:28","date_gmt":"2026-02-19T16:02:28","guid":{"rendered":"https:\/\/acfhab.be\/?page_id=5858"},"modified":"2026-02-25T08:16:21","modified_gmt":"2026-02-25T07:16:21","slug":"formulaire-en-ligne","status":"publish","type":"page","link":"https:\/\/acfhab.be\/?page_id=5858","title":{"rendered":"Formulaire en ligne"},"content":{"rendered":"<style id=\"wpforms-css-vars-5906\">\n\t\t\t\t#wpforms-5906 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-quiz wpforms-stripe wpforms-render-modern\" id=\"wpforms-5906\"><form id=\"wpforms-form-5906\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"5906\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F5858&#038;wpforms_form_id=5906\" data-token=\"dba491c5daeb20f911c20fff8e8b08e9\" data-token-time=\"1775834075\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-5906-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5906-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" placeholder=\"Pr\u00e9nom\" aria-errormessage=\"wpforms-5906-field_0-error\" required><label for=\"wpforms-5906-field_0\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5906-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" placeholder=\"Nom\" aria-errormessage=\"wpforms-5906-field_0-last-error\" required><label for=\"wpforms-5906-field_0-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-5906-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_20\">Fonction\/institution <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5906-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-5906-field_20-error\" required><\/div><div id=\"wpforms-5906-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_1\">Courriel <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5906-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-5906-field_1-error\" required><\/div><div id=\"wpforms-5906-field_34-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_34\">T\u00e9l\u00e9phone (optionnel)<\/label><input type=\"tel\" id=\"wpforms-5906-field_34\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][34]\" aria-label=\"T\u00e9l\u00e9phone (optionnel)\" aria-errormessage=\"wpforms-5906-field_34-error\" ><\/div><div id=\"wpforms-5906-field_9-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Adresse (optionnel)<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5906-field_9\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][9][address1]\" placeholder=\"Adresse\" aria-errormessage=\"wpforms-5906-field_9-error\" ><label for=\"wpforms-5906-field_9\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5906-field_9-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][9][city]\" placeholder=\"Ville\" aria-errormessage=\"wpforms-5906-field_9-city-error\" ><label for=\"wpforms-5906-field_9-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5906-field_9-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][9][state]\" placeholder=\"Commune\" aria-errormessage=\"wpforms-5906-field_9-state-error\" ><label for=\"wpforms-5906-field_9-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5906-field_9-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][9][postal]\" placeholder=\"Code postel\" aria-errormessage=\"wpforms-5906-field_9-postal-error\" ><label for=\"wpforms-5906-field_9-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-5906-field_9-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][9][country]\" aria-errormessage=\"wpforms-5906-field_9-country-error\" ><option class=\"placeholder\" value=\"\" selected disabled>Pays<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/option><option value=\"DE\" >Allemagne<\/option><option value=\"AD\" >Andorre<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctique<\/option><option value=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\" >France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordanie<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KG\" >Kirghizistan<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malaisie<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malte<\/option><option value=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"TR\" >Turquie<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard et McDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-5906-field_9-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-5906-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_3\">J&#039;ai l&#039;intention de prendre part au Congr\u00e8s de Bruxelles <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-5906-field_3\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"\" name=\"wpforms[fields][3]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Please select -<\/option><option value=\"d\u2019y pr\u00e9senter une communication\"  class=\"choice-1 depth-1\"  >d\u2019y pr\u00e9senter une communication<\/option><option value=\"d\u2019assister aux journ\u00e9es d\u2019\u00e9tudes\"  class=\"choice-2 depth-1\"  >d\u2019assister aux journ\u00e9es d\u2019\u00e9tudes<\/option><\/select><\/div><div id=\"wpforms-5906-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_10\">Je d\u00e9sire y pr\u00e9senter une communication dans la section : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-5906-field_10\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"1\" name=\"wpforms[fields][10]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Please select -<\/option><option value=\"Arch\u00e9ologie\"  class=\"choice-1 depth-1\"  >Arch\u00e9ologie<\/option><option value=\"Histoire politique, militaire et relations internationales\"  class=\"choice-2 depth-1\"  >Histoire politique, militaire et relations internationales<\/option><option value=\"Histoire \u00e9conomique et sociale (+ numismatique, d\u00e9mographie, vie quotidienne)\"  class=\"choice-10 depth-1\"  >Histoire \u00e9conomique et sociale (+ numismatique, d\u00e9mographie, vie quotidienne)<\/option><option value=\"Histoire des institutions et du droit (+ sigillographie)\"  class=\"choice-9 depth-1\"  >Histoire des institutions et du droit (+ sigillographie)<\/option><option value=\"Histoire des religions et des mouvements philosophiques\"  class=\"choice-8 depth-1\"  >Histoire des religions et des mouvements philosophiques<\/option><option value=\"Histoire des sciences, des techniques et des savoirs anciens\"  class=\"choice-7 depth-1\"  >Histoire des sciences, des techniques et des savoirs anciens<\/option><option value=\"Histoire de l\u2019environnement et de l\u2019am\u00e9nagement du territoire\"  class=\"choice-6 depth-1\"  >Histoire de l\u2019environnement et de l\u2019am\u00e9nagement du territoire<\/option><option value=\"G\u00e9n\u00e9alogie et histoire des familles (+ h\u00e9raldique)\"  class=\"choice-5 depth-1\"  >G\u00e9n\u00e9alogie et histoire des familles (+ h\u00e9raldique)<\/option><option value=\"Histoire des arts\"  class=\"choice-4 depth-1\"  >Histoire des arts<\/option><option value=\"Patrimoine oral et immat\u00e9riel, folklore\"  class=\"choice-3 depth-1\"  >Patrimoine oral et immat\u00e9riel, folklore<\/option><option value=\"Archives et biblioth\u00e8ques\"  class=\"choice-12 depth-1\"  >Archives et biblioth\u00e8ques<\/option><option value=\"Patrimoine mobilier et mus\u00e9es\"  class=\"choice-11 depth-1\"  >Patrimoine mobilier et mus\u00e9es<\/option><\/select><\/div><div id=\"wpforms-5906-field_23-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_23\">Titre de la communication : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5906-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-5906-field_23-error\" required><\/div><div id=\"wpforms-5906-field_11-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"file-upload\" data-field-id=\"11\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_11\">T\u00e9l\u00e9chargement du r\u00e9sum\u00e9 de la communication (max 4 Mo) Indiquez votre nom dans le document svp. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"file\" id=\"wpforms-5906-field_11\" class=\"wpforms-field-required\" data-rule-extension=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages,json\" data-rule-maxsize=\"4194304\" name=\"wpforms_5906_11\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.json\" aria-errormessage=\"wpforms-5906-field_11-error\" required><\/div><div id=\"wpforms-5906-field_19-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"19\" style=\"display:none;\"><div id=\"wpforms-5906-field_19\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-5906-field_19-error\"><p>Je vais recevoir les circulaires ult\u00e9rieurs.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5906-field_36-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_36\">Paiement :  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-5906-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- S\u00e9lectionner un choix ---<\/option><option value=\"par virement\"  class=\"choice-1 depth-1\"  >par virement<\/option><option value=\"en ligne\"  class=\"choice-2 depth-1\"  >en ligne<\/option><\/select><\/div><div id=\"wpforms-5906-field_22-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"22\" style=\"display:none;\"><div id=\"wpforms-5906-field_22\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-5906-field_22-error\"><p>Je m'engage \u00e0 verser sur le compte de la SRAB, IBAN<strong> BE24 0000 0265 1938 - <\/strong>BIC GEBABEBB avec, dans la communication la mention : \"Congr\u00e8s 2026 + Nom\", la somme de :<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5906-field_33-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"33\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Tarif<\/legend><ul id=\"wpforms-5906-field_33\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5906-field_33_1\" name=\"wpforms[fields][33][]\" value=\"Tarif plein : 60.00\u20ac\" aria-errormessage=\"wpforms-5906-field_33_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_33_1\">Tarif plein : 60.00\u20ac<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5906-field_33_2\" name=\"wpforms[fields][33][]\" value=\"Tarif \u00e9tudiant : 30.00\u20ac\" aria-errormessage=\"wpforms-5906-field_33_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_33_2\">Tarif \u00e9tudiant : 30.00\u20ac<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5906-field_33_3\" name=\"wpforms[fields][33][]\" value=\"Tarif demandeur d&#039;emploi : 30.00\u20ac\" aria-errormessage=\"wpforms-5906-field_33_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_33_3\">Tarif demandeur d'emploi : 30.00\u20ac<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5906-field_37-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-multiple\" data-field-id=\"37\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Tarif <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5906-field_37\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5906-field_37_1\" class=\"wpforms-payment-price\" data-amount=\"60,00\" name=\"wpforms[fields][37]\" value=\"1\" aria-errormessage=\"wpforms-5906-field_37_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_37_1\">Tarif plein - <span class=\"wpforms-currency-symbol\">60,00 &euro;<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5906-field_37_2\" class=\"wpforms-payment-price\" data-amount=\"30,00\" name=\"wpforms[fields][37]\" value=\"2\" aria-errormessage=\"wpforms-5906-field_37_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_37_2\">Tarif \u00e9tudiant - <span class=\"wpforms-currency-symbol\">30,00 &euro;<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-5906-field_37_4\" class=\"wpforms-payment-price\" data-amount=\"30,00\" name=\"wpforms[fields][37]\" value=\"4\" aria-errormessage=\"wpforms-5906-field_37_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_37_4\">Tarif demandeur d'empoi - <span class=\"wpforms-currency-symbol\">30,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-5906-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-5906-field_4\" >communication en (optionnel)<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-5906-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-5906-field_39-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-conditional-field wpforms-conditional-show wpforms-field-medium\" data-field-type=\"payment-total\" data-field-id=\"39\" style=\"display:none;\" aria-live=\"polite\" aria-atomic=\"true\"><label class=\"wpforms-field-label\">Total<\/label><div class=\"wpforms-payment-total\" style=\"\">0,00 &euro;<\/div><input type=\"hidden\" id=\"wpforms-5906-field_39\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][39]\" value=\"0\"><\/div><div id=\"wpforms-5906-field_38-container\" class=\"wpforms-field wpforms-field-stripe-credit-card wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"stripe-credit-card\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\">Paiement en ligne <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-no-columns wpforms-field-medium \" data-sublabel-position=\"above\" data-link-email=\"\" data-required=\"1\"><div id=\"wpforms-field-stripe-link-element-5906\"><\/div><div id=\"wpforms-field-stripe-payment-element-5906\"><\/div><input type=\"text\" class=\"wpforms-stripe-credit-card-hidden-input\" name=\"wpforms[stripe-credit-card-hidden-input-5906]\" disabled style=\"display: none;\"><\/div><\/div><div id=\"wpforms-5906-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-5906-field_2\">Commentaire<\/label><textarea id=\"wpforms-5906-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-5906-field_2-error\" ><\/textarea><\/div><div id=\"wpforms-5906-field_40-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"40\"><fieldset><legend class=\"wpforms-field-label\">Protection des donn\u00e9es personnelles (RGPD) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5906-field_40\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5906-field_40_1\" name=\"wpforms[fields][40][]\" value=\"J\u2019ai pris connaissance de l\u2019information relative \u00e0 la protection des donn\u00e9es personnelles et j\u2019accepte le traitement de mes donn\u00e9es dans le cadre de l\u2019organisation du congr\u00e8s.\" aria-errormessage=\"wpforms-5906-field_40_1-error\" aria-describedby=\"wpforms-5906-field_40-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5906-field_40_1\">J\u2019ai pris connaissance de l\u2019information relative \u00e0 la protection des donn\u00e9es personnelles et j\u2019accepte le traitement de mes donn\u00e9es dans le cadre de l\u2019organisation du congr\u00e8s.<\/label><\/li><\/ul><div id=\"wpforms-5906-field_40-description\" class=\"wpforms-field-description\">Les donn\u00e9es personnelles collect\u00e9es via ce formulaire sont trait\u00e9es par la SRAB uniquement dans le cadre de l\u2019organisation et de la gestion du congr\u00e8s (inscriptions, communication pratique, facturation le cas \u00e9ch\u00e9ant). Elles ne seront en aucun cas utilis\u00e9es \u00e0 d\u2019autres fins ni transmises \u00e0 des tiers sans base l\u00e9gale ou consentement explicite. Conform\u00e9ment au R\u00e8glement (UE) 2016\/679 (RGPD), vous disposez d\u2019un droit d\u2019acc\u00e8s, de rectification, d\u2019effacement et de limitation du traitement de vos donn\u00e9es, que vous pouvez exercer en contactant :\u00a0secretariat@SRAB.be<\/div><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-5906-field_4-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-5906-field_4-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-5906-field_4-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"5906\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/pages\/5858\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-5906\" class=\"wpforms-submit\" data-alt-text=\"Envoi...\" data-submit-text=\"Soumettre\" aria-live=\"assertive\" value=\"wpforms-submit\">Soumettre<\/button><img decoding=\"async\" src=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%2726%27%20height%3D%2726%27%20viewBox%3D%270%200%2026%2026%27%3E%3Crect%20width%3D%2726%27%20height%3D%2726%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/acfhab.be\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"lazyload wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":5981,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5858","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/pages\/5858","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/acfhab.be\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5858"}],"version-history":[{"count":2,"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/pages\/5858\/revisions"}],"predecessor-version":[{"id":5942,"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/pages\/5858\/revisions\/5942"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/acfhab.be\/index.php?rest_route=\/wp\/v2\/media\/5981"}],"wp:attachment":[{"href":"https:\/\/acfhab.be\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5858"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}