{"id":13944,"date":"2026-04-08T15:00:24","date_gmt":"2026-04-08T13:00:24","guid":{"rendered":"https:\/\/lachinelle.be\/la-chinelle\/12h\/12-hour-race-registration\/"},"modified":"2026-04-08T15:00:28","modified_gmt":"2026-04-08T13:00:28","slug":"12-hour-race-registration","status":"publish","type":"page","link":"https:\/\/lachinelle.be\/en\/la-chinelle\/12h\/12-hour-race-registration\/","title":{"rendered":"12-hour race registration"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1185.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_19' style='display:none'><div id='gf_19' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Inscription 12h 2026<\/h2>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/en\/wp-json\/wp\/v2\/pages\/13944#gf_19' data-formid='19' novalidate><div id='gf_page_steps_19' class='gf_page_steps'><div id='gf_step_19_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Intro<\/span><\/div><div id='gf_step_19_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Manager<\/span><\/div><div id='gf_step_19_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Course<\/span><\/div><div id='gf_step_19_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Pilote #1<\/span><\/div><div id='gf_step_19_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>Pilote #2<\/span><\/div><div id='gf_step_19_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'>Pilote #3<\/span><\/div><div id='gf_step_19_7' class='gf_step gf_step_pending'><span class='gf_step_number'>7<\/span><span class='gf_step_label'>Pilote #4<\/span><\/div><div id='gf_step_19_8' class='gf_step gf_step_pending'><span class='gf_step_number'>8<\/span><span class='gf_step_label'>Moto(s)<\/span><\/div><div id='gf_step_19_9' class='gf_step gf_step_pending'><span class='gf_step_number'>9<\/span><span class='gf_step_label'>Validation<\/span><\/div><div id='gf_step_19_10' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>10<\/span><span class='gf_step_label'><\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_19_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_171\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_171'>URL<\/label><div class='ginput_container'><input name='input_171' id='input_19_171' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_19_171'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_19_1\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Pour faciliter votre inscription, veuillez vous munir des informations suivantes :<br>\n<\/p><ul role=\"tablist\" class=\"ui-tabs-nav ui-corner-all ui-helper-reset ui-helper-clearfix ui-widget-header\"><\/ul>\n<ul>\n  <li><b>Pour le Responsable Administratif:<\/b> nom, pr\u00e9nom, t\u00e9l\u00e9phone, email, adresse.<\/li>\n  <li><b>Pour le Team Manager\/Responsable de stand:<\/b> nom, pr\u00e9nom, t\u00e9l\u00e9phone, email, adresse, date et lieu de naissance, nationalit\u00e9.<\/li>\n  <li><b>Pour chaque pilote:<\/b> nom, pr\u00e9nom, t\u00e9l\u00e9phone, email, adresse, date et lieu de naissance, nationalit\u00e9, num\u00e9ro de licence \u00e9ventuelle, f\u00e9d\u00e9ration, nom et num\u00e9ro du club auquel vous \u00eates affili\u00e9.<\/li>\n<\/ul>\n<p><\/p>\n<h4>Dans un int\u00e9r\u00eat commun, nous avons pris diverses mesures qui permettront de faciliter la gestion de chaque dossier et le passage de chaque \u00e9quipage au secr\u00e9tariat:<\/h4>\n<p style=\"text-align:justify\">\n  <\/p><ul>\n      <li style=\"text-align:jusitfy\">\n          <u><b>Les pilotes licenci\u00e9s<\/b><\/u> et\/ou membres d'un club reconnu FMB devront nous transmettre une copie lors de l\u2019inscription comme demand\u00e9 ci-dessus. Nous v\u00e9rifierons les licences, si celles-ci ne sont pas valables, vous devrez prendre une licence \u00e0 la journ\u00e9e. dans ce cas, veuillez vous r\u00e9f\u00e9rer au point ci-dessous.\n      <\/li>\n      <br>\n      <li style=\"text-align:jusitfy\">\n          <u><b>Les pilotes non-licenci\u00e9s<\/b><\/u> devront s'inscrire sur le site de la FMB <a style=\"color:#ff0000\">http:\/\/fmb-bmb.magelan.be\/<\/a> pour une licence \u00e0 la journ\u00e9e (45\u20ac) + la carte d'adh\u00e9rent \u00e0 PRODUCTION EVENT  (15\u20ac) par pilote. \n      <\/li>\n      <br>\n      <li style=\"text-align:jusitfy\">\n          <u><b>Droit d'engagement<\/b><\/u> est fix\u00e9 \u00e0 950\u20ac par \u00e9quipage (800\u20ac + 150\u20ac de caution). <b>Seul le paiement total fait office de r\u00e9servation officielle.<\/b>\n      <\/li>\n      <br>\n      <li style=\"text-align:justify\">\n          150\u20ac de <b><u>caution pour le stand<\/u><\/b> vous serons rembours\u00e9s sur le compte de l'engagement apr\u00e8s confirmation du bon \u00e9tat g\u00e9n\u00e9ral de votre stand lors de votre d\u00e9part et que vous aurez ramen\u00e9 la chasuble de responsable stand.\n      <\/li>\n      <br>\n      <br>\n      <li style=\"text-align:justify\">\n          \u00catre en ordre de licence avant l\u2019\u00e9preuve\n      <\/li>\n\n\n  <\/ul>\nATTENTION, paiement en ligne \u00e0 la fin de ce formulaire (Bancontact\/Visa\/Mastercard).<\/div><div id=\"field_19_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Le droit d'engagement comprend:<\/h4>\n<ol>\n<li>Frais d'engagement;<\/li>\n<li>3 bons de 10 litres essence;<\/li>\n<li>2 cyalums;<\/li>\n<\/ol><\/div><div id=\"field_19_158\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Stand<\/h3><\/div><fieldset id=\"field_19_160\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Stand (non compris dans votre droit d&#039;inscription) - 525\u20ac<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_160'>\n\t\t\t<div class='gchoice gchoice_19_160_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_160' type='radio' value='STAND NON'  id='choice_19_160_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_160_0' id='label_19_160_0' class='gform-field-label gform-field-label--type-inline'>Je n'ai pas besoin Stand<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_160_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_160' type='radio' value='STAND OUI'  id='choice_19_160_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_160_1' id='label_19_160_1' class='gform-field-label gform-field-label--type-inline'>J'ai besoin d'un Stand mont\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_159\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">WC<\/h3><\/div><fieldset id=\"field_19_132\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >WC (non compris dans votre droit d&#039;inscription)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_132'>\n\t\t\t<div class='gchoice gchoice_19_132_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='WC OUI'  id='choice_19_132_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_132_0' id='label_19_132_0' class='gform-field-label gform-field-label--type-inline'>J'ai besoin d'un WC privatif - 80\u20ac<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_132_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='WC NON'  id='choice_19_132_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_132_1' id='label_19_132_1' class='gform-field-label gform-field-label--type-inline'>Je n'ai pas besoin de WC<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_5\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Adresse d'envoi de votre copie de licence et\/ou carte de membre d'un club reconnu FMB:<\/h4>\n<ul style=\"list-style-type:none\">\n<li>Par E-Mail : secretariat@lachinelle.be<\/li>\n<\/ul><\/div><div id=\"field_19_6\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b>Tous nos prix s\u2019entendent TVAC\nUne confirmation de votre engagement et commande vous parviendra par mail (adresse email du Responsable Administratif).<\/b><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_19_2' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_2' class='gform_page' data-js='page-field-id-2' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Responsable Administratif (personne \u00e0 contacter pour l&#039;\u00e9quipage dans le cadre du dossier d&#039;inscription)<\/h3><\/div><div id=\"field_19_141\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_141'>Nom responsable<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_19_141' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_142\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_142'>Pr\u00e9nom responsable<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_19_142' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_8\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_8'>E-mail Responsable Administratif<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_19_8' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_10'>TEL \/ GSM<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_19_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_154\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_19_154' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_154_1_container' >\n                                        <input type='text' name='input_154.1' id='input_19_154_1' value=''    aria-required='true'    \/>\n                                        <label for='input_19_154_1' id='input_19_154_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_154_3_container' >\n                                    <input type='text' name='input_154.3' id='input_19_154_3' value=''    aria-required='true'    \/>\n                                    <label for='input_19_154_3' id='input_19_154_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_154.4' id='input_19_154_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_19_154_5_container' >\n                                    <input type='text' name='input_154.5' id='input_19_154_5' value=''    aria-required='true'    \/>\n                                    <label for='input_19_154_5' id='input_19_154_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_19_154_6_container' >\n                                        <select name='input_154.6' id='input_19_154_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_19_154_6' id='input_19_154_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_19_122\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Team Manager \/ Responsable de stand (obligatoirement majeur)<\/h3><div class='gsection_description' id='gfield_description_19_122'><p style=\"color:#ff0000;font-size:18px;font-weight:600\">ATTENTION:<\/p> Unique personne de contact pour les commissaires, organisateur, directeur de course.\n<span style=\"color:#ff0000;font-size:18px;font-weight:600\">Ne peut pas \u00eatre un pilote <\/span> et devra \u00eatre pr\u00e9sent sur le stand tout au long de l'\u00e9preuve.<\/div><\/div><div id=\"field_19_137\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_137'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_137' id='input_19_137' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_138\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_138'>Pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_138' id='input_19_138' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_120\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_120'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_120' id='input_19_120' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_133\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_133'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_133' id='input_19_133' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_133_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_133_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_133' class='gform_hidden' value='https:\/\/lachinelle.be\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_121\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_121'>TEL \/ GSM<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_121' id='input_19_121' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_12' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_12' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_3' class='gform_page' data-js='page-field-id-12' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Choix de la course<\/h3><\/div><div id=\"field_19_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_13'>Choix de la cat\u00e9gorie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_19_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Internationaux (max 3 pilotes par \u00e9quipage)' >Internationaux (max 3 pilotes par \u00e9quipage)<\/option><option value='Nationaux (max 3 pilotes par \u00e9quipage)' >Nationaux (max 3 pilotes par \u00e9quipage)<\/option><option value='Gentlemen Open (+40 ans) (max 4 pilotes par \u00e9quipage)' >Gentlemen Open (+40 ans) (max 4 pilotes par \u00e9quipage)<\/option><option value='Chinelle Open ( -40 ans ) (max 4 pilotes par \u00e9quipage)' >Chinelle Open ( -40 ans ) (max 4 pilotes par \u00e9quipage)<\/option><option value='Girls Open (max 4 pilotes par \u00e9quipage)' >Girls Open (max 4 pilotes par \u00e9quipage)<\/option><option value='Espoirs (+15 ans\/23ans) (max 3 pilotes par \u00e9quipage)' >Espoirs (+15 ans\/23ans) (max 3 pilotes par \u00e9quipage)<\/option><option value='Jeunes (14 ans\/17ans) (max 4 pilotes par \u00e9quipage)' >Jeunes (14 ans\/17ans) (max 4 pilotes par \u00e9quipage)<\/option><\/select><\/div><\/div><div id=\"field_19_14\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_14'>Nombre de pilote(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_19_14' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><\/select><\/div><\/div><div id=\"field_19_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_15'>Nom de l&#039;\u00e9quipe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_19_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_20' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_20' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_4' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pilote #1<\/h3><\/div><div id=\"field_19_135\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_135'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_135' id='input_19_135' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_136\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_136'>Pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_19_136' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_23\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_23'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_23' id='input_19_23' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_24'>TEL \/ GSM<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_19_24' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_26'>Lieu de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_19_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_29\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_29'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_29' id='input_19_29' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_29_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_29_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_29' class='gform_hidden' value='https:\/\/lachinelle.be\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_27\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_27'>Nationalit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_27' id='input_19_27' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghan' >Afghan<\/option><option value='Albanais' >Albanais<\/option><option value='Alg\u00e9rien' >Alg\u00e9rien<\/option><option value='Allemand' >Allemand<\/option><option value='Am\u00e9ricain' >Am\u00e9ricain<\/option><option value='Angolais' >Angolais<\/option><option value='Argentin' >Argentin<\/option><option value='Arm\u00e9nien' >Arm\u00e9nien<\/option><option value='Arubais' >Arubais<\/option><option value='Australien' >Australien<\/option><option value='Autrichien' >Autrichien<\/option><option value='Azerba\u00efdjanais' >Azerba\u00efdjanais<\/option><option value='Baham\u00e9en' >Baham\u00e9en<\/option><option value='Bangladais' >Bangladais<\/option><option value='Belge' selected='selected'>Belge<\/option><option value='Benin' >Benin<\/option><option value='Bi\u00e9lorusse' >Bi\u00e9lorusse<\/option><option value='Birmain' >Birmain<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosniaque' >Bosniaque<\/option><option value='Botswanais' >Botswanais<\/option><option value='Bouthan' >Bouthan<\/option><option value='Br\u00e9silien' >Br\u00e9silien<\/option><option value='Britannique' >Britannique<\/option><option value='Bulgare' >Bulgare<\/option><option value='Burkinab\u00e8' >Burkinab\u00e8<\/option><option value='Burundais' >Burundais<\/option><option value='Ca\u00efmanien' >Ca\u00efmanien<\/option><option value='Cambodgien' >Cambodgien<\/option><option value='Camerounais' >Camerounais<\/option><option value='Canadien' >Canadien<\/option><option value='Chilien' >Chilien<\/option><option value='Chinois' >Chinois<\/option><option value='Chypriote' >Chypriote<\/option><option value='Colombien' >Colombien<\/option><option value='Congolais' >Congolais<\/option><option value='Costaricain' >Costaricain<\/option><option value='Croate' >Croate<\/option><option value='Cubain' >Cubain<\/option><option value='Danois' >Danois<\/option><option value='Dominicain' >Dominicain<\/option><option value='Egyptien' >Egyptien<\/option><option value='Emirati' >Emirati<\/option><option value='Equatorien' >Equatorien<\/option><option value='Espagnol' >Espagnol<\/option><option value='Estonien' >Estonien<\/option><option value='Ethiopien' >Ethiopien<\/option><option value='Europ\u00e9en' >Europ\u00e9en<\/option><option value='Finlandais' >Finlandais<\/option><option value='Fran\u00e7ais' >Fran\u00e7ais<\/option><option value='Gabonais' >Gabonais<\/option><option value='Georgien' >Georgien<\/option><option value='Ghan\u00e9en' >Ghan\u00e9en<\/option><option value='Grec' >Grec<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guin\u00e9en' >Guin\u00e9en<\/option><option value='Ha\u00eftien' >Ha\u00eftien<\/option><option value='Hollandais' >Hollandais<\/option><option value='Hondurien' >Hondurien<\/option><option value='Hong-Kong' >Hong-Kong<\/option><option value='Hongrois' >Hongrois<\/option><option value='Indien' >Indien<\/option><option value='Indon\u00e9sien' >Indon\u00e9sien<\/option><option value='Irakien' >Irakien<\/option><option value='Iranien' >Iranien<\/option><option value='Irlandais' >Irlandais<\/option><option value='Islandais' >Islandais<\/option><option value='Isra\u00e9lien' >Isra\u00e9lien<\/option><option value='Italien' >Italien<\/option><option value='Ivoirien' >Ivoirien<\/option><option value='Jama\u00efcain' >Jama\u00efcain<\/option><option value='Japonais' >Japonais<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kazakh' >Kazakh<\/option><option value='Kenyan' >Kenyan<\/option><option value='Kirghiz' >Kirghiz<\/option><option value='Kosovar' >Kosovar<\/option><option value='Kowe\u00eftien' >Kowe\u00eftien<\/option><option value='Kurde' >Kurde<\/option><option value='Laotien' >Laotien<\/option><option value='L\u00e9sothien' >L\u00e9sothien<\/option><option value='Letton' >Letton<\/option><option value='Libanais' >Libanais<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanien' >Lituanien<\/option><option value='Luxembourgeois' >Luxembourgeois<\/option><option value='Mac\u00e9donien' >Mac\u00e9donien<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisien' >Malaisien<\/option><option value='Malien' >Malien<\/option><option value='Maltais' >Maltais<\/option><option value='Marocain' >Marocain<\/option><option value='Mauritanien' >Mauritanien<\/option><option value='Mauritien' >Mauritien<\/option><option value='Mexicain' >Mexicain<\/option><option value='Mon\u00e9gasque' >Mon\u00e9gasque<\/option><option value='Mongol' >Mongol<\/option><option value='Mont\u00e9n\u00e9grin' >Mont\u00e9n\u00e9grin<\/option><option value='Mozambique' >Mozambique<\/option><option value='Namibien' >Namibien<\/option><option value='N\u00e9o-Z\u00e9landais' >N\u00e9o-Z\u00e9landais<\/option><option value='N\u00e9palais' >N\u00e9palais<\/option><option value='Nicaraguayen' >Nicaraguayen<\/option><option value='Nig\u00e9rien' >Nig\u00e9rien<\/option><option value='Nord Cor\u00e9en' >Nord Cor\u00e9en<\/option><option value='Norv\u00e9gien' >Norv\u00e9gien<\/option><option value='Ougandais' >Ougandais<\/option><option value='Pakistanais' >Pakistanais<\/option><option value='Palestinien' >Palestinien<\/option><option value='Panam\u00e9en' >Panam\u00e9en<\/option><option value='Paraguayen' >Paraguayen<\/option><option value='P\u00e9ruvien' >P\u00e9ruvien<\/option><option value='Philippiens' >Philippiens<\/option><option value='Polonais' >Polonais<\/option><option value='Portoricain' >Portoricain<\/option><option value='Portugais' >Portugais<\/option><option value='Qatar' >Qatar<\/option><option value='Roumain' >Roumain<\/option><option value='Russe' >Russe<\/option><option value='Rwandais' >Rwandais<\/option><option value='Saoudien' >Saoudien<\/option><option value='S\u00e9n\u00e9galais' >S\u00e9n\u00e9galais<\/option><option value='Serbe' >Serbe<\/option><option value='Singapour' >Singapour<\/option><option value='Slovaque' >Slovaque<\/option><option value='Somalien' >Somalien<\/option><option value='Soudanais' >Soudanais<\/option><option value='Sovi\u00e9tique' >Sovi\u00e9tique<\/option><option value='Sri-Lankais' >Sri-Lankais<\/option><option value='Sud-Africain' >Sud-Africain<\/option><option value='Sud-Cor\u00e9en' >Sud-Cor\u00e9en<\/option><option value='Su\u00e9dois' >Su\u00e9dois<\/option><option value='Suisse' >Suisse<\/option><option value='Syrien' >Syrien<\/option><option value='Tadjik' >Tadjik<\/option><option value='Ta\u00efwanais' >Ta\u00efwanais<\/option><option value='Tanzanien' >Tanzanien<\/option><option value='Tchadien' >Tchadien<\/option><option value='Tch\u00e8que' >Tch\u00e8que<\/option><option value='Tch\u00e9tch\u00e8ne' >Tch\u00e9tch\u00e8ne<\/option><option value='Tha\u00eflandais' >Tha\u00eflandais<\/option><option value='Tunisien' >Tunisien<\/option><option value='Turc' >Turc<\/option><option value='Ukranien' >Ukranien<\/option><option value='Uruguayen' >Uruguayen<\/option><option value='V\u00e9n\u00e9zu\u00e9lien' >V\u00e9n\u00e9zu\u00e9lien<\/option><option value='Vietnamien' >Vietnamien<\/option><option value='Y\u00e9m\u00e9nite' >Y\u00e9m\u00e9nite<\/option><option value='Yougoslave' >Yougoslave<\/option><option value='Zimbabw\u00e9en' >Zimbabw\u00e9en<\/option><\/select><\/div><\/div><fieldset id=\"field_19_25\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_19_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_25_1_container' >\n                                        <input type='text' name='input_25.1' id='input_19_25_1' value=''    aria-required='true'    \/>\n                                        <label for='input_19_25_1' id='input_19_25_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_25_3_container' >\n                                    <input type='text' name='input_25.3' id='input_19_25_3' value=''    aria-required='true'    \/>\n                                    <label for='input_19_25_3' id='input_19_25_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_25.4' id='input_19_25_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_19_25_5_container' >\n                                    <input type='text' name='input_25.5' id='input_19_25_5' value=''    aria-required='true'    \/>\n                                    <label for='input_19_25_5' id='input_19_25_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_19_25_6_container' >\n                                        <select name='input_25.6' id='input_19_25_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_19_25_6' id='input_19_25_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_19_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Document du pilote 1<\/h3><\/div><div id=\"field_19_128\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_128'>Licence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_128' id='input_19_128' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan' >AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><option value='Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen' >Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen<\/option><option value='Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9' >Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9<\/option><option value='Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs' >Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs<\/option><option value='Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration OU je m&#039;engage \u00e0 en prendre une sur Magelan' >Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration OU je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><\/select><\/div><\/div><div id=\"field_19_34\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_34'>Carte d&#039;identit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_34' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_34&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_34&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_34&quot;,&quot;filelist&quot;:&quot;gform_preview_19_34&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:34,&quot;_gform_file_upload_nonce_19_34&quot;:&quot;a0572b19a5&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_34&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_34' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_34' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_34\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_34'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_34'><\/ul> <div id='gform_preview_19_34' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_52\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_52'>Licence FMB ou autre<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_52' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_52&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_52&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_52&quot;,&quot;filelist&quot;:&quot;gform_preview_19_52&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:52,&quot;_gform_file_upload_nonce_19_52&quot;:&quot;3d35b42eec&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_52&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_52' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_52' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_52\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_52'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_52'><\/ul> <div id='gform_preview_19_52' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Club du pilote 1<\/h3><\/div><div id=\"field_19_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_38'>Nom du club<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_19_38' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_39'>Num\u00e9ro du club<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_19_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_41' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_41' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_5' class='gform_page' data-js='page-field-id-41' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_40\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pilote #2<\/h3><\/div><div id=\"field_19_144\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_144'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_144' id='input_19_144' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_145\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_145'>Pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_145' id='input_19_145' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_43\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_43'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_43' id='input_19_43' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_45'>TEL \/ GSM<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_19_45' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_46\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_19_46' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_46_1_container' >\n                                        <input type='text' name='input_46.1' id='input_19_46_1' value=''    aria-required='true'    \/>\n                                        <label for='input_19_46_1' id='input_19_46_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_46_3_container' >\n                                    <input type='text' name='input_46.3' id='input_19_46_3' value=''    aria-required='true'    \/>\n                                    <label for='input_19_46_3' id='input_19_46_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_46.4' id='input_19_46_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_19_46_5_container' >\n                                    <input type='text' name='input_46.5' id='input_19_46_5' value=''    aria-required='true'    \/>\n                                    <label for='input_19_46_5' id='input_19_46_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_19_46_6_container' >\n                                        <select name='input_46.6' id='input_19_46_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_19_46_6' id='input_19_46_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_19_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_47'>Lieu de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_19_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_48\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_48'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_48' id='input_19_48' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_48_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_48_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_48' class='gform_hidden' value='https:\/\/lachinelle.be\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_49\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_49'>Nationalit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_19_49' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghan' >Afghan<\/option><option value='Albanais' >Albanais<\/option><option value='Alg\u00e9rien' >Alg\u00e9rien<\/option><option value='Allemand' >Allemand<\/option><option value='Am\u00e9ricain' >Am\u00e9ricain<\/option><option value='Angolais' >Angolais<\/option><option value='Argentin' >Argentin<\/option><option value='Arm\u00e9nien' >Arm\u00e9nien<\/option><option value='Arubais' >Arubais<\/option><option value='Australien' >Australien<\/option><option value='Autrichien' >Autrichien<\/option><option value='Azerba\u00efdjanais' >Azerba\u00efdjanais<\/option><option value='Baham\u00e9en' >Baham\u00e9en<\/option><option value='Bangladais' >Bangladais<\/option><option value='Belge' selected='selected'>Belge<\/option><option value='Benin' >Benin<\/option><option value='Bi\u00e9lorusse' >Bi\u00e9lorusse<\/option><option value='Birmain' >Birmain<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosniaque' >Bosniaque<\/option><option value='Botswanais' >Botswanais<\/option><option value='Bouthan' >Bouthan<\/option><option value='Br\u00e9silien' >Br\u00e9silien<\/option><option value='Britannique' >Britannique<\/option><option value='Bulgare' >Bulgare<\/option><option value='Burkinab\u00e8' >Burkinab\u00e8<\/option><option value='Burundais' >Burundais<\/option><option value='Ca\u00efmanien' >Ca\u00efmanien<\/option><option value='Cambodgien' >Cambodgien<\/option><option value='Camerounais' >Camerounais<\/option><option value='Canadien' >Canadien<\/option><option value='Chilien' >Chilien<\/option><option value='Chinois' >Chinois<\/option><option value='Chypriote' >Chypriote<\/option><option value='Colombien' >Colombien<\/option><option value='Congolais' >Congolais<\/option><option value='Costaricain' >Costaricain<\/option><option value='Croate' >Croate<\/option><option value='Cubain' >Cubain<\/option><option value='Danois' >Danois<\/option><option value='Dominicain' >Dominicain<\/option><option value='Egyptien' >Egyptien<\/option><option value='Emirati' >Emirati<\/option><option value='Equatorien' >Equatorien<\/option><option value='Espagnol' >Espagnol<\/option><option value='Estonien' >Estonien<\/option><option value='Ethiopien' >Ethiopien<\/option><option value='Europ\u00e9en' >Europ\u00e9en<\/option><option value='Finlandais' >Finlandais<\/option><option value='Fran\u00e7ais' >Fran\u00e7ais<\/option><option value='Gabonais' >Gabonais<\/option><option value='Georgien' >Georgien<\/option><option value='Ghan\u00e9en' >Ghan\u00e9en<\/option><option value='Grec' >Grec<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guin\u00e9en' >Guin\u00e9en<\/option><option value='Ha\u00eftien' >Ha\u00eftien<\/option><option value='Hollandais' >Hollandais<\/option><option value='Hondurien' >Hondurien<\/option><option value='Hong-Kong' >Hong-Kong<\/option><option value='Hongrois' >Hongrois<\/option><option value='Indien' >Indien<\/option><option value='Indon\u00e9sien' >Indon\u00e9sien<\/option><option value='Irakien' >Irakien<\/option><option value='Iranien' >Iranien<\/option><option value='Irlandais' >Irlandais<\/option><option value='Islandais' >Islandais<\/option><option value='Isra\u00e9lien' >Isra\u00e9lien<\/option><option value='Italien' >Italien<\/option><option value='Ivoirien' >Ivoirien<\/option><option value='Jama\u00efcain' >Jama\u00efcain<\/option><option value='Japonais' >Japonais<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kazakh' >Kazakh<\/option><option value='Kenyan' >Kenyan<\/option><option value='Kirghiz' >Kirghiz<\/option><option value='Kosovar' >Kosovar<\/option><option value='Kowe\u00eftien' >Kowe\u00eftien<\/option><option value='Kurde' >Kurde<\/option><option value='Laotien' >Laotien<\/option><option value='L\u00e9sothien' >L\u00e9sothien<\/option><option value='Letton' >Letton<\/option><option value='Libanais' >Libanais<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanien' >Lituanien<\/option><option value='Luxembourgeois' >Luxembourgeois<\/option><option value='Mac\u00e9donien' >Mac\u00e9donien<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisien' >Malaisien<\/option><option value='Malien' >Malien<\/option><option value='Maltais' >Maltais<\/option><option value='Marocain' >Marocain<\/option><option value='Mauritanien' >Mauritanien<\/option><option value='Mauritien' >Mauritien<\/option><option value='Mexicain' >Mexicain<\/option><option value='Mon\u00e9gasque' >Mon\u00e9gasque<\/option><option value='Mongol' >Mongol<\/option><option value='Mont\u00e9n\u00e9grin' >Mont\u00e9n\u00e9grin<\/option><option value='Mozambique' >Mozambique<\/option><option value='Namibien' >Namibien<\/option><option value='N\u00e9o-Z\u00e9landais' >N\u00e9o-Z\u00e9landais<\/option><option value='N\u00e9palais' >N\u00e9palais<\/option><option value='Nicaraguayen' >Nicaraguayen<\/option><option value='Nig\u00e9rien' >Nig\u00e9rien<\/option><option value='Nord Cor\u00e9en' >Nord Cor\u00e9en<\/option><option value='Norv\u00e9gien' >Norv\u00e9gien<\/option><option value='Ougandais' >Ougandais<\/option><option value='Pakistanais' >Pakistanais<\/option><option value='Palestinien' >Palestinien<\/option><option value='Panam\u00e9en' >Panam\u00e9en<\/option><option value='Paraguayen' >Paraguayen<\/option><option value='P\u00e9ruvien' >P\u00e9ruvien<\/option><option value='Philippiens' >Philippiens<\/option><option value='Polonais' >Polonais<\/option><option value='Portoricain' >Portoricain<\/option><option value='Portugais' >Portugais<\/option><option value='Qatar' >Qatar<\/option><option value='Roumain' >Roumain<\/option><option value='Russe' >Russe<\/option><option value='Rwandais' >Rwandais<\/option><option value='Saoudien' >Saoudien<\/option><option value='S\u00e9n\u00e9galais' >S\u00e9n\u00e9galais<\/option><option value='Serbe' >Serbe<\/option><option value='Singapour' >Singapour<\/option><option value='Slovaque' >Slovaque<\/option><option value='Somalien' >Somalien<\/option><option value='Soudanais' >Soudanais<\/option><option value='Sovi\u00e9tique' >Sovi\u00e9tique<\/option><option value='Sri-Lankais' >Sri-Lankais<\/option><option value='Sud-Africain' >Sud-Africain<\/option><option value='Sud-Cor\u00e9en' >Sud-Cor\u00e9en<\/option><option value='Su\u00e9dois' >Su\u00e9dois<\/option><option value='Suisse' >Suisse<\/option><option value='Syrien' >Syrien<\/option><option value='Tadjik' >Tadjik<\/option><option value='Ta\u00efwanais' >Ta\u00efwanais<\/option><option value='Tanzanien' >Tanzanien<\/option><option value='Tchadien' >Tchadien<\/option><option value='Tch\u00e8que' >Tch\u00e8que<\/option><option value='Tch\u00e9tch\u00e8ne' >Tch\u00e9tch\u00e8ne<\/option><option value='Tha\u00eflandais' >Tha\u00eflandais<\/option><option value='Tunisien' >Tunisien<\/option><option value='Turc' >Turc<\/option><option value='Ukranien' >Ukranien<\/option><option value='Uruguayen' >Uruguayen<\/option><option value='V\u00e9n\u00e9zu\u00e9lien' >V\u00e9n\u00e9zu\u00e9lien<\/option><option value='Vietnamien' >Vietnamien<\/option><option value='Y\u00e9m\u00e9nite' >Y\u00e9m\u00e9nite<\/option><option value='Yougoslave' >Yougoslave<\/option><option value='Zimbabw\u00e9en' >Zimbabw\u00e9en<\/option><\/select><\/div><\/div><div id=\"field_19_71\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Document du pilote 2<\/h3><\/div><div id=\"field_19_129\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_129'>Licence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_19_129' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan' >AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><option value='Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen' >Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen<\/option><option value='Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9.' >Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9.<\/option><option value='Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs.' >Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs.<\/option><option value='Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration  OU je m&#039;engage \u00e0 en prendre une sur Magelan' >Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration  OU je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><\/select><\/div><\/div><div id=\"field_19_51\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_51'>Carte d&#039;identit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_51' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_51&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_51&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_51&quot;,&quot;filelist&quot;:&quot;gform_preview_19_51&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:51,&quot;_gform_file_upload_nonce_19_51&quot;:&quot;bb5f79648f&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_51&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_51' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_51' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_51\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_51'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_51'><\/ul> <div id='gform_preview_19_51' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_35\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_35'>Licence FMB ou autre<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_35' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_35&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_35&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_35&quot;,&quot;filelist&quot;:&quot;gform_preview_19_35&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:35,&quot;_gform_file_upload_nonce_19_35&quot;:&quot;718684491a&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_35&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_35' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_35' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_35\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_35'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_35'><\/ul> <div id='gform_preview_19_35' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_54\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Club du pilote 2<\/h3><\/div><div id=\"field_19_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_55'>Nom du club #2<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_19_55' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_56'>Num\u00e9ro du club #2<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_19_56' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_61' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_61' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_6' class='gform_page' data-js='page-field-id-61' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pilote #3<\/h3><\/div><div id=\"field_19_146\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_146'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_146' id='input_19_146' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_147'>Pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_19_147' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_65\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_65'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_65' id='input_19_65' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_66'>TEL \/ GSM<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_19_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_67\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_19_67' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_67_1_container' >\n                                        <input type='text' name='input_67.1' id='input_19_67_1' value=''    aria-required='true'    \/>\n                                        <label for='input_19_67_1' id='input_19_67_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_67_3_container' >\n                                    <input type='text' name='input_67.3' id='input_19_67_3' value=''    aria-required='true'    \/>\n                                    <label for='input_19_67_3' id='input_19_67_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_67.4' id='input_19_67_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_19_67_5_container' >\n                                    <input type='text' name='input_67.5' id='input_19_67_5' value=''    aria-required='true'    \/>\n                                    <label for='input_19_67_5' id='input_19_67_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_19_67_6_container' >\n                                        <select name='input_67.6' id='input_19_67_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_19_67_6' id='input_19_67_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_19_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_68'>Lieu de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_19_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_69\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_69'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_69' id='input_19_69' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_69_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_69_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_69' class='gform_hidden' value='https:\/\/lachinelle.be\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_70\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_70'>Nationalit\u00e9<\/label><div class='ginput_container ginput_container_select'><select name='input_70' id='input_19_70' class='large gfield_select'     aria-invalid=\"false\" ><option value='Afghan' >Afghan<\/option><option value='Albanais' >Albanais<\/option><option value='Alg\u00e9rien' >Alg\u00e9rien<\/option><option value='Allemand' >Allemand<\/option><option value='Am\u00e9ricain' >Am\u00e9ricain<\/option><option value='Angolais' >Angolais<\/option><option value='Argentin' >Argentin<\/option><option value='Arm\u00e9nien' >Arm\u00e9nien<\/option><option value='Arubais' >Arubais<\/option><option value='Australien' >Australien<\/option><option value='Autrichien' >Autrichien<\/option><option value='Azerba\u00efdjanais' >Azerba\u00efdjanais<\/option><option value='Baham\u00e9en' >Baham\u00e9en<\/option><option value='Bangladais' >Bangladais<\/option><option value='Belge' selected='selected'>Belge<\/option><option value='Benin' >Benin<\/option><option value='Bi\u00e9lorusse' >Bi\u00e9lorusse<\/option><option value='Birmain' >Birmain<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosniaque' >Bosniaque<\/option><option value='Botswanais' >Botswanais<\/option><option value='Bouthan' >Bouthan<\/option><option value='Br\u00e9silien' >Br\u00e9silien<\/option><option value='Britannique' >Britannique<\/option><option value='Bulgare' >Bulgare<\/option><option value='Burkinab\u00e8' >Burkinab\u00e8<\/option><option value='Burundais' >Burundais<\/option><option value='Ca\u00efmanien' >Ca\u00efmanien<\/option><option value='Cambodgien' >Cambodgien<\/option><option value='Camerounais' >Camerounais<\/option><option value='Canadien' >Canadien<\/option><option value='Chilien' >Chilien<\/option><option value='Chinois' >Chinois<\/option><option value='Chypriote' >Chypriote<\/option><option value='Colombien' >Colombien<\/option><option value='Congolais' >Congolais<\/option><option value='Costaricain' >Costaricain<\/option><option value='Croate' >Croate<\/option><option value='Cubain' >Cubain<\/option><option value='Danois' >Danois<\/option><option value='Dominicain' >Dominicain<\/option><option value='Egyptien' >Egyptien<\/option><option value='Emirati' >Emirati<\/option><option value='Equatorien' >Equatorien<\/option><option value='Espagnol' >Espagnol<\/option><option value='Estonien' >Estonien<\/option><option value='Ethiopien' >Ethiopien<\/option><option value='Europ\u00e9en' >Europ\u00e9en<\/option><option value='Finlandais' >Finlandais<\/option><option value='Fran\u00e7ais' >Fran\u00e7ais<\/option><option value='Gabonais' >Gabonais<\/option><option value='Georgien' >Georgien<\/option><option value='Ghan\u00e9en' >Ghan\u00e9en<\/option><option value='Grec' >Grec<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guin\u00e9en' >Guin\u00e9en<\/option><option value='Ha\u00eftien' >Ha\u00eftien<\/option><option value='Hollandais' >Hollandais<\/option><option value='Hondurien' >Hondurien<\/option><option value='Hong-Kong' >Hong-Kong<\/option><option value='Hongrois' >Hongrois<\/option><option value='Indien' >Indien<\/option><option value='Indon\u00e9sien' >Indon\u00e9sien<\/option><option value='Irakien' >Irakien<\/option><option value='Iranien' >Iranien<\/option><option value='Irlandais' >Irlandais<\/option><option value='Islandais' >Islandais<\/option><option value='Isra\u00e9lien' >Isra\u00e9lien<\/option><option value='Italien' >Italien<\/option><option value='Ivoirien' >Ivoirien<\/option><option value='Jama\u00efcain' >Jama\u00efcain<\/option><option value='Japonais' >Japonais<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kazakh' >Kazakh<\/option><option value='Kenyan' >Kenyan<\/option><option value='Kirghiz' >Kirghiz<\/option><option value='Kosovar' >Kosovar<\/option><option value='Kowe\u00eftien' >Kowe\u00eftien<\/option><option value='Kurde' >Kurde<\/option><option value='Laotien' >Laotien<\/option><option value='L\u00e9sothien' >L\u00e9sothien<\/option><option value='Letton' >Letton<\/option><option value='Libanais' >Libanais<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanien' >Lituanien<\/option><option value='Luxembourgeois' >Luxembourgeois<\/option><option value='Mac\u00e9donien' >Mac\u00e9donien<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisien' >Malaisien<\/option><option value='Malien' >Malien<\/option><option value='Maltais' >Maltais<\/option><option value='Marocain' >Marocain<\/option><option value='Mauritanien' >Mauritanien<\/option><option value='Mauritien' >Mauritien<\/option><option value='Mexicain' >Mexicain<\/option><option value='Mon\u00e9gasque' >Mon\u00e9gasque<\/option><option value='Mongol' >Mongol<\/option><option value='Mont\u00e9n\u00e9grin' >Mont\u00e9n\u00e9grin<\/option><option value='Mozambique' >Mozambique<\/option><option value='Namibien' >Namibien<\/option><option value='N\u00e9o-Z\u00e9landais' >N\u00e9o-Z\u00e9landais<\/option><option value='N\u00e9palais' >N\u00e9palais<\/option><option value='Nicaraguayen' >Nicaraguayen<\/option><option value='Nig\u00e9rien' >Nig\u00e9rien<\/option><option value='Nord Cor\u00e9en' >Nord Cor\u00e9en<\/option><option value='Norv\u00e9gien' >Norv\u00e9gien<\/option><option value='Ougandais' >Ougandais<\/option><option value='Pakistanais' >Pakistanais<\/option><option value='Palestinien' >Palestinien<\/option><option value='Panam\u00e9en' >Panam\u00e9en<\/option><option value='Paraguayen' >Paraguayen<\/option><option value='P\u00e9ruvien' >P\u00e9ruvien<\/option><option value='Philippiens' >Philippiens<\/option><option value='Polonais' >Polonais<\/option><option value='Portoricain' >Portoricain<\/option><option value='Portugais' >Portugais<\/option><option value='Qatar' >Qatar<\/option><option value='Roumain' >Roumain<\/option><option value='Russe' >Russe<\/option><option value='Rwandais' >Rwandais<\/option><option value='Saoudien' >Saoudien<\/option><option value='S\u00e9n\u00e9galais' >S\u00e9n\u00e9galais<\/option><option value='Serbe' >Serbe<\/option><option value='Singapour' >Singapour<\/option><option value='Slovaque' >Slovaque<\/option><option value='Somalien' >Somalien<\/option><option value='Soudanais' >Soudanais<\/option><option value='Sovi\u00e9tique' >Sovi\u00e9tique<\/option><option value='Sri-Lankais' >Sri-Lankais<\/option><option value='Sud-Africain' >Sud-Africain<\/option><option value='Sud-Cor\u00e9en' >Sud-Cor\u00e9en<\/option><option value='Su\u00e9dois' >Su\u00e9dois<\/option><option value='Suisse' >Suisse<\/option><option value='Syrien' >Syrien<\/option><option value='Tadjik' >Tadjik<\/option><option value='Ta\u00efwanais' >Ta\u00efwanais<\/option><option value='Tanzanien' >Tanzanien<\/option><option value='Tchadien' >Tchadien<\/option><option value='Tch\u00e8que' >Tch\u00e8que<\/option><option value='Tch\u00e9tch\u00e8ne' >Tch\u00e9tch\u00e8ne<\/option><option value='Tha\u00eflandais' >Tha\u00eflandais<\/option><option value='Tunisien' >Tunisien<\/option><option value='Turc' >Turc<\/option><option value='Ukranien' >Ukranien<\/option><option value='Uruguayen' >Uruguayen<\/option><option value='V\u00e9n\u00e9zu\u00e9lien' >V\u00e9n\u00e9zu\u00e9lien<\/option><option value='Vietnamien' >Vietnamien<\/option><option value='Y\u00e9m\u00e9nite' >Y\u00e9m\u00e9nite<\/option><option value='Yougoslave' >Yougoslave<\/option><option value='Zimbabw\u00e9en' >Zimbabw\u00e9en<\/option><\/select><\/div><\/div><div id=\"field_19_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Document du pilote 3<\/h3><\/div><div id=\"field_19_130\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_130'>Licence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_130' id='input_19_130' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan' >AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><option value='Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen' >Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen<\/option><option value='Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9.' >Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9.<\/option><option value='Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs.' >Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs.<\/option><option value='Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration  OU je m&#039;engage \u00e0 en prendre une sur Magelan' >Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration  OU je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><\/select><\/div><\/div><div id=\"field_19_72\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_72'>Carte d&#039;identit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_72' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_72&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_72&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_72&quot;,&quot;filelist&quot;:&quot;gform_preview_19_72&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:72,&quot;_gform_file_upload_nonce_19_72&quot;:&quot;3923254ea3&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_72&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_72' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_72' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_72\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_72'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_72'><\/ul> <div id='gform_preview_19_72' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_73\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_73'>Licence FMB ou autre<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_73' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_73&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_73&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_73&quot;,&quot;filelist&quot;:&quot;gform_preview_19_73&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:73,&quot;_gform_file_upload_nonce_19_73&quot;:&quot;c1eb8a4788&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_73&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_73' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_73' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_73\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_73'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_73'><\/ul> <div id='gform_preview_19_73' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Club du pilote 3<\/h3><\/div><div id=\"field_19_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_76'>Nom du club<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_19_76' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_77\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_77'>Num\u00e9ro du club<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_19_77' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_82' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_82' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_7' class='gform_page' data-js='page-field-id-82' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_83\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pilote #4<\/h3><\/div><div id=\"field_19_148\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_148'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_19_148' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_149\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_149'>Pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_149' id='input_19_149' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_99\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_99'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_99' id='input_19_99' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_100\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_100'>TEL \/ GSM<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_100' id='input_19_100' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_98\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_19_98' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_98_1_container' >\n                                        <input type='text' name='input_98.1' id='input_19_98_1' value=''    aria-required='true'    \/>\n                                        <label for='input_19_98_1' id='input_19_98_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_98_3_container' >\n                                    <input type='text' name='input_98.3' id='input_19_98_3' value=''    aria-required='true'    \/>\n                                    <label for='input_19_98_3' id='input_19_98_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_98.4' id='input_19_98_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_19_98_5_container' >\n                                    <input type='text' name='input_98.5' id='input_19_98_5' value=''    aria-required='true'    \/>\n                                    <label for='input_19_98_5' id='input_19_98_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_19_98_6_container' >\n                                        <select name='input_98.6' id='input_19_98_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_19_98_6' id='input_19_98_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_19_95\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_95'>Lieu de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_19_95' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_96\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_96'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_96' id='input_19_96' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_96_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_96_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_96' class='gform_hidden' value='https:\/\/lachinelle.be\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_97\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_97'>Nationalit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_19_97' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghan' >Afghan<\/option><option value='Albanais' >Albanais<\/option><option value='Alg\u00e9rien' >Alg\u00e9rien<\/option><option value='Allemand' >Allemand<\/option><option value='Am\u00e9ricain' >Am\u00e9ricain<\/option><option value='Angolais' >Angolais<\/option><option value='Argentin' >Argentin<\/option><option value='Arm\u00e9nien' >Arm\u00e9nien<\/option><option value='Arubais' >Arubais<\/option><option value='Australien' >Australien<\/option><option value='Autrichien' >Autrichien<\/option><option value='Azerba\u00efdjanais' >Azerba\u00efdjanais<\/option><option value='Baham\u00e9en' >Baham\u00e9en<\/option><option value='Bangladais' >Bangladais<\/option><option value='Belge' selected='selected'>Belge<\/option><option value='Benin' >Benin<\/option><option value='Bi\u00e9lorusse' >Bi\u00e9lorusse<\/option><option value='Birmain' >Birmain<\/option><option value='Bolivien' >Bolivien<\/option><option value='Bosniaque' >Bosniaque<\/option><option value='Botswanais' >Botswanais<\/option><option value='Bouthan' >Bouthan<\/option><option value='Br\u00e9silien' >Br\u00e9silien<\/option><option value='Britannique' >Britannique<\/option><option value='Bulgare' >Bulgare<\/option><option value='Burkinab\u00e8' >Burkinab\u00e8<\/option><option value='Burundais' >Burundais<\/option><option value='Ca\u00efmanien' >Ca\u00efmanien<\/option><option value='Cambodgien' >Cambodgien<\/option><option value='Camerounais' >Camerounais<\/option><option value='Canadien' >Canadien<\/option><option value='Chilien' >Chilien<\/option><option value='Chinois' >Chinois<\/option><option value='Chypriote' >Chypriote<\/option><option value='Colombien' >Colombien<\/option><option value='Congolais' >Congolais<\/option><option value='Costaricain' >Costaricain<\/option><option value='Croate' >Croate<\/option><option value='Cubain' >Cubain<\/option><option value='Danois' >Danois<\/option><option value='Dominicain' >Dominicain<\/option><option value='Egyptien' >Egyptien<\/option><option value='Emirati' >Emirati<\/option><option value='Equatorien' >Equatorien<\/option><option value='Espagnol' >Espagnol<\/option><option value='Estonien' >Estonien<\/option><option value='Ethiopien' >Ethiopien<\/option><option value='Europ\u00e9en' >Europ\u00e9en<\/option><option value='Finlandais' >Finlandais<\/option><option value='Fran\u00e7ais' >Fran\u00e7ais<\/option><option value='Gabonais' >Gabonais<\/option><option value='Georgien' >Georgien<\/option><option value='Ghan\u00e9en' >Ghan\u00e9en<\/option><option value='Grec' >Grec<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guin\u00e9en' >Guin\u00e9en<\/option><option value='Ha\u00eftien' >Ha\u00eftien<\/option><option value='Hollandais' >Hollandais<\/option><option value='Hondurien' >Hondurien<\/option><option value='Hong-Kong' >Hong-Kong<\/option><option value='Hongrois' >Hongrois<\/option><option value='Indien' >Indien<\/option><option value='Indon\u00e9sien' >Indon\u00e9sien<\/option><option value='Irakien' >Irakien<\/option><option value='Iranien' >Iranien<\/option><option value='Irlandais' >Irlandais<\/option><option value='Islandais' >Islandais<\/option><option value='Isra\u00e9lien' >Isra\u00e9lien<\/option><option value='Italien' >Italien<\/option><option value='Ivoirien' >Ivoirien<\/option><option value='Jama\u00efcain' >Jama\u00efcain<\/option><option value='Japonais' >Japonais<\/option><option value='Jordanien' >Jordanien<\/option><option value='Kazakh' >Kazakh<\/option><option value='Kenyan' >Kenyan<\/option><option value='Kirghiz' >Kirghiz<\/option><option value='Kosovar' >Kosovar<\/option><option value='Kowe\u00eftien' >Kowe\u00eftien<\/option><option value='Kurde' >Kurde<\/option><option value='Laotien' >Laotien<\/option><option value='L\u00e9sothien' >L\u00e9sothien<\/option><option value='Letton' >Letton<\/option><option value='Libanais' >Libanais<\/option><option value='Libyen' >Libyen<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanien' >Lituanien<\/option><option value='Luxembourgeois' >Luxembourgeois<\/option><option value='Mac\u00e9donien' >Mac\u00e9donien<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisien' >Malaisien<\/option><option value='Malien' >Malien<\/option><option value='Maltais' >Maltais<\/option><option value='Marocain' >Marocain<\/option><option value='Mauritanien' >Mauritanien<\/option><option value='Mauritien' >Mauritien<\/option><option value='Mexicain' >Mexicain<\/option><option value='Mon\u00e9gasque' >Mon\u00e9gasque<\/option><option value='Mongol' >Mongol<\/option><option value='Mont\u00e9n\u00e9grin' >Mont\u00e9n\u00e9grin<\/option><option value='Mozambique' >Mozambique<\/option><option value='Namibien' >Namibien<\/option><option value='N\u00e9o-Z\u00e9landais' >N\u00e9o-Z\u00e9landais<\/option><option value='N\u00e9palais' >N\u00e9palais<\/option><option value='Nicaraguayen' >Nicaraguayen<\/option><option value='Nig\u00e9rien' >Nig\u00e9rien<\/option><option value='Nord Cor\u00e9en' >Nord Cor\u00e9en<\/option><option value='Norv\u00e9gien' >Norv\u00e9gien<\/option><option value='Ougandais' >Ougandais<\/option><option value='Pakistanais' >Pakistanais<\/option><option value='Palestinien' >Palestinien<\/option><option value='Panam\u00e9en' >Panam\u00e9en<\/option><option value='Paraguayen' >Paraguayen<\/option><option value='P\u00e9ruvien' >P\u00e9ruvien<\/option><option value='Philippiens' >Philippiens<\/option><option value='Polonais' >Polonais<\/option><option value='Portoricain' >Portoricain<\/option><option value='Portugais' >Portugais<\/option><option value='Qatar' >Qatar<\/option><option value='Roumain' >Roumain<\/option><option value='Russe' >Russe<\/option><option value='Rwandais' >Rwandais<\/option><option value='Saoudien' >Saoudien<\/option><option value='S\u00e9n\u00e9galais' >S\u00e9n\u00e9galais<\/option><option value='Serbe' >Serbe<\/option><option value='Singapour' >Singapour<\/option><option value='Slovaque' >Slovaque<\/option><option value='Somalien' >Somalien<\/option><option value='Soudanais' >Soudanais<\/option><option value='Sovi\u00e9tique' >Sovi\u00e9tique<\/option><option value='Sri-Lankais' >Sri-Lankais<\/option><option value='Sud-Africain' >Sud-Africain<\/option><option value='Sud-Cor\u00e9en' >Sud-Cor\u00e9en<\/option><option value='Su\u00e9dois' >Su\u00e9dois<\/option><option value='Suisse' >Suisse<\/option><option value='Syrien' >Syrien<\/option><option value='Tadjik' >Tadjik<\/option><option value='Ta\u00efwanais' >Ta\u00efwanais<\/option><option value='Tanzanien' >Tanzanien<\/option><option value='Tchadien' >Tchadien<\/option><option value='Tch\u00e8que' >Tch\u00e8que<\/option><option value='Tch\u00e9tch\u00e8ne' >Tch\u00e9tch\u00e8ne<\/option><option value='Tha\u00eflandais' >Tha\u00eflandais<\/option><option value='Tunisien' >Tunisien<\/option><option value='Turc' >Turc<\/option><option value='Ukranien' >Ukranien<\/option><option value='Uruguayen' >Uruguayen<\/option><option value='V\u00e9n\u00e9zu\u00e9lien' >V\u00e9n\u00e9zu\u00e9lien<\/option><option value='Vietnamien' >Vietnamien<\/option><option value='Y\u00e9m\u00e9nite' >Y\u00e9m\u00e9nite<\/option><option value='Yougoslave' >Yougoslave<\/option><option value='Zimbabw\u00e9en' >Zimbabw\u00e9en<\/option><\/select><\/div><\/div><div id=\"field_19_94\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Document du pilote 4<\/h3><\/div><div id=\"field_19_131\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_131'>Licence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_131' id='input_19_131' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan' >AUCUNE\/AUTRE - je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><option value='Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen' >Une licence BEX Europe Open \u00e9mise par la FMWB ou Motorsport Vlaanderen<\/option><option value='Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9.' >Une licence \u00e9mise par une FMN reconnue par la F.I.M., de type Europ\u00e9enne ou Internationale en cours de validit\u00e9.<\/option><option value='Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs.' >Une licence FMB csr, enduro, motocross, supermotard, ampl, pcna (blanche), Vmcf avec un paiement de 20\u20ac de frais administratifs.<\/option><option value='Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration  OU je m&#039;engage \u00e0 en prendre une sur Magelan' >Je poss\u00e8de une licence europ\u00e9enne ou internationale \u00e9mise par un autre pays que la Belgique, je m&#039;engage \u00e0 fournir une autorisation de sortie de ma f\u00e9d\u00e9ration  OU je m&#039;engage \u00e0 en prendre une sur Magelan<\/option><\/select><\/div><\/div><div id=\"field_19_91\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_91'>Carte d&#039;identit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_91' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_91&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_91&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_91&quot;,&quot;filelist&quot;:&quot;gform_preview_19_91&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:91,&quot;_gform_file_upload_nonce_19_91&quot;:&quot;b7921cd926&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_91&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_91' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_91' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_91\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_91'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_91'><\/ul> <div id='gform_preview_19_91' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_92\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_19_92'>Licence FMB ou autre<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_19_92' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_19_92&quot;,&quot;container&quot;:&quot;gform_multifile_upload_19_92&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_19_92&quot;,&quot;filelist&quot;:&quot;gform_preview_19_92&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/en\\\/?gf_page=1df6b0ef8dd0380&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lachinelle.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;4194304b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:19,&quot;field_id&quot;:92,&quot;_gform_file_upload_nonce_19_92&quot;:&quot;694f390dd0&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_19_92&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_19_92' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_19_92' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_19_92\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_19_92'>Max. file size: 4 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_19_92'><\/ul> <div id='gform_preview_19_92' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_19_90\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Club du pilote 4<\/h3><\/div><div id=\"field_19_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_88'>Nom du club<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_19_88' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_89\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_89'>Num\u00e9ro du club<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_19_89' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_102' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_102' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_8' class='gform_page' data-js='page-field-id-102' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_101\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Moto 1<\/h3><\/div><div id=\"field_19_106\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_106'>Marque 1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_106' id='input_19_106' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_103\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_103'>Type 1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_19_103' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_109\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_109'>Moteur 1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_109' id='input_19_109' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='2 temps' >2 temps<\/option><option value='4 temps' >4 temps<\/option><\/select><\/div><\/div><div id=\"field_19_104\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Moto 2<\/h3><\/div><div id=\"field_19_105\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_105'>Marque 2<\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_19_105' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_107\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_107'>Type 2<\/label><div class='ginput_container ginput_container_text'><input name='input_107' id='input_19_107' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_110\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_110'>Moteur 2<\/label><div class='ginput_container ginput_container_select'><select name='input_110' id='input_19_110' class='large gfield_select'     aria-invalid=\"false\" ><option value='2 temps' >2 temps<\/option><option value='4 temps' >4 temps<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_19_111' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_19_111' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_9' class='gform_page' data-js='page-field-id-111' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_164\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_164'>Emplacement prairie souhait\u00e9 (sous r\u00e9serve de possibilit\u00e9)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_164' id='input_19_164' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Peu importe' >Peu importe<\/option><option value='Sur le Haut de la prairie' >Sur le Haut de la prairie<\/option><option value='Dans le bas de la prairie' >Dans le bas de la prairie<\/option><\/select><\/div><\/div><div id=\"field_19_163\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_163'>Commentaire(s) additionnel(s) - Remarque(s)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_163' id='input_19_163' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_19_112\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Conditions g\u00e9n\u00e9rales<\/h4>\n<p style=\"text-align:justify\">\n                                        Le Team Manager\/Reponsable de stand et les pilotes s'engagent \u00e0 avoir pris connaissance du r\u00e8glement particulier. Ils renoncent formellement \u00e0 se pourvoir en justice contre la F.M.B. et tous les organisateurs de \u00abLa Chinelle\u00bb \u00e0 titre personnel ou comme civilement responsable. Ils renoncent formellement, pour les ayants-droit et eux-m\u00eame, \u00e0 r\u00e9clamer une indemnit\u00e9 quelconque au pilote qui, involontairement en course, aurait caus\u00e9 un dommage, si important soit-il. <\/p><p>\n<b>En acceptant les conditions mentionn\u00e9es ci-dessus et dans le r\u00e8glement t\u00e9l\u00e9chargeable ci-dessous, j'affirme avoir t\u00e9l\u00e9charg\u00e9 et lu ce r\u00e8glement.<\/b><\/p><\/div><div id=\"field_19_165\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>RGPD<\/h4>\n<p>Consentement au traitement des donn\u00e9es personnelles (RGPD) En vertu du R\u00e8glement G\u00e9n\u00e9ral sur la Protection des Donn\u00e9es (RGPD) (UE) 2016\/679, nous nous engageons \u00e0 prot\u00e9ger la confidentialit\u00e9 des donn\u00e9es personnelles collect\u00e9es.\n\nResponsable du traitement : Production Event asbl \nFinalit\u00e9 des donn\u00e9es collect\u00e9es : Les informations fournies dans ce formulaire seront utilis\u00e9es pour :\n\nG\u00e9rer l'inscription aux activit\u00e9s sportives ;\nCommuniquer sur les activit\u00e9s du club\/association ;\nGarantir la s\u00e9curit\u00e9 et le bien-\u00eatre des participants.\nDonn\u00e9es collect\u00e9es : Les donn\u00e9es personnelles collect\u00e9es incluent, mais ne se limitent pas \u00e0 :\n\nLe nom, pr\u00e9nom et date de naissance du pilote ;\nLes coordonn\u00e9es des ayant droits l\u00e9gaux ;\nDes informations m\u00e9dicales essentielles (allergies, besoins sp\u00e9cifiques).\nBase l\u00e9gale : Le traitement de ces donn\u00e9es repose sur votre consentement explicite. Vous avez le droit de retirer votre consentement \u00e0 tout moment en contactant secretariat@lachinelle.be.\n\nDur\u00e9e de conservation : Les donn\u00e9es personnelles seront conserv\u00e9es pendant la dur\u00e9e de l'inscription et archiv\u00e9es pour une p\u00e9riode maximale de 6 mois, sauf obligation l\u00e9gale contraire.\n\nDroits des personnes concern\u00e9es : Conform\u00e9ment au RGPD, vous avez le droit d'acc\u00e9der \u00e0 vos donn\u00e9es, de les rectifier, de demander leur effacement ou de limiter leur traitement. Pour toute demande, veuillez contacter secretariat@lachinelle.be\n\nConsentement sp\u00e9cifique pour les donn\u00e9es des mineurs : En signant ce formulaire, je confirme en tant que parent\/tuteur l\u00e9gal du\/des pilotes repris dans le formulaire d'inscription que :\n\nJ'autorise le traitement des donn\u00e9es personnelles de mon\/mes enfant(s) pour les finalit\u00e9s mentionn\u00e9es.\nJ'ai \u00e9t\u00e9 inform\u00e9(e) de mes droits en mati\u00e8re de protection des donn\u00e9es.<\/p><\/div><fieldset id=\"field_19_113\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Reglement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_19_113'><div class='gchoice gchoice_19_113_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.1' type='checkbox'  value='J&#039;accepte les conditions mentionn\u00e9es dans le r\u00e8glement, les conditions g\u00e9n\u00e9rales et les RGPD repris ci-avant'  id='choice_19_113_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_113_1' id='label_19_113_1' class='gform-field-label gform-field-label--type-inline'>J'accepte les conditions mentionn\u00e9es dans le r\u00e8glement, les conditions g\u00e9n\u00e9rales et les RGPD repris ci-avant<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_127\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Paiement<\/h3>\n\n<p>Les inscriptions sont valid\u00e9es apr\u00e8s r\u00e9ception du paiement de 950\u20ac, en ligne \u00e0 la cl\u00f4ture de ce formulaire<\/p>\n<p>Nom : <b>ASBL PRODUCTION EVENT EVENT<\/b> <\/p>\n<p>Communication : \nNom de l'\u00e9quipe - Nom du Responsable administratif<\/p>\n<p>Le paiement pour le Stand et\/ou le WC se font directement aupr\u00e8s de nos partenaires<\/p><\/div><fieldset id=\"field_19_152\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Facturation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_152'>\n\t\t\t<div class='gchoice gchoice_19_152_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_152' type='radio' value='oui'  id='choice_19_152_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_152_0' id='label_19_152_0' class='gform-field-label gform-field-label--type-inline'>Besoin d'une facture<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_152_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_152' type='radio' value='non'  id='choice_19_152_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_152_1' id='label_19_152_1' class='gform-field-label gform-field-label--type-inline'>Pas besoin de facture<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_151\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Coordonn\u00e9es de facturation<\/h3><\/div><div id=\"field_19_153\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_153'>Nom<\/label><div class='ginput_container ginput_container_text'><input name='input_153' id='input_19_153' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_155\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_155'>Pr\u00e9nom<\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_19_155' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_11\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_19_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_19_11_1' value=''    aria-required='false'    \/>\n                                        <label for='input_19_11_1' id='input_19_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_19_11_3' value=''    aria-required='false'    \/>\n                                    <label for='input_19_11_3' id='input_19_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_11.4' id='input_19_11_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_19_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_19_11_5' value=''    aria-required='false'    \/>\n                                    <label for='input_19_11_5' id='input_19_11_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_19_11_6_container' >\n                                        <select name='input_11.6' id='input_19_11_6'   aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' 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