{"id":13933,"date":"2024-03-18T14:22:25","date_gmt":"2024-03-18T13:22:25","guid":{"rendered":"https:\/\/backup.supernils.be\/?p=13933"},"modified":"2024-09-24T12:39:33","modified_gmt":"2024-09-24T10:39:33","slug":"aanmeldformulier","status":"publish","type":"post","link":"https:\/\/backup.supernils.be\/fr\/2024\/03\/18\/formulaire-dinscription\/","title":{"rendered":"Groupes de discussion - int\u00e9r\u00eat"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"13933\" class=\"elementor elementor-13933\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0ab8b1f e-flex e-con-boxed e-con e-parent\" data-id=\"0ab8b1f\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-097d406 elementor-widget elementor-widget-spacer\" data-id=\"097d406\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-296d743c e-con-full e-flex e-con e-parent\" data-id=\"296d743c\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-756a35e8 e-con-full e-flex e-con e-child\" data-id=\"756a35e8\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e442f7 elementor-widget elementor-widget-heading\" data-id=\"e442f7\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">L'Asbl SuperNils et Servier organisent ...<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6ad5c94d elementor-widget elementor-widget-heading\" data-id=\"6ad5c94d\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Groupes de parole pour les proches de patients atteints d'un cancer h\u00e9matologique<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-210ff1e7 e-con-full e-flex e-con e-child\" data-id=\"210ff1e7\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f06a7f9 e-flex e-con-boxed e-con e-parent\" data-id=\"f06a7f9\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0ecace5 elementor-widget elementor-widget-spacer\" data-id=\"0ecace5\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b8b0427 e-flex e-con-boxed e-con e-parent\" data-id=\"b8b0427\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c407387 elementor-widget elementor-widget-wpforms\" data-id=\"c407387\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-13929\"><form id=\"wpforms-form-13929\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"13929\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/posts\/13933\" data-token=\"4b405014cc72abe1123a21fb02c0a204\" data-token-time=\"1778947873\" data-trp-original-action=\"\/fr\/wp-json\/wp\/v2\/posts\/13933\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-13929-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-13929-field_1\">Nom <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-13929-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" required><label for=\"wpforms-13929-field_1\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-13929-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" required><label for=\"wpforms-13929-field_1-last\" class=\"wpforms-field-sublabel after\">Nom<\/label><\/div><\/div><\/div><div id=\"wpforms-13929-field_2-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-13929-field_2\">Ma ville natale se trouve dans la province <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-13929-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_1\" name=\"wpforms[fields][2]\" value=\"Antwerpen\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_1\">Anvers<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_2\" name=\"wpforms[fields][2]\" value=\"Limburg\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_2\">Limbourg<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_3\" name=\"wpforms[fields][2]\" value=\"West-Vlaanderen\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_3\">Flandre occidentale<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_4\" name=\"wpforms[fields][2]\" value=\"Oost-Vlaanderen\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_4\">Flandre orientale<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_5\" name=\"wpforms[fields][2]\" value=\"Vlaams-Brabant\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_5\">Brabant flamand<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_6\" name=\"wpforms[fields][2]\" value=\"Waals-Brabant\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_6\">Brabant wallon<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_7\" name=\"wpforms[fields][2]\" value=\"Luik\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_7\">Li\u00e8ge<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_8\" name=\"wpforms[fields][2]\" value=\"Namen\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_8\">Noms<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_9\" name=\"wpforms[fields][2]\" value=\"Henegouwen\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_9\">Hainaut<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"radio\" id=\"wpforms-13929-field_2_10\" name=\"wpforms[fields][2]\" value=\"Luxemburg\" required><label class=\"wpforms-field-label-inline\" for=\"wpforms-13929-field_2_10\">Luxembourg<\/label><\/li><\/ul><\/div><div id=\"wpforms-13929-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-13929-field_3\">Contactez-nous \u00e0 cette adresse e-mail <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-13929-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-13929-field_4-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-13929-field_4\">T\u00e9l\u00e9phone (non obligatoire)<\/label><input type=\"tel\" id=\"wpforms-13929-field_4\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"13929\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/posts\/13933\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-13929\" class=\"wpforms-submit\" data-alt-text=\"Verzenden...\" data-submit-text=\"Verzend\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer<\/button><img decoding=\"async\" src=\"https:\/\/backup.supernils.be\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>L'asbl SuperNils et Servier organisent ... Groupes de parole pour les proches de patients atteints d'un cancer h\u00e9matologique Activez JavaScript dans votre navigateur pour remplir ce formulaire.Nom *Pr\u00e9nomSurnomMon lieu de r\u00e9sidence se trouve dans la province * Anvers Limbourg Flandre occidentale Flandre orientale Brabant flamand Brabant wallon Li\u00e8ge Namur Hainaut Luxembourg Contact via cette adresse e-mail *T\u00e9l\u00e9phone (non obligatoire) Envoyer<\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-13933","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/posts\/13933","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/comments?post=13933"}],"version-history":[{"count":14,"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/posts\/13933\/revisions"}],"predecessor-version":[{"id":16011,"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/posts\/13933\/revisions\/16011"}],"wp:attachment":[{"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/media?parent=13933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/categories?post=13933"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/backup.supernils.be\/fr\/wp-json\/wp\/v2\/tags?post=13933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}