{"id":7577,"date":"2026-02-09T15:20:46","date_gmt":"2026-02-09T15:20:46","guid":{"rendered":"https:\/\/hygie31.com\/?page_id=7577"},"modified":"2026-02-17T09:34:02","modified_gmt":"2026-02-17T09:34:02","slug":"formulaire-adherent","status":"publish","type":"page","link":"https:\/\/hygie31.com\/en\/formulaire-adherent\/","title":{"rendered":"Formulaire adh\u00e9rent"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7577\" class=\"elementor elementor-7577\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-31ef3780 e-flex e-con-boxed e-con e-parent\" data-id=\"31ef3780\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-25b7551 elementor-widget elementor-widget-heading\" data-id=\"25b7551\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"> Prix de l'engagement <br>Adh\u00e9rent<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c0c990a elementor-widget elementor-widget-heading\" data-id=\"c0c990a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Fondation la sant\u00e9 pour tous Hygie31<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64dfaf9 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"64dfaf9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Si vous \u00eates adh\u00e9rent ou salari\u00e9 d&rsquo;un adh\u00e9rent du groupe Hygie 31 et que vous souhaitez candidater pour le Prix de l&rsquo;Engagement propos\u00e9 par la Fondation La sant\u00e9 pour tous Hygie 31, remplissez le formulaire ci-dessous et envoyez nous les documents demand\u00e9s en fin de questionnaire. Si vous avez la moindre question, vous pouvez nous contacter : fondation@hygie31group.com<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ac63bc6 elementor-align-center elementor-mobile-align-center elementor-widget elementor-widget-button\" data-id=\"ac63bc6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-shrink\" href=\"https:\/\/hygie31.com\/wp-content\/uploads\/2026\/02\/Formulaire-adherent2026.pdf\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-right\" viewBox=\"0 0 320 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M285.476 272.971L91.132 467.314c-9.373 9.373-24.569 9.373-33.941 0l-22.667-22.667c-9.357-9.357-9.375-24.522-.04-33.901L188.505 256 34.484 101.255c-9.335-9.379-9.317-24.544.04-33.901l22.667-22.667c9.373-9.373 24.569-9.373 33.941 0L285.475 239.03c9.373 9.372 9.373 24.568.001 33.941z\"><\/path><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">T\u00e9l\u00e9charger le formulaire vierge ici<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-318e018 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"318e018\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Ce document a pour objectif de vous aider \u00e0 pr\u00e9parer vos r\u00e9ponses, <br \/>mais il ne se substitue pas au remplissage du formulaire en ligne.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d99a011 elementor-widget elementor-widget-formidable\" data-id=\"d99a011\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_forms  with_frm_style frm_style_style-formidable\" id=\"frm_form_4_container\" data-token=\"0f7d517e665976fb24324fa604a14110\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_5r3pm\" data-token=\"0f7d517e665976fb24324fa604a14110\">\n<div class=\"frm_form_fields  frm_page_num_1\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Formulaire adh\u00e9rent<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<div class=\"frm_rootline_group\" role=\"group\" tabindex=\"0\" aria-label=\"Page 1 of 6\" ><ul class=\"frm_page_bar frm_rootline_6 frm_rootline frm_rootline_line  frm_show_lines \"><li class=\"frm_rootline_single frm_current_page\"><input type=\"button\" value=\"1\" data-page=\"\" class=\" frm_page_1\" aria-disabled=\"true\" data-field=\"0\" aria-label=\"Page 1\"  \/><\/li><li class=\"frm_rootline_single\"><input type=\"button\" value=\"2\" data-page=\"16\" class=\"frm_page_skip frm_page_2\" data-field=\"44\" aria-label=\"Suivant\"  \/><\/li><li class=\"frm_rootline_single\"><input type=\"button\" value=\"3\" data-page=\"28\" class=\"frm_page_skip frm_page_3\" data-field=\"51\" aria-label=\"Suivant\"  \/><\/li><li class=\"frm_rootline_single\"><input type=\"button\" value=\"4\" data-page=\"64\" class=\"frm_page_skip frm_page_4\" data-field=\"70\" aria-label=\"Suivant\"  \/><\/li><li class=\"frm_rootline_single\"><input type=\"button\" value=\"5\" data-page=\"72\" class=\"frm_page_skip frm_page_5\" data-field=\"74\" aria-label=\"Suivant\"  \/><\/li>\t\t<li class=\"frm_rootline_single frm_rootline_show_hidden_steps_btn frm_hidden\">\n\t\t\t<input type=\"button\" class=\"frm_rootline_show_more_btn\" value=\"\u00b7\u00b7\u00b7\" \/>\n\t\t\t<ul class=\"frm_rootline_hidden_steps frm_hidden\"><\/ul>\n\t\t<\/li>\n\t\t<li class=\"frm_rootline_single\"><input type=\"button\" value=\"6\" data-page=\"92\" class=\"frm_page_skip frm_page_6\" data-field=\"82\" aria-label=\"Suivant\"  \/><\/li><\/ul><div class=\"frm_clearfix\"><\/div><\/div><input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"5r3pm\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"0e85aca018\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/7577\" \/><div id=\"frm_field_36_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_3i3xu\" id=\"field_3i3xu_label\" class=\"frm_primary_label\">Adresse e-mail\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_3i3xu\" name=\"item_meta[36]\" value=\"\"  autocomplete=\"email\"  data-reqmsg=\"Adresse e-mail ne peut pas \u00eatre vide.\" aria-required=\"true\" data-invmsg=\"Adresse e-mail est non valide\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_7xphe\" id=\"field_7xphe_label\" class=\"frm_primary_label\">Identit\u00e9 du candidat : NOM et Pr\u00e9nom\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_7xphe\" name=\"item_meta[38]\" value=\"\"  data-reqmsg=\"Identit\u00e9 du candidat : NOM et Pr\u00e9nom ne peut pas \u00eatre vide.\" aria-required=\"true\" data-invmsg=\"Identit\u00e9 du candidat : NOM et Pr\u00e9nom est non valide\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_3h7hx\" id=\"field_3h7hx_label\" class=\"frm_primary_label\">Contact du candidat : t\u00e9l\u00e9phone\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_3h7hx\" name=\"item_meta[39]\" value=\"\"  data-reqmsg=\"Contact du candidat : t\u00e9l\u00e9phone ne peut pas \u00eatre vide.\" aria-required=\"true\" data-invmsg=\"Contact du candidat : t\u00e9l\u00e9phone est non valide\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_fyb7t\" id=\"field_fyb7t_label\" class=\"frm_primary_label\">Contact du candidat : email (si diff\u00e9rente de l'adresse indiqu\u00e9e ci-dessus)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_fyb7t\" name=\"item_meta[40]\" value=\"\"  data-invmsg=\"Contact du candidat : email (si diff\u00e9rente de l&#039;adresse indiqu\u00e9e ci-dessus) est non valide\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_p3e9h_label\" class=\"frm_primary_label\">Enseigne ou groupement de rattachement\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_p3e9h_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-0\">\t\t\t<label  for=\"field_p3e9h-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-0\" value=\"Pharmacie Lafayette\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   aria-required=\"true\"  \/> Pharmacie Lafayette<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-1\">\t\t\t<label  for=\"field_p3e9h-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-1\" value=\"Optique Lafayette\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Optique Lafayette<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-21\">\t\t\t<label  for=\"field_p3e9h-21\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-21\" value=\"M\u00e9dical Lafayette\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> M\u00e9dical Lafayette<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-20\">\t\t\t<label  for=\"field_p3e9h-20\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-20\" value=\"Parapharmacie Lafayette\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Parapharmacie Lafayette<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-19\">\t\t\t<label  for=\"field_p3e9h-19\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-19\" value=\"Pharmacorp\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Pharmacorp<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-18\">\t\t\t<label  for=\"field_p3e9h-18\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-18\" value=\"Madgal\u00e9on\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Madgal\u00e9on<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-17\">\t\t\t<label  for=\"field_p3e9h-17\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-17\" value=\"Pharm&#039;Auvergne\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Pharm'Auvergne<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-16\">\t\t\t<label  for=\"field_p3e9h-16\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-16\" value=\"Quartz\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Quartz<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-15\">\t\t\t<label  for=\"field_p3e9h-15\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-15\" value=\"RPM\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> RPM<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-14\">\t\t\t<label  for=\"field_p3e9h-14\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-14\" value=\"P&amp;P\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> P&amp;P<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-13\">\t\t\t<label  for=\"field_p3e9h-13\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-13\" value=\"Pharmacyal\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Pharmacyal<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-12\">\t\t\t<label  for=\"field_p3e9h-12\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-12\" value=\"MVD\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> MVD<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-11\">\t\t\t<label  for=\"field_p3e9h-11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-11\" value=\"Distrimed\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Distrimed<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-10\">\t\t\t<label  for=\"field_p3e9h-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-10\" value=\"lasant\u00e9 .net\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> lasant\u00e9 .net<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-9\">\t\t\t<label  for=\"field_p3e9h-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-9\" value=\"Cocoon center\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Cocoon center<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-8\">\t\t\t<label  for=\"field_p3e9h-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-8\" value=\"Pascal Coste shopping\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Pascal Coste shopping<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-7\">\t\t\t<label  for=\"field_p3e9h-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-7\" value=\"Parapharmacielafayette.com\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Parapharmacielafayette.com<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_41-6\">\t\t\t<label  for=\"field_p3e9h-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[41][]\" id=\"field_p3e9h-6\" value=\"Autre\"  data-frmlimit=\"1\"  data-frmmin=\"1\"  data-reqmsg=\"Enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" data-invmsg=\"Enseigne ou groupement de rattachement est non valide\"   \/> Autre<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_pepiz\" id=\"field_pepiz_label\" class=\"frm_primary_label\">Entrez votre enseigne ou groupement de rattachement\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_pepiz\" name=\"item_meta[42]\" value=\"\"  data-reqmsg=\"Entrez votre enseigne ou groupement de rattachement ne peut pas \u00eatre vide.\" aria-required=\"true\" data-invmsg=\"Entrez votre enseigne ou groupement de rattachement est non valide\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_8b72a\" id=\"field_8b72a_label\" class=\"frm_primary_label\">Nom de l'officine ou magasin pr\u00e9cis\u00e9ment\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_8b72a\" name=\"item_meta[43]\" value=\"\"  data-reqmsg=\"Nom de l&#039;officine ou magasin pr\u00e9cis\u00e9ment ne peut pas \u00eatre vide.\" aria-required=\"true\" data-invmsg=\"Nom de l&#039;officine ou magasin pr\u00e9cis\u00e9ment est non valide\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<input type=\"hidden\" name=\"frm_page_order_4\" id=\"frm_page_order_4\" value=\"16\" \/>\t\t<input  type=\"hidden\" name=\"item_meta[47]\" id=\"field_ebvgx-0\" value=\"\"  data-frmlimit=\"1\"  data-frmmin=\"1\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[48]\" id=\"field_hq0sh\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[220]\" id=\"field_fdml3\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[50]\" id=\"field_l6rdy\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[51]\" id=\"field_1kuqm\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[53]\" id=\"field_k2f43\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[54]\" id=\"field_zrddk\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" 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ci-dessous et envoyez nous les documents demand\u00e9s en fin de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-7577","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Formulaire adh\u00e9rent - Hygie31<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/hygie31.com\/en\/formulaire-adherent\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaire adh\u00e9rent - Hygie31\" \/>\n<meta property=\"og:description\" content=\"Prix 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