{"id":201,"date":"2021-03-17T12:17:21","date_gmt":"2021-03-17T11:17:21","guid":{"rendered":"http:\/\/smrea.fr\/?page_id=201"},"modified":"2021-03-27T11:48:01","modified_gmt":"2021-03-27T10:48:01","slug":"register","status":"publish","type":"page","link":"https:\/\/smrea.fr\/?page_id=201","title":{"rendered":"Formulaire d&#8217;adh\u00e9sion au SMR"},"content":{"rendered":"\n<div class=\"um um-register um-195\">\n\t<div class=\"um-form\" data-mode=\"register\">\n\t\t<form method=\"post\" action=\"\">\n\t\t\t<div class=\"um-row _um_row_1 \" style=\"margin: 0 0 30px 0;\"><div class=\"um-col-1\"><div  id=\"um_field_195_Titre\" class=\"um-field um-field-select  um-field-Titre um-field-select um-field-type_select\" data-key=\"Titre\"><div class=\"um-field-label\"><label for=\"Titre-195\">Titre<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area  \"><select data-default=\"\"     name=\"Titre\" id=\"Titre\" data-validate=\"\" data-key=\"Titre\" class=\"um-form-field valid um-s1 \" style=\"width: 100%\" data-placeholder=\"\"   aria-invalid=\"false\" ><option value=\"\"><\/option><option value=\"Monsieur\" >Monsieur<\/option><option value=\"Madame\" >Madame<\/option><option value=\"Docteur\" >Docteur<\/option><option value=\"Professeur\" >Professeur<\/option><\/select><\/div><\/div><div  id=\"um_field_195_last_name\" class=\"um-field um-field-text  um-field-last_name um-field-text um-field-type_text\" data-key=\"last_name\"><div class=\"um-field-label\"><label for=\"last_name-195\">Nom<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"text\" name=\"last_name-195\" id=\"last_name-195\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"last_name\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_first_name\" class=\"um-field um-field-text  um-field-first_name um-field-text um-field-type_text\" data-key=\"first_name\"><div class=\"um-field-label\"><label for=\"first_name-195\">Pr\u00e9nom<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"text\" name=\"first_name-195\" id=\"first_name-195\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"first_name\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_user_email\" class=\"um-field um-field-text  um-field-user_email um-field-text um-field-type_text\" data-key=\"user_email\"><div class=\"um-field-label\"><label for=\"user_email-195\">E-mail Address<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"text\" name=\"user_email-195\" id=\"user_email-195\" value=\"\" placeholder=\"\" data-validate=\"unique_email\" data-key=\"user_email\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_birth_date\" class=\"um-field um-field-date  um-field-birth_date um-field-date um-field-type_date\" data-key=\"birth_date\"><div class=\"um-field-label\"><div class=\"um-field-label-icon\"><i class=\"um-faicon-calendar\" aria-label=\"Date de naissance\"><\/i><\/div><label for=\"birth_date-195\">Date de naissance<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input   class=\"um-form-field valid um-datepicker \" type=\"text\" name=\"birth_date-195\" id=\"birth_date-195\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"birth_date\" data-range=\"years\" data-years=\"115\" data-years_x=\"past\" data-disabled_weekdays=\"\" data-date_min=\"1911,4,21\" data-date_max=\"2026,4,21\" data-format=\"d mmm yyyy\" data-value=\"\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_specialite_principale\" class=\"um-field um-field-select  um-field-specialite_principale um-field-select um-field-type_select\" data-key=\"specialite_principale\"><div class=\"um-field-label\"><label for=\"specialite_principale-195\">Sp\u00e9cialit\u00e9 Principale<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area  \"><select data-default=\"\"     name=\"specialite_principale\" id=\"specialite_principale\" data-validate=\"\" data-key=\"specialite_principale\" class=\"um-form-field valid um-s1 \" style=\"width: 100%\" data-placeholder=\"\"   aria-invalid=\"false\" ><option value=\"\"><\/option><option value=\"DESC R\u00e9animation\" >DESC R\u00e9animation<\/option><option value=\"DES MIR\" >DES MIR<\/option><option value=\"DES AR\" >DES AR<\/option><option value=\"Qualification Ordinale en R\u00e9animation\" >Qualification Ordinale en R\u00e9animation<\/option><option value=\"Autre\" >Autre<\/option><\/select><\/div><\/div><div  id=\"um_field_195_service_exercice\" class=\"um-field um-field-text  um-field-service_exercice um-field-text um-field-type_text\" data-key=\"service_exercice\"><div class=\"um-field-label\"><label for=\"service_exercice-195\">Intitul\u00e9 du service d&#039;exercice<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"text\" name=\"service_exercice-195\" id=\"service_exercice-195\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"service_exercice\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_adresse_professionelle\" class=\"um-field um-field-text  um-field-adresse_professionelle um-field-text um-field-type_text\" data-key=\"adresse_professionelle\"><div class=\"um-field-label\"><label for=\"adresse_professionelle-195\">Adresse Professionelle<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"text\" name=\"adresse_professionelle-195\" id=\"adresse_professionelle-195\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"adresse_professionelle\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_mobile_number\" class=\"um-field um-field-tel  um-field-mobile_number um-field-tel um-field-type_tel\" data-key=\"mobile_number\"><div class=\"um-field-label\"><div class=\"um-field-label-icon\"><i class=\"um-faicon-mobile\" aria-label=\"Num\u00e9ro de mobile\"><\/i><\/div><label for=\"mobile_number-195\">Num\u00e9ro de mobile<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"tel\" name=\"mobile_number-195\" id=\"mobile_number-195\" value=\"\" placeholder=\"\" data-validate=\"phone_number\" data-key=\"mobile_number\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_Appartenance\" class=\"um-field um-field-select  um-field-Appartenance um-field-select um-field-type_select\" data-key=\"Appartenance\"><div class=\"um-field-label\"><label for=\"Appartenance-195\">Appartenance \u00e0 un autre syndicat<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area  \"><select data-default=\"\"     name=\"Appartenance\" id=\"Appartenance\" data-validate=\"\" data-key=\"Appartenance\" class=\"um-form-field valid not-required um-s1 \" style=\"width: 100%\" data-placeholder=\"\"   aria-invalid=\"false\" ><option value=\"\"><\/option><option value=\"Oui\" >Oui<\/option><option value=\"Non\" >Non<\/option><\/select><\/div><\/div><div  id=\"um_field_195_username\" class=\"um-field um-field-text  um-field-username um-field-text um-field-type_text\" data-key=\"username\"><div class=\"um-field-label\"><label for=\"username-195\">Identifiant ou e-mail<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid \" type=\"text\" name=\"username-195\" id=\"username-195\" value=\"\" placeholder=\"Cr\u00e9ez votre identifiant login ou email pour vous identifier plus atrd sur le site et acc\u00e9der \u00e0 des rubriques suppl\u00e9mentaires\" data-validate=\"unique_username_or_email\" data-key=\"username\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_user_password\" class=\"um-field um-field-password  um-field-user_password um-field-password um-field-type_password\" data-key=\"user_password\"><div class=\"um-field-label\"><label for=\"user_password-195\">Mot de passe<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input class=\"um-form-field valid \" type=\"password\" name=\"user_password-195\" id=\"user_password-195\" value=\"\" placeholder=\"8 caract\u00e8res minimum\" data-validate=\"\" data-key=\"user_password\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_195_confirm_user_password\" class=\"um-field um-field-password  um-field-user_password um-field-password um-field-type_password\" data-key=\"confirm_user_password\"><div class=\"um-field-label\"><label for=\"confirm_user_password-195\">Confirmer le Mot de passe<span class=\"um-req\" title=\"Obligatoire\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input class=\"um-form-field valid \" type=\"password\" name=\"confirm_user_password-195\" id=\"confirm_user_password-195\" value=\"\" placeholder=\"Confirmer le Mot de passe\" data-validate=\"\" data-key=\"confirm_user_password\"  aria-invalid=\"false\" \/><\/div><\/div><\/div><\/div>\t\t<input type=\"hidden\" name=\"form_id\" id=\"form_id_195\" value=\"195\" \/>\n\t\n\t<p class=\"um_request_name\">\n\t\t<label for=\"um_request_195\">Only fill in if you are not human<\/label>\n\t\t<input type=\"hidden\" name=\"um_request\" id=\"um_request_195\" class=\"input\" value=\"\" size=\"25\" autocomplete=\"off\" \/>\n\t<\/p>\n\n\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"82f5644972\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F201\" \/>\n<div class=\"um-field\">\n\t<div class=\"g-recaptcha\" id=\"um-195\" data-type=\"image\" data-size=\"normal\" data-theme=\"light\" data-sitekey=\"6LcyYoMaAAAAAKEmjTfZ8Q5L-dxJzQ0xRA4MqOgq\"><\/div>\n<\/div>\n\n\n<script type=\"text\/javascript\">\n\t\n\t\tvar onloadCallback = function () {\n\t\t\tjQuery('.g-recaptcha').each( function (i) {\n\t\t\t\tgrecaptcha.render( jQuery(this).attr('id'), {\n\t\t\t\t\t'sitekey': jQuery(this).attr('data-sitekey'),\n\t\t\t\t\t'theme': jQuery(this).attr('data-theme')\n\t\t\t\t});\n\t\t\t});\n\t\t};\n\n\t\tfunction um_recaptcha_refresh() {\n\t\t\tjQuery('.g-recaptcha').html('');\n\t\t\tgrecaptcha.reset();\n\t\t\tonloadCallback();\n\t\t}\n\n\t<\/script>\n\n\t<div class=\"um-col-alt\">\n\n\t\t\n\t\t\t<div class=\"um-center\">\n\t\t\t\t<input type=\"submit\" value=\"Inscription\" class=\"um-button\" id=\"um-submit-btn\" \/>\n\t\t\t<\/div>\n\n\t\t\n\t\t<div class=\"um-clear\"><\/div>\n\n\t<\/div>\n\n\t\t\t<\/form>\n\t<\/div>\n<\/div>\n<style>\n\t\t\t.um-195.um {\n\t\t\tmax-width: 450px;\n\t\t}\n\t\t<\/style>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/smrea.fr\/index.php?rest_route=\/wp\/v2\/pages\/201"}],"collection":[{"href":"https:\/\/smrea.fr\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/smrea.fr\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/smrea.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/smrea.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=201"}],"version-history":[{"count":3,"href":"https:\/\/smrea.fr\/index.php?rest_route=\/wp\/v2\/pages\/201\/revisions"}],"predecessor-version":[{"id":265,"href":"https:\/\/smrea.fr\/index.php?rest_route=\/wp\/v2\/pages\/201\/revisions\/265"}],"wp:attachment":[{"href":"https:\/\/smrea.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=201"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}