{"id":20491,"date":"2021-11-17T14:19:00","date_gmt":"2021-11-17T13:19:00","guid":{"rendered":"https:\/\/www.srfb.be\/?page_id=20491"},"modified":"2025-12-09T16:31:21","modified_gmt":"2025-12-09T15:31:21","slug":"formulaire-membre","status":"publish","type":"page","link":"https:\/\/staging.srfb.be\/nl\/devenir-membre\/formulaire-membre\/","title":{"rendered":"Formulier lid"},"content":{"rendered":"\n<div class=\"wp-block-group is-layout-constrained wp-block-group-is-layout-constrained\" style=\"margin-top:var(--wp--preset--spacing--80);margin-bottom:var(--wp--preset--spacing--80)\"><\/div>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-48d0e691 wp-block-buttons-is-layout-flex\" style=\"margin-top:var(--wp--preset--spacing--60);margin-bottom:var(--wp--preset--spacing--60)\">\n<div class=\"wp-block-button is-style-fill\"><a class=\"wp-block-button__link has-vert-fonce-color-color has-grey-color-background-color has-text-color has-background has-link-color wp-element-button\" href=\"https:\/\/staging.srfb.be\/wp-content\/uploads\/2024\/12\/AppelACotisation_FR_2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"wp-rich-text-font-awesome-icon wp-font-awesome-icon\"><svg aria-hidden=\"true\" focusable=\"false\" data-prefix=\"fas\" data-icon=\"tag\" class=\"svg-inline--fa fa-tag \" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 448 512\"><path fill=\"currentColor\" d=\"M0 80V229.5c0 17 6.7 33.3 18.7 45.3l176 176c25 25 65.5 25 90.5 0L418.7 317.3c25-25 25-65.5 0-90.5l-176-176c-12-12-28.3-18.7-45.3-18.7H48C21.5 32 0 53.5 0 80zm112 32a32 32 0 1 1 0 64 32 32 0 1 1 0-64z\"><\/path><\/svg><\/span> D\u00e9tails sur les tarifs et services<\/a><\/div>\n\n\n\n<div class=\"wp-block-button is-style-fill\"><a class=\"wp-block-button__link has-vert-fonce-color-color has-grey-color-background-color has-text-color has-background has-link-color wp-element-button\" href=\"https:\/\/staging.srfb.be\/devenir-membre\/changer-de-formule-de-cotisation\/\"><span class=\"wp-rich-text-font-awesome-icon wp-font-awesome-icon\"><svg aria-hidden=\"true\" focusable=\"false\" data-prefix=\"fas\" data-icon=\"address-card\" class=\"svg-inline--fa fa-address-card \" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 576 512\"><path fill=\"currentColor\" d=\"M64 32C28.7 32 0 60.7 0 96V416c0 35.3 28.7 64 64 64H512c35.3 0 64-28.7 64-64V96c0-35.3-28.7-64-64-64H64zm80 256h64c44.2 0 80 35.8 80 80c0 8.8-7.2 16-16 16H80c-8.8 0-16-7.2-16-16c0-44.2 35.8-80 80-80zm-32-96a64 64 0 1 1 128 0 64 64 0 1 1 -128 0zm256-32H496c8.8 0 16 7.2 16 16s-7.2 16-16 16H368c-8.8 0-16-7.2-16-16s7.2-16 16-16zm0 64H496c8.8 0 16 7.2 16 16s-7.2 16-16 16H368c-8.8 0-16-7.2-16-16s7.2-16 16-16zm0 64H496c8.8 0 16 7.2 16 16s-7.2 16-16 16H368c-8.8 0-16-7.2-16-16s7.2-16 16-16z\"><\/path><\/svg><\/span> Changer de formule de cotisation<\/a><\/div>\n<\/div>\n\n\n<div class='fluentform ff-default fluentform_wrapper_175  ff_guten_block ff_guten_block-175 ffs_custom_wrap'><form data-form_id=\"175\" id=\"fluentform_175\" class=\"frm-fluent-form fluent_form_175 ff-el-form-top ff_form_instance_175_1 ff-form-loading ff-form-has-steps ffs_custom\" data-form_instance=\"ff_form_instance_175_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Devenir Membre 2025<\/legend><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"50\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><input type='hidden' name='__fluent_form_embded_post_id' value='20491' \/><input type=\"hidden\" id=\"_fluentform_175_fluentformnonce\" name=\"_fluentform_175_fluentformnonce\" value=\"065840cbff\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nl\/wp-json\/wp\/v2\/pages\/20491\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_1\" ><h2 style=\"text-align: center\">Informations membre<\/h2>\n<p style=\"text-align: center\"><em>Ces donn\u00e9es resteront strictement confidentielles.<\/em><\/p><\/div><div class='ff-el-group ff-el-form-hide_label center pad-25 ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Je suis une...\">Je suis une&#8230;<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='type_2660c6c0c31c7b0b4b2b73185d8041fe'><input  type=\"radio\" name=\"type\" data-name=\"type\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"personne physique\"  id='type_2660c6c0c31c7b0b4b2b73185d8041fe' aria-label='personne physique' aria-invalid='false' aria-required=true> <span>personne physique<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='type_7ea67b3187d5ed2b54879ea53cfae086'><input  type=\"radio\" name=\"type\" data-name=\"type\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"soci\u00e9t\u00e9\"  id='type_7ea67b3187d5ed2b54879ea53cfae086' aria-label='soci\u00e9t\u00e9' aria-invalid='false' aria-required=true> <span>soci\u00e9t\u00e9<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-hide_label center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Civilit\u00e9\">Civilit\u00e9<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='civilite_7edfda932b4f530a4c1873055fca770e'><input  type=\"radio\" name=\"civilite\" data-name=\"civilite\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Madame\"  id='civilite_7edfda932b4f530a4c1873055fca770e' aria-label='Madame' aria-invalid='false' aria-required=true> <span>Madame<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='civilite_6f935366628e7e3755d9e93eab4e91c9'><input  type=\"radio\" name=\"civilite\" data-name=\"civilite\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Monsieur\"  id='civilite_6f935366628e7e3755d9e93eab4e91c9' aria-label='Monsieur' aria-invalid='false' aria-required=true> <span>Monsieur<\/span><\/label><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_first_name_' id='label_ff_175_names_first_name_' >Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" value=\"\" id=\"ff_175_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Pr\u00e9nom\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_last_name_' id='label_ff_175_names_last_name_' >Nom de famille<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" value=\"\" id=\"ff_175_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Nom de famille\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_email' id='label_ff_175_email' aria-label=\"E-mail\">E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" value=\"\" id=\"ff_175_email\" class=\"ff-el-form-control\" placeholder=\"E-mail\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_compagny_name' id='label_ff_175_compagny_name' >Nom de votre soci\u00e9t\u00e9<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"compagny_name\" class=\"ff-el-form-control\" placeholder=\"Soci\u00e9t\u00e9 Royale Foresti\u00e8re de Belgique\" data-name=\"compagny_name\" id=\"ff_175_compagny_name\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_input_text' id='label_ff_175_input_text' aria-label=\"N\u00b0 TVA\">N\u00b0 TVA<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"BE 0408 558 654\" data-name=\"input_text\" id=\"ff_175_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_address_line_1_' id='label_ff_175_address_1_address_line_1_' aria-label=\"Rue\">Rue<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_175_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Rue\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_address_line_2_' id='label_ff_175_address_1_address_line_2_' aria-label=\"Num\u00e9ro\">Num\u00e9ro<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_175_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_zip_' id='label_ff_175_address_1_zip_' aria-label=\"Code postal\">Code postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_175_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Code Postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_city_' id='label_ff_175_address_1_city_' aria-label=\"Ville\">Ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_175_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"Ville\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_country_' id='label_ff_175_address_1_country_' aria-label=\"Pays\">Pays<\/label><\/div><div class='ff-el-input--content'><select name=\"address_1[country]\" id=\"ff_175_address_1_country_\" class=\"ff-el-form-control\" placeholder=\"S\u00e9lectionner le pays\" data-key_name=\"country\" aria-invalid='false' aria-required=true><option value=''>S\u00e9lectionner le pays<\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland Eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden (VS)<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbados<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' selected>Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb-Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouveteiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits Indische Oceaanterritorium<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocos (Keeling) eilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CK' >Cookeilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CD' >Democratische Republiek Congo (Kinshasa)<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faero\u00ebr eilanden<\/option><option value='FK' >Falklandeilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans-Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard en McDonaldeilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >Ijsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine Afgelegen Eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='XK' >Kosovo<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Laos<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macao S.A.R., China<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Malediven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall Eilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesi\u00eb<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord Macedoni\u00eb<\/option><option value='KP' >Noord-Korea<\/option><option value='MP' >Noordelijke Marianen eilanden<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestijnse Gebieden<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='CG' >Republiek Congo (Brazzaville)<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Rusland<\/option><option value='RW' >Rwanda<\/option><option value='RE' >R\u00e9union<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='MF' >Saint Martin (Frans deel)<\/option><option value='PM' >Saint-Pierre en Miquelon<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='BL' >Sint Barthelemy<\/option><option value='SH' >Sint Helena<\/option><option value='LC' >Sint Lucia<\/option><option value='SX' >Sint Maarten (Nederlands deel)<\/option><option value='VC' >Sint Vincent en de Grenadines<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SB' >Solomon eilanden<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard en Jan Mayen<\/option><option value='SY' >Syri\u00eb<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaan<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk (VK)<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten (VS)<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='GS' >Zuid-Georgia \/ Sandwicheilanden<\/option><option value='KR' >Zuid-Korea<\/option><option value='SS' >Zuid-Soedan<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Souhaitez-vous que certaines communications (factures, courriers, revues) soient envoy\u00e9es \u00e0 une autre personne ou adresse ?\">Souhaitez-vous que certaines communications (factures, courriers, revues) soient envoy\u00e9es \u00e0 une autre personne ou adresse ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='other_person_42c76b7e13e759ddbca20a6ad2bb2889'><input  type=\"radio\" name=\"other_person\" data-name=\"other_person\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='other_person_42c76b7e13e759ddbca20a6ad2bb2889' aria-label='Oui' aria-invalid='false' aria-required=true> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='other_person_dfcd18ffd72747eba6bbd6f8714aad66'><input  type=\"radio\" name=\"other_person\" data-name=\"other_person\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Non\"  id='other_person_dfcd18ffd72747eba6bbd6f8714aad66' aria-label='Non' aria-invalid='false' aria-required=true> <span>Non<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group center ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Types d\u2019envois concern\u00e9s :\">Types d\u2019envois concern\u00e9s :<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='envoi_type_b6da15b037d4327be8377dffd9ac4200'><input  type=\"checkbox\" name=\"envoi_type[]\" data-name=\"envoi_type\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"revues\"  id='envoi_type_b6da15b037d4327be8377dffd9ac4200' aria-label='Les revues' aria-invalid='false' aria-required=true> <span>Les revues<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='envoi_type_0e7b3e27a4de3fb4575264d872191ed1'><input  type=\"checkbox\" name=\"envoi_type[]\" data-name=\"envoi_type\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"factures et courriers\"  id='envoi_type_0e7b3e27a4de3fb4575264d872191ed1' aria-label='Les factures et courriers' aria-invalid='false' aria-required=true> <span>Les factures et courriers<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-hide_label center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Civilit\u00e9\">Civilit\u00e9<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='civilite_contact_d12acee6476fe7dc4ff41da41ab8f011'><input  type=\"radio\" name=\"civilite_contact\" data-name=\"civilite_contact\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Madame\"  id='civilite_contact_d12acee6476fe7dc4ff41da41ab8f011' aria-label='Madame' aria-invalid='false' aria-required=true> <span>Madame<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='civilite_contact_ba251ccc83e91ac1310d37dc116ade06'><input  type=\"radio\" name=\"civilite_contact\" data-name=\"civilite_contact\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Monsieur\"  id='civilite_contact_ba251ccc83e91ac1310d37dc116ade06' aria-label='Monsieur' aria-invalid='false' aria-required=true> <span>Monsieur<\/span><\/label><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_contact\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_contact_first_name_' id='label_ff_175_names_contact_first_name_' >Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_contact[first_name]\" id=\"ff_175_names_contact_first_name_\" class=\"ff-el-form-control\" placeholder=\"Pr\u00e9nom\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_contact_last_name_' id='label_ff_175_names_contact_last_name_' >Nom de famille<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_contact[last_name]\" id=\"ff_175_names_contact_last_name_\" class=\"ff-el-form-control\" placeholder=\"Nom de famille\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"num_contact\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_num_contact_first_name_' id='label_ff_175_num_contact_first_name_' >E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"num_contact[first_name]\" id=\"ff_175_num_contact_first_name_\" class=\"ff-el-form-control\" placeholder=\"E-mail\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_num_contact_last_name_' id='label_ff_175_num_contact_last_name_' >T\u00e9l\u00e9phone \/ GSM<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"num_contact[last_name]\" id=\"ff_175_num_contact_last_name_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro de portable\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_contact\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_address_line_1_' id='label_ff_175_address_contact_address_line_1_' aria-label=\"Rue\">Rue<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[address_line_1]\" id=\"ff_175_address_contact_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Rue\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_address_line_2_' id='label_ff_175_address_contact_address_line_2_' aria-label=\"Num\u00e9ro\">Num\u00e9ro<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[address_line_2]\" id=\"ff_175_address_contact_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_zip_' id='label_ff_175_address_contact_zip_' aria-label=\"Code postal\">Code postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[zip]\" id=\"ff_175_address_contact_zip_\" class=\"ff-el-form-control\" placeholder=\"Code Postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_city_' id='label_ff_175_address_contact_city_' aria-label=\"Ville\">Ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[city]\" id=\"ff_175_address_contact_city_\" class=\"ff-el-form-control\" placeholder=\"Ville\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_country_' id='label_ff_175_address_contact_country_' aria-label=\"Pays\">Pays<\/label><\/div><div class='ff-el-input--content'><select name=\"address_contact[country]\" id=\"ff_175_address_contact_country_\" class=\"ff-el-form-control\" placeholder=\"S\u00e9lectionner le pays\" data-key_name=\"country\" aria-invalid='false' aria-required=true><option value=''>S\u00e9lectionner le pays<\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland Eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden (VS)<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbados<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' selected>Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb-Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouveteiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits Indische Oceaanterritorium<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocos (Keeling) eilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CK' >Cookeilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CD' >Democratische Republiek Congo (Kinshasa)<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faero\u00ebr eilanden<\/option><option value='FK' >Falklandeilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans-Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard en McDonaldeilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >Ijsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine Afgelegen Eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='XK' >Kosovo<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Laos<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macao S.A.R., China<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Malediven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshall Eilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesi\u00eb<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord Macedoni\u00eb<\/option><option value='KP' >Noord-Korea<\/option><option value='MP' >Noordelijke Marianen eilanden<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestijnse Gebieden<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='CG' >Republiek Congo (Brazzaville)<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Rusland<\/option><option value='RW' >Rwanda<\/option><option value='RE' >R\u00e9union<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='MF' >Saint Martin (Frans deel)<\/option><option value='PM' >Saint-Pierre en Miquelon<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='BL' >Sint Barthelemy<\/option><option value='SH' >Sint Helena<\/option><option value='LC' >Sint Lucia<\/option><option value='SX' >Sint Maarten (Nederlands deel)<\/option><option value='VC' >Sint Vincent en de Grenadines<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SB' >Solomon eilanden<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard en Jan Mayen<\/option><option value='SY' >Syri\u00eb<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaan<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk (VK)<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten (VS)<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='GS' >Zuid-Georgia \/ Sandwicheilanden<\/option><option value='KR' >Zuid-Korea<\/option><option value='SS' >Zuid-Soedan<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-175_3\" ><h3 class='ff-el-section-title'>Votre patrimoine<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_4\" ><h3 style=\"text-align: center;text-transform:uppercase;color:var(--wpem-second-color)\">Non-propri\u00e9taire<\/h3>\n<p style=\"text-align: center;font-size: .85em\">Cette formule s\u2019adresse aux personnes<b>\u00a0int\u00e9ress\u00e9es par la for\u00eat<\/b>\u00a0sans \u00eatre propri\u00e9taires forestiers. Elle permet de soutenir les actions de la SRFB et de profiter de nos publications et activit\u00e9s de formation au tarif membre.<\/p><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_5\" ><h3 style=\"text-align: center;text-transform:uppercase;color:var(--wpem-second-color)\">Base<\/h3>\n<p style=\"text-align: center;font-size: .85em\">R\u00e9serv\u00e9e aux <strong>propri\u00e9taires forestiers<\/strong> souhaitant rejoindre la SRFB. Elle donne acc\u00e8s \u00e0 l\u2019ensemble de nos services : conseils techniques, informations r\u00e9glementaires, formation personnalis\u00e9es, revues.<\/p><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_6\" ><h3 style=\"text-align: center;text-transform:uppercase;color:var(--wpem-second-color)\">Premium<\/h3>\n<p style=\"text-align: center;font-size: .85em\">Cotisation suppl\u00e9mentaire \u00e0 la cotisation de base. Elle offre des r\u00e9ductions suppl\u00e9mentaires sur nos services et inclut l\u2019<b>acc\u00e8s au service RC For\u00eat<\/b>, une\u00a0<b>assurance collective<\/b>\u00a0en responsabilit\u00e9 civile couvrant le propri\u00e9taire en cas de d\u00e9g\u00e2ts caus\u00e9s \u00e0 des tiers par la chute d\u2019un arbre ou d\u2019une branche provenant de sa propri\u00e9t\u00e9.<\/p><\/div><\/div><\/div><div class='ff-el-group center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Type de cotisation\">Type de cotisation<\/label><div class=\"ff-el-tooltip\" data-content=\"Choisissez le type de cotisation que vous souhaitez souscrire.\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='cotisation_5666460077af282d6942aa3c576ec767'><input  type=\"radio\" name=\"cotisation\" data-name=\"cotisation\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no-proprio\"  id='cotisation_5666460077af282d6942aa3c576ec767' aria-label='Non-propri\u00e9taire' aria-invalid='false' aria-required=true> <span>Non-propri\u00e9taire<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='cotisation_dbc996d753cbeba882c5beecbaf838c3'><input  type=\"radio\" name=\"cotisation\" data-name=\"cotisation\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"base\"  id='cotisation_dbc996d753cbeba882c5beecbaf838c3' aria-label='Base' aria-invalid='false' aria-required=true> <span>Base<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='cotisation_ef226c64a11211a9d6c842705710b738'><input  type=\"radio\" name=\"cotisation\" data-name=\"cotisation\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"premium\"  id='cotisation_ef226c64a11211a9d6c842705710b738' aria-label='Premium' aria-invalid='false' aria-required=true> <span>Premium<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions tip-box' tabindex='-1' data-name=\"custom_html-175_7\" ><h3 style=\"text-align: center\">Les hectares \u00e0 assurer<\/h3>\n<p style=\"text-align: center\">\u00c9tant donn\u00e9 votre demande d\u2019adh\u00e9sion \u00e0 la cotisation Premium, nous vous invitons \u00e0 nous transmettre la d\u00e9claration de vos parcelles cadastrales sous forme de fichier Excel. <br \/><em>(possibilit\u00e9 de t\u00e9l\u00e9charger la liste de vos parcelles depuis votre <a href=\"https:\/\/www.minfin.fgov.be\/\" target=\"_blank\" rel=\"noopener\">espace MyMinfin<\/a>)<\/em><\/p><\/div><div class='ff-el-group has-conditions center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Encoder mon patrimoine\">Encoder mon patrimoine<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='encodage_98eaea2625af0d4ea99224e6384ede88'><input  type=\"radio\" name=\"encodage\" data-name=\"encodage\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Manuellement\"  id='encodage_98eaea2625af0d4ea99224e6384ede88' aria-label='Manuellement' aria-invalid='false' aria-required=true> <span>Manuellement<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='encodage_d5162b1a23ad2f36ca361348cfce8656'><input  type=\"radio\" name=\"encodage\" data-name=\"encodage\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Via un fichier Excel\"  id='encodage_d5162b1a23ad2f36ca361348cfce8656' aria-label='Via un fichier Excel' aria-invalid='false' aria-required=true> <span>Via un fichier Excel<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_1 pad-25 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_8\" ><p style=\"text-align: center\"><em>Utilisez ce gabarit de fichier Excel (<a href=\"https:\/\/staging.srfb.be\/wp-content\/uploads\/2025\/12\/Gabarit-Devenir-membre-Premium.xlsx\">lien t\u00e9l\u00e9chargeable<\/a>) pour nous fournir une liste vos parcelles compl\u00e8te.<\/em><\/p><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions tip-box' tabindex='-1' data-name=\"custom_html-175_9\" ><h3 style=\"text-align: center\">L&rsquo;assurance collective <a href=\"\/assurances\/\" target=\"_blank\" rel=\"noopener\">RC FOR\u00caT<\/a><\/h3>\n<p style=\"text-align: center\">Pour b\u00e9n\u00e9ficier de l&rsquo;assurance collective pour vos for\u00eats, bois, peupleraies, haies, arbres isol\u00e9s ou en alignements, s\u00e9lectionnez la <strong>cotisation premium<\/strong> ci-dessus.<\/p><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_1 pad-25 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Voorwaarden: D\u00e9clare avoir pris connaissance du texte de la police collective RC For\u00eat et en accepter toutes les conditions g\u00e9n\u00e9rales et modalit\u00e9s de couvertures ; bevat 2 links. Gebruik tab navigatie voor beoordeling.' class='ff-el-form-check-label ff_tc_label' for=terms_n_conditions_5a1d8e5dfce1fd279871adb39ee24114><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms_n_conditions\" class=\"ff-el-form-check-input\" data-name=\"terms_n_conditions\" id=\"terms_n_conditions_5a1d8e5dfce1fd279871adb39ee24114\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>D\u00e9clare avoir pris connaissance du texte de la police collective RC For\u00eat et en accepter toutes les <a href=\"https:\/\/staging.srfb.be\/wp-content\/uploads\/2021\/05\/VIVIUM_ConditionsGenerales_FR.pdf\" target=\"_blank\" rel=\"noopener\">conditions g\u00e9n\u00e9rales<\/a> et <a href=\"https:\/\/staging.srfb.be\/wp-content\/uploads\/2025\/11\/2.-MODALITES_RC_Foret_2026.pdf\" target=\"_blank\" rel=\"noopener\">modalit\u00e9s de couvertures<\/a> ;<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='D\u00e9clare avoir mentionn\u00e9 ci-dessus la superficie totale de mes propri\u00e9t\u00e9s bois\u00e9es en Belgique. Cette d\u00e9claration constitue un \u00e9l\u00e9ment essentiel de la police, sous peine de d\u00e9ch\u00e9ance ;' class='ff-el-form-check-label ff_tc_label' for=terms_n_parcelles_9be3405c264acc98d7be24ea1b79d988><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms_n_parcelles\" class=\"ff-el-form-check-input\" data-name=\"terms_n_parcelles\" id=\"terms_n_parcelles_9be3405c264acc98d7be24ea1b79d988\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>D\u00e9clare avoir mentionn\u00e9 ci-dessus la superficie totale de mes propri\u00e9t\u00e9s bois\u00e9es en Belgique. Cette d\u00e9claration constitue un \u00e9l\u00e9ment essentiel de la police, sous peine de d\u00e9ch\u00e9ance ;<\/p><\/div><\/label><\/div><\/div><\/div><\/div><div class='ff-el-group center pad-25 ff_list_buttons'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Je souhaite devenir aussi membre des syndicats de propri\u00e9taires ruraux...\">Je souhaite devenir aussi membre des syndicats de propri\u00e9taires ruraux&#8230;<\/label><div class=\"ff-el-tooltip\" data-content=\"Plusieurs choix possibles (optionnel)\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='membre_base_81c9daf54c113eea5a6c16bae7b979a8'><input  type=\"checkbox\" name=\"membre_base[]\" data-name=\"membre_base\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"NTF\" data-calc_value=\"1\"  id='membre_base_81c9daf54c113eea5a6c16bae7b979a8' aria-label='NTF' aria-invalid='false' aria-required=false> <span>NTF<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='membre_base_bafe898114378a8ae387a485833c94c8'><input  type=\"checkbox\" name=\"membre_base[]\" data-name=\"membre_base\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"LV\" data-calc_value=\"1\"  id='membre_base_bafe898114378a8ae387a485833c94c8' aria-label='LV' aria-invalid='false' aria-required=false> <span>LV<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-175_11\" ><h3 class='ff-el-section-title'>Divers<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Je deviens membre gr\u00e2ce...\">Je deviens membre gr\u00e2ce&#8230;<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_90a01d0acc8f866303cf4c0535eced5d'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"au bouche \u00e0 oreille\"  id='communication_90a01d0acc8f866303cf4c0535eced5d' aria-label='au bouche \u00e0 oreille' aria-invalid='false' aria-required=false> <span>au bouche \u00e0 oreille<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_ee2bec2a4f029ddabc02f4744705add8'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u00e0 la newsletter\"  id='communication_ee2bec2a4f029ddabc02f4744705add8' aria-label='\u00e0 la newsletter' aria-invalid='false' aria-required=false> <span>\u00e0 la newsletter<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_3adbb57083b8db151fbc642ec6bcc9ca'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"au site internet\"  id='communication_3adbb57083b8db151fbc642ec6bcc9ca' aria-label='au site internet' aria-invalid='false' aria-required=false> <span>au site internet<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_922973888a3a9d3e3c9c09d03f469e3c'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u00e0 la participation \u00e0 une journ\u00e9e de terrain\/formation\"  id='communication_922973888a3a9d3e3c9c09d03f469e3c' aria-label='\u00e0 la participation \u00e0 une journ\u00e9e de terrain\/formation' aria-invalid='false' aria-required=false> <span>\u00e0 la participation \u00e0 une journ\u00e9e de terrain\/formation<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_12\" ><p><em>En devenant membre de la SRFB, vous recevrez automatiquement notre newsletter, qui vous permet de rester inform\u00e9(e) de nos activit\u00e9s de formation et des informations relatives \u00e0 la vie de l\u2019association.<\/em><br \/><em>Vous pouvez \u00e0 tout moment vous d\u00e9sinscrire de ces communications.<\/em><\/p><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_13\" ><p><i>En devenant membre, vous affirmez avoir lu et acceptez la <a href=\"https:\/\/staging.srfb.be\/declaration-de-confidentialite\" target=\"_blank\" rel=\"noopener\">d\u00e9claration de confidentialit\u00e9<\/a>\u00a0et \u00eates conscient d&rsquo;avoir le droit \u00e0 tout moment de vous r\u00e9tracter en faisant part de votre d\u00e9cision \u00e0 la SRFB Boulevard Bischoffsheim, 1-8 \u00e0 1000 Bruxelles ou par mail \u00e0\u00a0<a id=\"OWAb79d679b-bcaa-5714-6911-22a5d7fae149\" class=\"x_OWAAutoLink\" title=\"mailto:secretariat@srfb-kbbm.be\" href=\"mailto:secretariat@srfb-kbbm.be\" 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