{"id":145825,"date":"2023-08-30T16:29:33","date_gmt":"2023-08-30T14:29:33","guid":{"rendered":"https:\/\/mercyships.be\/?page_id=145825"},"modified":"2023-09-20T08:42:01","modified_gmt":"2023-09-20T06:42:01","slug":"invulformulier-reac","status":"publish","type":"page","link":"https:\/\/mercyships.be\/fr\/invulformulier-reac\/","title":{"rendered":"Invulformulier REAC"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-a72f04h-72dd24fb46099d71833a7bb0cbd9c5d8\">\n.avia-section.av-a72f04h-72dd24fb46099d71833a7bb0cbd9c5d8{\nbackground-color:#eff4f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='av_section_1'  class='avia-section av-a72f04h-72dd24fb46099d71833a7bb0cbd9c5d8 main_color avia-section-default avia-no-border-styling  avia-builder-el-0  avia-builder-el-no-sibling  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  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fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Votre avis compte beaucoup<\/h2>\n                            <p class='gform_description'>Votre avis a une valeur inestimable \u00e0 nos yeux. Dites-nous comment vous garder \u00e0 bord de Mercy Ships.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_47'  action='\/fr\/wp-json\/wp\/v2\/pages\/145825' data-formid='47' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_47' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_47_29\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_29'>Votre adresse e-mail :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_47_29' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_5\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_5'>Cela fait un moment que je n\u2019ai plus soutenu Mercy Ships. La raison principale :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_47_5' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='je soutiens d\u2019autres organisations' >je soutiens d\u2019autres organisations<\/option><option value='j\u2019ai des probl\u00e8mes de sant\u00e9' >j\u2019ai des probl\u00e8mes de sant\u00e9<\/option><option value='je traverse une situation financi\u00e8re (plus) difficile' >je traverse une situation financi\u00e8re (plus) difficile<\/option><option value='je ne crois plus \u00e0 la mission de Mercy Ships' >je ne crois plus \u00e0 la mission de Mercy Ships<\/option><option value='j\u2019ai une autre raison' >j\u2019ai une autre raison<\/option><\/select><\/div><\/div><div id=\"field_47_7\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_7'>J\u2019ai une autre raison, \u00e0 savoir :<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_47_7' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_47_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Je souhaite rester au courant de ce que fait Mercy Ships \u00e0 cette fr\u00e9quence :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_47_8'>\n\t\t\t<div class='gchoice gchoice_47_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1 fois par an'  id='choice_47_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_8_0' id='label_47_8_0' class='gform-field-label gform-field-label--type-inline'>1 fois par an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2 fois par an'  id='choice_47_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_8_1' id='label_47_8_1' class='gform-field-label gform-field-label--type-inline'>2 fois par an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='3 fois par an'  id='choice_47_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_8_2' id='label_47_8_2' class='gform-field-label gform-field-label--type-inline'>3 fois par an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1 fois par mois'  id='choice_47_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_8_3' id='label_47_8_3' class='gform-field-label gform-field-label--type-inline'>1 fois par mois<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_8_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Jamais'  id='choice_47_8_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_8_4' id='label_47_8_4' class='gform-field-label gform-field-label--type-inline'>Jamais<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_47_9\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_9'>Pourquoi?<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_47_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_47_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Si je soutiens Mercy Ships, je pr\u00e9f\u00e8re le faire :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_47_10'>\n\t\t\t<div class='gchoice gchoice_47_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='par un virement'  id='choice_47_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_10_0' id='label_47_10_0' class='gform-field-label gform-field-label--type-inline'>par un virement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='par un ordre permanent (un (plus petit) montant tous les mois)'  id='choice_47_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_10_1' id='label_47_10_1' class='gform-field-label gform-field-label--type-inline'>par un ordre permanent (un (plus petit) montant tous les mois)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='par un don \u00e0 l\u2019occasion d\u2019une f\u00eate (jubil\u00e9, anniversaire, d\u00e9part \u00e0 la retraite\u2026)'  id='choice_47_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_10_2' id='label_47_10_2' class='gform-field-label gform-field-label--type-inline'>par un don \u00e0 l\u2019occasion d\u2019une f\u00eate (jubil\u00e9, anniversaire, d\u00e9part \u00e0 la retraite\u2026)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='lors d\u2019\u00e9v\u00e9nements (visite du navire, conf\u00e9rence, \u00e9v\u00e9nement sportif\u2026)'  id='choice_47_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_10_3' id='label_47_10_3' class='gform-field-label gform-field-label--type-inline'>lors d\u2019\u00e9v\u00e9nements (visite du navire, conf\u00e9rence, \u00e9v\u00e9nement sportif\u2026)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='comme b\u00e9n\u00e9vole'  id='choice_47_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_10_4' id='label_47_10_4' class='gform-field-label gform-field-label--type-inline'>comme b\u00e9n\u00e9vole<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_10_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='par testament'  id='choice_47_10_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_10_5' id='label_47_10_5' class='gform-field-label gform-field-label--type-inline'>par testament<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_47_11\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_11'>Mes suggestions :<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_47_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_12\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">NOUS TENONS \u00c0 VOUS INFORMER CORRECTEMENT<\/h3><div class='gsection_description' id='gfield_description_47_12'>Nous voulons nous assurer que vos donn\u00e9es sont correctes. Vous voulez les modifier ? Faites-le-nous savoir !<\/div><\/div><fieldset id=\"field_47_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Mes donn\u00e9es sont les suivantes :<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_47_13'>\n\t\t\t<div class='gchoice gchoice_47_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='M.'  id='choice_47_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_13_0' id='label_47_13_0' class='gform-field-label gform-field-label--type-inline'>M.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Mme'  id='choice_47_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_13_1' id='label_47_13_1' class='gform-field-label gform-field-label--type-inline'>Mme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='M. et Mme'  id='choice_47_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_13_2' id='label_47_13_2' class='gform-field-label gform-field-label--type-inline'>M. et Mme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='M. et M.'  id='choice_47_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_13_3' id='label_47_13_3' class='gform-field-label gform-field-label--type-inline'>M. et M.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_47_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Mme et Mme'  id='choice_47_13_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_47_13_4' id='label_47_13_4' class='gform-field-label gform-field-label--type-inline'>Mme et Mme<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_47_14\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_14'>Pr\u00e9nom :<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_47_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_15\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_15'>Nom :<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_47_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_16\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_16'>Soci\u00e9t\u00e9 :<\/label><div class='gfield_description' id='gfield_description_47_16'>(si vous soutenez nos projets via une entreprise)<\/div><div class='ginput_container ginput_container_text'><input name='input_16' id='input_47_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_47_16\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_17\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_17'>Rue + n\u00b0 :<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_47_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_18\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_18'>Code postal :<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_47_18' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_20\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_20'>Localit\u00e9 :<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_47_20' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_19\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_19'>Tel.:<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_47_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_21\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_21'>Num\u00e9ro de registre national :<\/label><div class='gfield_description' id='gfield_description_47_21'>(nous avons uniquement besoin de ce num\u00e9ro afin de l\u2019inscrire sur votre attestation fiscale. De cette fa\u00e7on, le montant de votre don\nfigurera automatiquement dans votre d\u00e9claration d\u2019imp\u00f4ts.)<\/div><div class='ginput_container ginput_container_text'><input name='input_21' id='input_47_21' type='text' value='' class='large'  aria-describedby=\"gfield_description_47_21\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_47_25\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_25'>Vous pouvez continuer \u00e0 m\u2019envoyer des courriers \u00e0 cette adresse.<\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_47_25' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_47_26\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_26'>Je veux encore recevoir des cadeaux de Mercy Ships.<\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_47_26' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_47_27\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_47_27'>Mercy Ships peut continuer \u00e0 m\u2019informer par e-mail \u00e0 l\u2019adresse suivante :<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_47_27' type='text' value='' class='large'     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