{"id":39747,"date":"2022-04-21T11:59:17","date_gmt":"2022-04-21T15:59:17","guid":{"rendered":"https:\/\/cimbcc.org\/test2\/?page_id=39747"},"modified":"2025-05-30T05:32:17","modified_gmt":"2025-05-30T09:32:17","slug":"formulaire-dadhesion-interac-couple","status":"publish","type":"page","link":"https:\/\/cimbcc.org\/test2\/adhesion-au-club\/adhesion-en-ligne\/choix-du-mode-de-paiement-couple\/formulaire-dadhesion-interac-couple\/","title":{"rendered":"Formulaire d&rsquo;adh\u00e9sion au Club"},"content":{"rendered":"\n<p>Voici comment proc\u00e9der pour devenir membre du Club :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Remplir le formulaire plus bas.<\/li>\n\n\n\n<li>Cliquer sur le bouton <strong>Envoyer<\/strong>.<\/li>\n\n\n\n<li>Effectuer votre paiement par virement Interac en suivant les instructions contenues dans le courriel que nous vous enverrons lorsque vous cliquerez sur le bouton <strong>Envoyer<\/strong>.<\/li>\n<\/ul>\n\n\n\n<p>Si vous avez des questions au sujet de ce formulaire ou si vous \u00e9prouvez des difficult\u00e9s en tentant d\u2019adh\u00e9rer au Club, vous pouvez demander qu\u2019un b\u00e9n\u00e9vole du Club vous rappelle d&rsquo;ici 48 heures en cliquant sur <a href=\"https:\/\/cimbcc.org\/test2\/formulaire-de-demande-daide\" target=\"_blank\" rel=\"noopener noreferrer\">ce lien<\/a>.<\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f39737-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"39737\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/test2\/wp-json\/wp\/v2\/pages\/39747#wpcf7-f39737-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"39737\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f39737-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<style>\ninput, textarea {\nborder: 1px solid grey;\n}\n<\/style>\n<h3>Renseignements sur une des personnes du couple\n<\/h3>\n<p><label> Pr\u00e9nom (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-94\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-94\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nom (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-228\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-228\" \/><\/span> <\/label>\n<\/p>\n<p><label> Num\u00e9ro de t\u00e9l\u00e9phone (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-979\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-979\" \/><\/span> <\/label>\n<\/p>\n<p><label> Ville (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-852\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"address-level2\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-852\" \/><\/span> <\/label>\n<\/p>\n<p><label> Code postal (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-824\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"postal-code\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-824\" \/><\/span> <\/label>\n<\/p>\n<p><label> Adresse de courriel (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u00c2ge au 30 septembre prochain (champ obligatoire, requis par la ville de St-Bruno-de-Montarville)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"number-414\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"10\" max=\"125\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-414\" \/><\/span> <\/label>\n<\/p>\n<h3>Renseignements sur l'autre personne du couple\n<\/h3>\n<p><label> Pr\u00e9nom (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenom-conjoint\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom-conjoint\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nom (champ obligatoire)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom-conjoint\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom-conjoint\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u00c2ge au 30 septembre prochain (champ obligatoire, requis par la ville de St-Bruno-de-Montarville)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"number-415\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"10\" max=\"125\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-415\" \/><\/span> <\/label>\n<\/p>\n<p><label> Num\u00e9ro de t\u00e9l\u00e9phone (si diff\u00e9rent de la premi\u00e8re personne)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-conjoint\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-conjoint\" \/><\/span> <\/label>\n<\/p>\n<p><label> Ville (si diff\u00e9rente de la premi\u00e8re personne)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville-conjoint\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"address-level2\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ville-conjoint\" \/><\/span> <\/label>\n<\/p>\n<p><label> Code postal (si diff\u00e9rent de la premi\u00e8re personne)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"code-postal-conjoint\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"postal-code\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"code-postal-conjoint\" \/><\/span> <\/label>\n<\/p>\n<p><label> Adresse de courriel (si diff\u00e9rente de la premi\u00e8re personne)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-conjoint\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"email\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"email-conjoint\" \/><\/span> <\/label>\n<\/p>\n<h3>Information sur le paiement\n<\/h3>\n<p><label> Pour que nous puissions associer votre paiement avec votre demande d'adh\u00e9sion au Club, inscrivez le nom du d\u00e9tenteur du compte bancaire \u00e0 partir duquel sera fait le virement Interac (champ obligatoire).<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"detenteur-compte\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"detenteur-compte\" \/><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"198\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\n\n\n<p><span style=\"font-size: x-small;\">Derni\u00e8re r\u00e9vision de cette page : ao\u00fbt 2024.<\/span><br><span style=\"font-size: x-small;\">Responsable de la mise \u00e0 jour de cette page : Gilbert Girard.&nbsp;<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Voici comment proc\u00e9der pour devenir membre du Club : Si vous avez des questions au sujet de ce formulaire ou si vous \u00e9prouvez des difficult\u00e9s en tentant d\u2019adh\u00e9rer au Club, vous pouvez demander qu\u2019un b\u00e9n\u00e9vole du Club vous rappelle d&rsquo;ici 48 heures en cliquant sur ce lien. Derni\u00e8re r\u00e9vision de cette page : ao\u00fbt 2024.Responsable &hellip; <a href=\"https:\/\/cimbcc.org\/test2\/adhesion-au-club\/adhesion-en-ligne\/choix-du-mode-de-paiement-couple\/formulaire-dadhesion-interac-couple\/\" class=\"more-link\">Continuer la lecture de <span class=\"screen-reader-text\">Formulaire d&rsquo;adh\u00e9sion au Club<\/span>  <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":33,"featured_media":0,"parent":39726,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-39747","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/pages\/39747","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/users\/33"}],"replies":[{"embeddable":true,"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/comments?post=39747"}],"version-history":[{"count":9,"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/pages\/39747\/revisions"}],"predecessor-version":[{"id":53646,"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/pages\/39747\/revisions\/53646"}],"up":[{"embeddable":true,"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/pages\/39726"}],"wp:attachment":[{"href":"https:\/\/cimbcc.org\/test2\/wp-json\/wp\/v2\/media?parent=39747"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}