{"id":4713,"date":"2018-02-18T14:53:40","date_gmt":"2018-02-18T13:53:40","guid":{"rendered":"https:\/\/www.alfa.be\/sinscrire\/"},"modified":"2023-07-05T16:51:35","modified_gmt":"2023-07-05T14:51:35","slug":"sinscrire","status":"publish","type":"page","link":"https:\/\/www.alfa.be\/fr\/sinscrire\/","title":{"rendered":"S&rsquo;inscrire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4713\" class=\"elementor elementor-4713 elementor-1476\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-712c415c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"712c415c\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-35b84b9e\" data-id=\"35b84b9e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3f1050af elementor-widget elementor-widget-text-editor\" data-id=\"3f1050af\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"text-align: center;\">S&rsquo;inscrire<\/h2><p>\u00a0<\/p><p style=\"text-align: center;\">Veuillez remplir le formulaire ci-dessous pour acc\u00e9der aux informations professionnelles des produits.<\/p><div class=\"piereg_container pieregWrapper\"><div class=\"pieregformWrapper pieregWrapper\"><div id=\"show_pie_register_error_js\" class=\"piereg_entry-content\"><\/div><div id=\"pie_register_reg_form\"><form enctype=\"multipart\/form-data\" class=\"pie_register_reg_form\" id=\"pie_regiser_form\" method=\"post\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/4713\" data-form=\"5\"><input type=\"hidden\" id=\"piereg_registration_form_nonce\" name=\"piereg_registration_form_nonce\" value=\"0b9e26ae9f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/4713\" \/><div class=\"fieldset \"><p id=\"piereg_pie_form_desc\" ><\/p><\/div><ul id=\"pie_register\"><input type=\"hidden\" value=\"5\" name=\"form_id\" \/><input type=\"hidden\" value=\"\" name=\"limit_submission\" \/><li class=\"fields   pageFields_1 piereg_li_5\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_5\">Nom&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input  id=\"text_5\" name=\"text_5\" data-field_id=\"piereg_field_5\" class=\"input_fields  piereg_validate[required] \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_6\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_6\">Pr\u00e9nom&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input  id=\"text_6\" name=\"text_6\" data-field_id=\"piereg_field_6\" class=\"input_fields  piereg_validate[required] \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_13\"   ><div class=\"fieldset\" ><label class=\"\" for=\"dropdown_13\">Activit\u00e9 prof&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><select   id=\"dropdown_13\" name=\"dropdown_13[]\" data-field_id=\"piereg_field_13\" class=\"input_fields  piereg_validate[required] \"   ><option selected=\"selected\" value=\"\"><\/option><option  value=\"Pharmacien\">Pharmacien<\/option><option  value=\"M\u00e9decin\">M\u00e9decin<\/option><option  value=\"Th\u00e9rapeute\">Th\u00e9rapeute<\/option><option  value=\"Autre\">Autre<\/option><\/select><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_7\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_7\">INAMI-APB<\/label><input  id=\"text_7\" name=\"text_7\" data-field_id=\"piereg_field_7\" class=\"input_fields  \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_8\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_8\">Rue + n\u00b0<\/label><input  id=\"text_8\" name=\"text_8\" data-field_id=\"piereg_field_8\" class=\"input_fields  \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_9\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_9\">Code postal&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input  id=\"text_9\" name=\"text_9\" data-field_id=\"piereg_field_9\" class=\"input_fields  piereg_validate[required] \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_10\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_10\">Ville<\/label><input  id=\"text_10\" name=\"text_10\" data-field_id=\"piereg_field_10\" class=\"input_fields  \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_14\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_14\">Pays<\/label><input  id=\"text_14\" name=\"text_14\" data-field_id=\"piereg_field_14\" class=\"input_fields  \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_11\"   ><div class=\"fieldset\"><label class=\"\" for=\"text_11\">T\u00e9l\u00e9phone&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input  id=\"text_11\" name=\"text_11\" data-field_id=\"piereg_field_11\" class=\"input_fields  piereg_validate[required] \"    placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_1\"   ><div class=\"fieldset\"><label class=\"\" for=\"email_1\">Email&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input  id=\"email_1\" name=\"e_mail\" data-field_id=\"piereg_field_1\" class=\"input_fields  piereg_validate[required,custom[email]] \"  data-errormessage-custom-error=\"\" placeholder=\"\" type=\"text\" value=\"\" \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_0\"   ><div class=\"fieldset\"><label class=\"\" for=\"username_0\">Username&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input id=\"username\" name=\"username\" data-field_id=\"piereg_field_0\" class=\"input_fields  piereg_validate[required,username] piereg_username_input_field \" placeholder=\"\" type=\"text\" value=\"\" data-errormessage-value-missing=\"\"  \/><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_2\"   ><div class=\"fieldset\"><label class=\"\" for=\"password_2\">Password&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input id=\"password_2\" name=\"password\" data-field_id=\"piereg_field_2\" class=\"input_fields  piereg_validate[minSize[8],required] prPass1\" placeholder=\"\" type=\"password\" data-errormessage-value-missing=\"\" data-errormessage-range-underflow=\"\" data-errormessage-range-overflow=\"\" autocomplete=\"off\" ><span class=\"show-hide-password-innerbtn pass-eye-reg pass-eye-reg_left_label_no_desc  eye\"><\/span><\/div><div class=\"fieldset\"><label>Confirm password&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><input id=\"confirm_password_password_2\" type=\"password\" data-errormessage-value-missing=\"\" data-errormessage-range-underflow=\"\" data-errormessage-range-overflow=\"\" class=\"input_fields  piereg_validate[minSize[8],required,equals[password_2]]  prPass2\" placeholder=\"\" autocomplete=\"off\" \/><span class=\"show-hide-password-innerbtn confirm-pass-eye-reg_left_label_no_desc eye\"><\/span><input class=\"prMinimumPasswordStrengthlength\" type=\"hidden\" id=\"password_strength_meter_5\" data-id=\"5\" value=\"1\" \/><span class=\"prMinimumPasswordStrengthMessage\" id=\"password_strength_message_5\" style=\"display:none;\">Weak Password<\/span><\/li><li class=\"fields   pageFields_1 piereg_li_12\"   ><div class=\"fieldset\"><label class=\"\" for=\"checkbox_12\">Privacy opt-in&nbsp;<span class=\"piereg_field_required_label\">*<\/span><\/label><div class=\"radio_wrap\"><div class=\"radio_container\"><input   checked=\"checked\" value=\"GDPR opt-in\" data-field_id=\"piereg_field_12\" type=\"checkbox\" name=\"checkbox_12[]\" class=\"input_fields  piereg_validate[required] radio_fields \"   data-map-field-by-class=\"checkbox_12\" ><label>GDPR opt-in<\/label><\/div><\/div><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_15\"   ><div class=\"fieldset\"><div class=\"input_fields piereg_recaptcha_reg_div piereg_validate[required]\" data-form-id=\"reg_form_5\"  id=\"piereg_form_5_not_registration_widget\" data-type=\"recaptcha\" ><\/div><\/div><\/li><li class=\"fields   pageFields_1 piereg_li_\"   ><div class=\"fieldset\"><div class=\"pie_wrap_buttons\"><input name=\"pie_submit\" class=\"pie_submit\" type=\"submit\" value=\"Submit\" \/><\/div><\/div><\/li><\/ul><\/form><\/div><\/div><\/div><p style=\"text-align: center;\"><span style=\"color: #ff0000;\">Apr\u00e8s cette inscription vous recevrez automatiquement un email pour v\u00e9rifier \/ confirmer votre demande. Ensuite seulement vous aurez acc\u00e8s \u00e0 la partie professionnelle de notre site. Jeter \u00e9galement un oeil dans le courrier ind\u00e9sirable pour cet email.<\/span><\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>S&rsquo;inscrire \u00a0 Veuillez remplir le formulaire ci-dessous pour acc\u00e9der aux informations professionnelles des produits. Apr\u00e8s cette inscription vous recevrez automatiquement un email pour v\u00e9rifier \/ confirmer votre demande. Ensuite seulement vous aurez acc\u00e8s \u00e0 la partie professionnelle de notre site. Jeter \u00e9galement un oeil dans le courrier ind\u00e9sirable pour cet email. \u00a0<\/p>\n","protected":false},"author":177,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"__cvm_playback_settings":[],"__cvm_video_id":"","footnotes":""},"class_list":["post-4713","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/pages\/4713","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/users\/177"}],"replies":[{"embeddable":true,"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/comments?post=4713"}],"version-history":[{"count":0,"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/pages\/4713\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.alfa.be\/fr\/wp-json\/wp\/v2\/media?parent=4713"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}