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campagne-adhesion-2015-www/adhesion.html

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<!DOCTYPE html>
<html class='no-js' lang='fr'>
<head>
<meta charset='utf-8'>
<meta content='width=device-width, initial-scale=1.0' name='viewport'>
<meta content="Campagne d'adhésion 2015 de l'April" name='description'>
<meta content='april - Campagne 2015' name='dcterms.title'>
<meta content='Emmanuel Charpentier' name='dcterms.creator'>
<meta content='April' name='dcterms.description'>
<meta content='april' name='dcterms.publisher'>
<meta content='fr' name='dcterms.language'>
<title>April</title>
<link href='favicon.ico' rel='shortcut icon' type='image/ico'>
<link href='favicon.ico' rel='icon' type='image/ico'>
<link href='http://www.april.org/rss.xml' rel='alternate' title='Actualités April' type='application/rss+xml'>
<link href='http://www.april.org/communiques/feed' rel='alternate' title='Communiqués April' type='application/rss+xml'>
<link href='http://www.april.org/revue-de-presse/feed' rel='alternate' title='Revue de presse April' type='application/rss+xml'>
<link href='http://www.april.org/citations/feed' rel='alternate' title='Citations April' type='application/rss+xml'>
<link href='http://www.april.org/event/feed' rel='alternate' title='Événements April' type='application/rss+xml'>
<link href="font/opensans_regular_macroman/stylesheet.css" rel="stylesheet" /><link href="font/distantgalaxy_regular_macroman/stylesheet.css" rel="stylesheet" /><link href="stylesheets/application.css?1449241671" rel="stylesheet" />
<script src="javascripts/jquery-1.11.0.js?1448926495"></script><script src="javascripts/all.js?1449665754"></script>
</head>
<body class='adhesion'>
<header>
<h1>April</h1>
</header>
<main>
<main class='zone'>
<blockquote>J'adhère à l'April</blockquote>
<form accept-charset='UTF-8' action='https://adherents.april.org/cgi-bin/adhesion.cgi' id='form_adhesion' method='post'>
<input id='turingtest' name='turingtest' type='hidden'>
<input id='form_adhesion_captcha' name='captcha' type='hidden' value='April'>
<fieldset class='field cotisation' title='Le paiement de la cotisation peut être versé annuellement, semestriellement, trimestriellement, mensuellement à votre convenance.'>
<legend class='extra'>Choix de la cotisation</legend>
<em class='fa fa-sign-in'></em>
<input class='num' id='radio10' name='cotisation' type='radio' value='10'>
<label for='radio10'>10 €</label>
<input class='num' id='radio30' name='cotisation' type='radio' value='30'>
<label for='radio30'>30 €</label>
<input checked='checked' class='num' id='radio50' name='cotisation' type='radio' value='50'>
<label for='radio50'>50 €</label>
<input class='num' id='radio100' name='cotisation' type='radio' value='100'>
<label for='radio100'>100 €</label>
<span class='zoneAutreMontant'>
<input id='radioAutreMontant' name='cotisation' type='radio' value='1'>
<label for='radioAutreMontant'>Autre montant à votre convenance:</label>
<label class='extra' for='autreMontant'>Montant</label>
<input id='autreMontant' max='10000' min='0' name='autreMontant' step='5' type='number' value='50'>
€
</span>
</fieldset>
<fieldset>
<legend>Informations nécessaires</legend>
<div class='field'>
<em class='fa fa-user'></em>
<label for='form_adhesion_titre'>Titre:</label>
<select id='form_adhesion_titre' name='titre' required='required'>
<option value=''>Titre</option>
<option>M</option>
<option>Mme</option>
</select>
<label for='form_adhesion_nom'>Nom:</label>
<input id='form_adhesion_nom' name='nom' placeHolder='Nom' required='required' size='30' type='text'>
<label for='form_adhesion_prenom'>Prénom:</label>
<input id='form_adhesion_prenom' name='prenom' placeHolder='Prénom' required='required' size='30' type='text'>
</div>
<div class='field'>
<em class='fa fa-map-marker'></em>
<label for='form_adhesion_adresse1'>Adresse:</label><textarea cols='40' id='form_adhesion_adresse1' name='adresse1' placeHolder='Adresse' required='required' rows='3'></textarea></div>
<div class='field'>
<em class='fa fa-location-arrow'></em>
<label for='form_adhesion_code_postal'>Code postal:</label>
<input id='form_adhesion_code_postal' name='code_postal' placeHolder='Code postal' required='required' size='8' type='text'>
<label for='form_adhesion_ville'>Ville:</label>
<input id='form_adhesion_ville' name='ville' placeHolder='Ville' required='required' size='40' type='text'>
</div>
<div class='field'>
<em class='fa fa-flag'></em>
<label for='form_adhesion_pays'>Pays:</label>
<select id='form_adhesion_pays' name='pays' required='required'>
<option disabled='disabled' value=''>Pays</option>
<option selected='selected' value='FRA'>France</option>
<option value='BEL'>Belgique</option>
<option value='CHE'>Suisse</option>
<option value='MAR'>Maroc</option>
<option value='DZA'>Algérie</option>
<option value='AFG'>Afghanistan</option>
<option value='ZAF'>Afrique du Sud</option>
<option value='ALA'>Åland</option>
<option value='ALB'>Albanie</option>
<option value='DEU'>Allemagne</option>
<option value='AND'>Andorre</option>
<option value='AGO'>Angola</option>
<option value='AIA'>Anguilla</option>
<option value='ATA'>Antarctique</option>
<option value='ATG'>Antigua-et-Barbuda</option>
<option value='ANT'>Antilles néerlandaises</option>
<option value='SAU'>Arabie saoudite</option>
<option value='ARG'>Argentine</option>
<option value='ARM'>Arménie</option>
<option value='ABW'>Aruba</option>
<option value='AUS'>Australie</option>
<option value='AUT'>Autriche</option>
<option value='AZE'>Azerbaïdjan</option>
<option value='BHS'>Bahamas</option>
<option value='BHR'>Bahreïn</option>
<option value='BGD'>Bangladesh</option>
<option value='BRB'>Barbade</option>
<option value='BLZ'>Belize</option>
<option value='BEN'>Bénin</option>
<option value='BMU'>Bermudes</option>
<option value='BTN'>Bhoutan</option>
<option value='BLR'>Biélorussie</option>
<option value='MMR'>Birmanie</option>
<option value='BOL'>Bolivie</option>
<option value='BIH'>Bosnie-Herzégovine</option>
<option value='BWA'>Botswana</option>
<option value='BRA'>Brésil</option>
<option value='BRN'>Brunei</option>
<option value='BGR'>Bulgarie</option>
<option value='BFA'>Burkina Faso</option>
<option value='BDI'>Burundi</option>
<option value='KHM'>Cambodge</option>
<option value='CMR'>Cameroun</option>
<option value='CAN'>Canada</option>
<option value='CPV'>Cap-Vert</option>
<option value='CAF'>Centrafrique</option>
<option value='CHL'>Chili</option>
<option value='CHN'>Chine</option>
<option value='CYP'>Chypre</option>
<option value='COL'>Colombie</option>
<option value='COM'>Comores</option>
<option value='COG'>Congo-Brazzaville</option>
<option value='COD'>Congo-Kinshasa</option>
<option value='PRK'>Corée du Nord</option>
<option value='KOR'>Corée du Sud</option>
<option value='CRI'>Costa Rica</option>
<option value='CIV'>Côte d'Ivoire</option>
<option value='HRV'>Croatie</option>
<option value='CUB'>Cuba</option>
<option value='DNK'>Danemark</option>
<option value='DJI'>Djibouti</option>
<option value='DMA'>Dominique</option>
<option value='EGY'>Égypte</option>
<option value='ARE'>Émirats arabes unis</option>
<option value='ECU'>Équateur</option>
<option value='ERI'>Érythrée</option>
<option value='ESP'>Espagne</option>
<option value='EST'>Estonie</option>
<option value='USA'>États-Unis</option>
<option value='ETH'>Éthiopie</option>
<option value='FJI'>Fidji</option>
<option value='FIN'>Finlande</option>
<option value='GAB'>Gabon</option>
<option value='GMB'>Gambie</option>
<option value='GEO'>Géorgie</option>
<option value='SGS'>Géorgie du Sud et les îles Sandwich du Sud</option>
<option value='GHA'>Ghana</option>
<option value='GIB'>Gibraltar</option>
<option value='GRC'>Grèce</option>
<option value='GRenaDe'>Grenade</option>
<option value='GRL'>Groenland</option>
<option value='GRD'>Groland</option>
<option value='GLP'>Guadeloupe</option>
<option value='GUM'>Guam</option>
<option value='GTM'>Guatemala</option>
<option value='GGY'>Guernesey</option>
<option value='GIN'>Guinée</option>
<option value='GNB'>Guinée-Bissau</option>
<option value='GNQ'>Guinée équatoriale</option>
<option value='GUY'>Guyana</option>
<option value='GUF'>Guyane</option>
<option value='HTI'>Haïti</option>
<option value='HND'>Honduras</option>
<option value='HKG'>Hong Kong</option>
<option value='HUN'>Hongrie</option>
<option value='BVT'>Île Bouvet</option>
<option value='CXR'>Île Christmas</option>
<option value='IMN'>Île de Man</option>
<option value='HMD'>Île Heard et îles McDonald</option>
<option value='CYM'>Îles Caïmans</option>
<option value='CCK'>Îles Cocos</option>
<option value='COK'>Îles Cook</option>
<option value='FRO'>Îles Féroé</option>
<option value='FLK'>Îles Malouines</option>
<option value='MNP'>Îles Mariannes du Nord</option>
<option value='UMI'>Îles mineures éloignées des États-Unis</option>
<option value='SLB'>Îles Salomon</option>
<option value='TCA'>Îles Turques-et-Caïques</option>
<option value='VIR'>Îles Vierges américaines</option>
<option value='VGB'>Îles Vierges britanniques</option>
<option value='IND'>Inde</option>
<option value='IDN'>Indonésie</option>
<option value='IRQ'>Irak</option>
<option value='IRN'>Iran</option>
<option value='IRL'>Irlande</option>
<option value='ISL'>Islande</option>
<option value='ISR'>Israël</option>
<option value='ITA'>Italie</option>
<option value='JAM'>Jamaïque</option>
<option value='JPN'>Japon</option>
<option value='JEY'>Jersey</option>
<option value='JOR'>Jordanie</option>
<option value='KAZ'>Kazakhstan</option>
<option value='KEN'>Kenya</option>
<option value='KGZ'>Kirghizistan</option>
<option value='KIR'>Kiribati</option>
<option value='KWT'>Koweït</option>
<option value='LAO'>Laos</option>
<option value='REU'>La Réunion</option>
<option value='LSO'>Lesotho</option>
<option value='LVA'>Lettonie</option>
<option value='LBN'>Liban</option>
<option value='LBR'>Libéria</option>
<option value='LBY'>Libye</option>
<option value='LIE'>Liechtenstein</option>
<option value='LTU'>Lituanie</option>
<option value='LUX'>Luxembourg</option>
<option value='MAC'>Macao</option>
<option value='MKD'>Macédoine</option>
<option value='MDG'>Madagascar</option>
<option value='MYS'>Malaisie</option>
<option value='MWI'>Malawi</option>
<option value='MDV'>Maldives</option>
<option value='MLI'>Mali</option>
<option value='MLT'>Malte</option>
<option value='MHL'>Marshall</option>
<option value='MTQ'>Martinique</option>
<option value='MUS'>Maurice</option>
<option value='MRT'>Mauritanie</option>
<option value='MYT'>Mayotte</option>
<option value='MEX'>Mexique</option>
<option value='FSM'>Micronésie</option>
<option value='MDA'>Moldavie</option>
<option value='MCO'>Monaco</option>
<option value='MNG'>Mongolie</option>
<option value='MNE'>Monténégro</option>
<option value='MSR'>Montserrat</option>
<option value='MOZ'>Mozambique</option>
<option value='NAM'>Namibie</option>
<option value='NRU'>Nauru</option>
<option value='NPL'>Népal</option>
<option value='NIC'>Nicaragua</option>
<option value='NER'>Niger</option>
<option value='NGA'>Nigeria</option>
<option value='NIU'>Niué</option>
<option value='NFK'>Norfolk</option>
<option value='NOR'>Norvège</option>
<option value='NCL'>Nouvelle-Calédonie</option>
<option value='NZL'>Nouvelle-Zélande</option>
<option value='OMN'>Oman</option>
<option value='UGA'>Ouganda</option>
<option value='UZB'>Ouzbékistan</option>
<option value='PAK'>Pakistan</option>
<option value='PLW'>Palaos</option>
<option value='PSE'>Palestine</option>
<option value='PAN'>Panamá</option>
<option value='PNG'>Papouasie-Nouvelle-Guinée</option>
<option value='PRY'>Paraguay</option>
<option value='NLD'>Pays Bas</option>
<option value='PER'>Pérou</option>
<option value='PHL'>Philippines</option>
<option value='PCN'>Pitcairn</option>
<option value='POL'>Pologne</option>
<option value='PYF'>Polynésie française</option>
<option value='PRI'>Porto Rico</option>
<option value='PRT'>Portugal</option>
<option value='QAT'>Qatar</option>
<option value='DOM'>République dominicaine</option>
<option value='CZE'>République tchèque</option>
<option value='ROU'>Roumanie</option>
<option value='GBR'>Royaume-Uni</option>
<option value='RUS'>Russie</option>
<option value='RWA'>Rwanda</option>
<option value='ESH'>Sahara occidental</option>
<option value='BLM'>Saint-Barthélemy</option>
<option value='KNA'>Saint-Christophe-et-Niévès</option>
<option value='SHN'>Sainte-Hélène (territoire)</option>
<option value='LCA'>Sainte-Lucie</option>
<option value='SMR'>Saint-Marin</option>
<option value='MAF'>Saint-Martin</option>
<option value='SPM'>Saint-Pierre-et-Miquelon</option>
<option value='VCT'>Saint-Vincent-et-les Grenadines</option>
<option value='SLV'>Salvador</option>
<option value='WSM'>Samoa</option>
<option value='ASM'>Samoa américaines</option>
<option value='STP'>Sao Tomé-et-Principe</option>
<option value='SEN'>Sénégal</option>
<option value='SRB'>Serbie</option>
<option value='SYC'>Seychelles</option>
<option value='SLE'>Sierra Leone</option>
<option value='SGP'>Singapour</option>
<option value='SVK'>Slovaquie</option>
<option value='SVN'>Slovénie</option>
<option value='SOM'>Somalie</option>
<option value='SDN'>Soudan</option>
<option value='LKA'>Sri Lanka</option>
<option value='SWE'>Suède</option>
<option value='SUR'>Suriname</option>
<option value='SJM'>Svalbard et île Jan Mayen</option>
<option value='SWZ'>Swaziland</option>
<option value='SYR'>Syrie</option>
<option value='TJK'>Tadjikistan</option>
<option value='TWN'>Taïwan</option>
<option value='TZA'>Tanzanie</option>
<option value='TCD'>Tchad</option>
<option value='ATF'>Terres australes et antarctiques françaises</option>
<option value='IOT'>Territoire britannique de l'océan Indien</option>
<option value='THA'>Thaïlande</option>
<option value='TLS'>Timor oriental</option>
<option value='TGO'>Togo</option>
<option value='TKL'>Tokelau</option>
<option value='TON'>Tonga</option>
<option value='TTO'>Trinité-et-Tobago</option>
<option value='TUN'>Tunisie</option>
<option value='TKM'>Turkménistan</option>
<option value='TUR'>Turquie</option>
<option value='TUV'>Tuvalu</option>
<option value='UKR'>Ukraine</option>
<option value='URY'>Uruguay</option>
<option value='VUT'>Vanuatu</option>
<option value='VAT'>Vatican</option>
<option value='VEN'>Venezuela</option>
<option value='VNM'>Viêt Nam</option>
<option value='WLF'>Wallis-et-Futuna</option>
<option value='YEM'>Yémen</option>
<option value='ZMB'>Zambie</option>
<option value='ZWE'>Zimbabwe</option>
</select>
</div>
<div class='field'>
<em class='fa fa-envelope'></em>
<label for='form_adhesion_email'>Votre adresse courriel:</label>
<input id='form_adhesion_email' name='email' placeHolder='Courriel' required='required' size='45' type='text'>
<input name='aliasmail' type='hidden'>
</div>
</fieldset>
<fieldset>
<legend>Informations facultatives</legend>
<div class='field'>
<em class='fa fa-phone'></em>
<label for='form_adhesion_tel'>N° de téléphone:</label>
<input id='form_adhesion_tel' name='tel' placeHolder='N° de tél' size='20' type='text'>
</div>
<div class='field'>
<em class='fa fa-calendar'></em>
<label for='form_adhesion_annee'>Date de naissance:</label>
<input id='form_adhesion_annee' name='annee' placeHolder='Date' size='10' type='text'>
<label for='form_adhesion_lieu'>Lieu de naissance:</label>
<input id='form_adhesion_lieu' name='lieu' placeHolder='Lieu de naissance' size='25' type='text'>
</div>
<div class='field'>
<em class='fa fa-wrench'></em>
<label for='form_adhesion_profession'>Profession (ou activité):</label>
<input id='form_adhesion_profession' name='profession' placeHolder='Profession (ou activité)' size='40' type='text'>
</div>
<div class='field'>
<em class='fa fa-comment'></em>
<label for='form_adhesion_motivations'>Commentaires éventuels/motivations:</label>
<textarea cols='40' id='form_adhesion_motivations' name='motivations' placeHolder='Commentaires éventuels/motivations' rows='5'></textarea>
</div>
</fieldset>
<p>
Une fois adhérent vous disposerez de cinq moyens de paiement:
<br>
en ligne par carte bancaire, prélèvement automatique, virement, chèques,
espèces.
</p>
<blockquote>Je déclare souhaiter devenir membre de l'association April.</blockquote>
<div class='field actions'>
<button type='submit' value='Adhérer maintenant!'>
<em class='fa fa-check'></em>
Adhérer maintenant!
<em class='fa fa-arrow-right'></em>
</button>
</div>
<div class='morales'>
<a href='https://april.org/adherer'>
Pour les adhésions de personnes morales
<em class='fa fa-external-link'></em>
</a>
</div>
</form>
<blockquote>De vous, l'April a besoin</blockquote>
</main>
</main>
</body>
</html>
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