document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_2344dc0981d7fa' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_2415-2344dc0981d7fa.html' name='Formulaire_Gratuit_PropulSite_2344dc0981d7fa'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_2344dc0981d7fa'> <th>* Votre e-mail :</th> <td> <input name='Mail_2344dc0981d7fa' id='Mail_2344dc0981d7fa'> </td> </tr> <tr id='PropulSite_2344dc0981d7fa_1_Info'> <th>* Civilités :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Mlle</th> <td><input name='PropulSite_2344dc0981d7fa_1[]' id='PropulSite_2344dc0981d7fa_1' type='checkbox' value='Mlle'></td> </tr> <tr> <th>Mme</th> <td><input name='PropulSite_2344dc0981d7fa_1[]' id='PropulSite_2344dc0981d7fa_1' type='checkbox' value='Mme'></td> </tr> <tr> <th>M.</th> <td><input name='PropulSite_2344dc0981d7fa_1[]' id='PropulSite_2344dc0981d7fa_1' type='checkbox' value='M.'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_2344dc0981d7fa_2_Info'> <th>* Prénoms :</th> <td><input name='PropulSite_2344dc0981d7fa_2' id='PropulSite_2344dc0981d7fa_2' type='text' size='10'></td> </tr> <tr id='PropulSite_2344dc0981d7fa_3_Info'> <th>* Noms :</th> <td><input name='PropulSite_2344dc0981d7fa_3' id='PropulSite_2344dc0981d7fa_3' type='text' size='10'></td> </tr> <tr id='PropulSite_2344dc0981d7fa_4_Info'> <th>* Représentativité :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Groupe Communautaire</th> <td><input name='PropulSite_2344dc0981d7fa_4[]' id='PropulSite_2344dc0981d7fa_4' type='checkbox' value='Groupe Communautaire'></td> </tr> <tr> <th>ONG / OSC</th> <td><input name='PropulSite_2344dc0981d7fa_4[]' id='PropulSite_2344dc0981d7fa_4' type='checkbox' value='ONG / OSC'></td> </tr> <tr> <th>Individuel</th> <td><input name='PropulSite_2344dc0981d7fa_4[]' id='PropulSite_2344dc0981d7fa_4' type='checkbox' value='Individuel'></td> </tr> <tr> <th>Autre</th> <td><input name='PropulSite_2344dc0981d7fa_4[]' id='PropulSite_2344dc0981d7fa_4' type='checkbox' value='Autre'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_2344dc0981d7fa_5_Info'> <th>* Désignation du groupe :</th> <td><textarea name='PropulSite_2344dc0981d7fa_5' id='PropulSite_2344dc0981d7fa_5' cols='1' rows='1'></textarea></td> </tr> <tr id='PropulSite_2344dc0981d7fa_6_Info'> <th>* Adresse :</th> <td><textarea name='PropulSite_2344dc0981d7fa_6' id='PropulSite_2344dc0981d7fa_6' cols='1' rows='3'></textarea></td> </tr> <tr id='PropulSite_2344dc0981d7fa_7_Info'> <th>* ville :</th> <td><input name='PropulSite_2344dc0981d7fa_7' id='PropulSite_2344dc0981d7fa_7' type='text' size='10'></td> </tr> <tr id='PropulSite_2344dc0981d7fa_8_Info'> <th>* Pays :</th> <td><input name='PropulSite_2344dc0981d7fa_8' id='PropulSite_2344dc0981d7fa_8' type='text' size='12'></td> </tr> <tr id='PropulSite_2344dc0981d7fa_9_Info'> <th>* Tél :</th> <td><input name='PropulSite_2344dc0981d7fa_9' id='PropulSite_2344dc0981d7fa_9' type='text' size='11'></td> </tr> <tr id='PropulSite_2344dc0981d7fa_10_Info'> <th>Fax :</th> <td><input name='PropulSite_2344dc0981d7fa_10' id='PropulSite_2344dc0981d7fa_10' type='text' size='11'></td> </tr> <tr id='PropulSite_2344dc0981d7fa_11_Info'> <th>Site Internet :</th> <td><textarea name='PropulSite_2344dc0981d7fa_11' id='PropulSite_2344dc0981d7fa_11' cols='1' rows='1'></textarea></td> </tr> <tr id='PropulSite_2344dc0981d7fa_12_Info'> <th>* Inscription Membre :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Nouveau</th> <td><input name='PropulSite_2344dc0981d7fa_12[]' id='PropulSite_2344dc0981d7fa_12' type='checkbox' value='Nouveau'></td> </tr> <tr> <th>Ancien</th> <td><input name='PropulSite_2344dc0981d7fa_12[]' id='PropulSite_2344dc0981d7fa_12' type='checkbox' value='Ancien'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_2344dc0981d7fa_13_Info'> <th>* Qualité de membre :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Promoteurs simples (USD 80)</th> <td><input name='PropulSite_2344dc0981d7fa_13[]' id='PropulSite_2344dc0981d7fa_13' type='checkbox' value='Promoteurs simples (USD 80)'></td> </tr> <tr> <th>Fondateurs (USD 50)</th> <td><input name='PropulSite_2344dc0981d7fa_13[]' id='PropulSite_2344dc0981d7fa_13' type='checkbox' value='Fondateurs (USD 50)'></td> </tr> <tr> <th>Adhérents simple (USD 30)</th> <td><input name='PropulSite_2344dc0981d7fa_13[]' id='PropulSite_2344dc0981d7fa_13' type='checkbox' value='Adhérents simple (USD 30)'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_2344dc0981d7fa_14_Info'> <th>* Mode de règlement :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Espèce</th> <td><input name='PropulSite_2344dc0981d7fa_14[]' id='PropulSite_2344dc0981d7fa_14' type='checkbox' value='Espèce'></td> </tr> <tr> <th>Carte de crédit</th> <td><input name='PropulSite_2344dc0981d7fa_14[]' id='PropulSite_2344dc0981d7fa_14' type='checkbox' value='Carte de crédit'></td> </tr> <tr> <th>Transfère d'argent</th> <td><input name='PropulSite_2344dc0981d7fa_14[]' id='PropulSite_2344dc0981d7fa_14' type='checkbox' value='Transfère d'argent'></td> </tr> <tr> <th>Mandat Poste</th> <td><input name='PropulSite_2344dc0981d7fa_14[]' id='PropulSite_2344dc0981d7fa_14' type='checkbox' value='Mandat Poste'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_2344dc0981d7fa_15_Info'> <th>* Date :</th> <td><input name='PropulSite_2344dc0981d7fa_15' id='PropulSite_2344dc0981d7fa_15' type='text' size='13'></td> </tr> <tr id='Genered_Info_2344dc0981d7fa'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_2344dc0981d7fa'> <img id='FormPropulSite_img_2344dc0981d7fa' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite2344dc0981d7fa-1725756765.png' ><input name='Genered_2344dc0981d7fa' id='Genered_2344dc0981d7fa' maxlength='5' size='5'></div> </td> </tr> <tr> <th>Options d'envoi :</th> <td> <div id=IdOptionSend> <small><a href='javascript:afficheoptions();'>Afficher les options d'envoi.</a></small></td> </div> </tr> </tbody> </table> <input name='hid_2344dc0981d7fa' id='hid_2344dc0981d7fa' value='hid_2344dc0981d7fa' type='hidden'> <br> <input name='Envoyer_2344dc0981d7fa' id='Envoyer_2344dc0981d7fa' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite2344dc0981d7fa(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite2344dc0981d7fa()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_2344dc0981d7fa').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_2344dc0981d7fa_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénoms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Noms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Désignation du groupe >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_6').value == '' & 1 == 1)
					{
						erreur = erreur+'Adresse >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_7').value == '' & 1 == 1)
					{
						erreur = erreur+'ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_8').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_9').value == '' & 1 == 1)
					{
						erreur = erreur+'Tél >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2344dc0981d7fa_15').value == '' & 1 == 1)
					{
						erreur = erreur+'Date >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_2344dc0981d7fa').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_2344dc0981d7fa.submit();
				ReloadImg_2344dc0981d7fa();
			}
			else
			{
				if(nberreur == 1)
				{
					alert('Une erreur à été trouvée :\n\n'+erreur+' ');
				}
				else
				{
					alert(nberreur+' erreurs ont été trouvées :\n\n'+erreur+' ');
				}
			}
			
			
			return false;
		}
		
		function ReloadImg_2344dc0981d7fa()
		{
			var nbtp = Math.floor(Math.random() * 1725756765)+0;
			document.getElementById('DivContImgAndGenered_2344dc0981d7fa').innerHTML = '<img id="FormPropulSite_img_2344dc0981d7fa" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite2344dc0981d7fa-'+nbtp+'.png"><input name="Genered_2344dc0981d7fa" id="Genered_2344dc0981d7fa">';
		}
		
		function Loadtoform()
		{
			document.getElementById('LoadModule').innerHTML = '<img alt="Envoi en cours..." title="Envoi en cours..." src="https://propulsite.com/images/attend.gif">';
		}
		
		function afficheoptions()
		{
			document.getElementById('IdOptionSend').innerHTML = '<input name="copie" value="1" type="checkbox"> Recevoir une copie de ce message.<br><input name="confirm" value="1" type="checkbox"> Recevoir une confirmation de lecture.<br><input name="newsletter" value="1" type="checkbox"> Recevoir la newsletter de PropulSite.com (1 à 2/an)';
		}