{"id":197,"date":"2012-09-01T18:00:33","date_gmt":"2012-09-01T16:00:33","guid":{"rendered":"http:\/\/mediagoras.fr\/?page_id=197"},"modified":"2012-09-01T18:00:33","modified_gmt":"2012-09-01T16:00:33","slug":"formulaire-contact","status":"publish","type":"page","link":"https:\/\/mediagoras.fr\/exemple\/nous-contacter\/formulaire-contact\/","title":{"rendered":"Formulaire de contact"},"content":{"rendered":"<h6 style=\"text-align: right\"><span style=\"color: #000000\">Derni\u00e8re mise \u00e0 jour de cette page 04 f\u00e9v\u00a02016<\/span><\/h6>\n<p style=\"text-align: center\"><span style=\"color: #000000\">Pr\u00e8s de chez vous, il n&rsquo;existe encore ni association M\u00e9diagora d\u00e9j\u00e0 constitu\u00e9e, ni de correspondant ou bien vous n&rsquo;arrivez pas \u00e0 contacter celle ou celui qui vous int\u00e9resse ?<\/span><\/p>\n<p style=\"text-align: center\"><span style=\"color: #000000\">Alors veuillez remplir le formulaire ci-dessous :<\/span><\/p>\n<p style=\"text-align: center\"><span style=\"color: #000000\"><em> <strong><span style=\"text-decoration: underline\">Tous les champs sont optionnels,<\/span><\/strong> mais plus vous en remplirez, et plus nous aurons de facilit\u00e9 pour vous r\u00e9pondre.<\/em><\/span><\/p>\n<p style=\"text-align: center\"><span style=\"font-size: small\">(si vous \u00eates allergique aux formulaires, vous pouvez nous t\u00e9l\u00e9phoner)<\/span><\/p>\n<p style=\"text-align: center\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f696-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"696\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/exemple\/wp-json\/wp\/v2\/pages\/197#wpcf7-f696-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"696\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f696-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>Version 1.5\n<\/p>\n<p>Politesse : <span class=\"wpcf7-form-control-wrap\" data-name=\"genre\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"genre\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Mme\">Mme<\/option><option value=\"Mlle\">Mlle<\/option><option value=\"Mr\">Mr<\/option><\/select><\/span>\n<\/p>\n<p>Votre pr\u00e9nom <span class=\"wpcf7-form-control-wrap\" data-name=\"prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom\" \/><\/span>\n<\/p>\n<p>Votre nom <span class=\"wpcf7-form-control-wrap\" data-name=\"nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom\" \/><\/span>\n<\/p>\n<p>Votre email (n\u00e9cessaire si vous souhaitez recevoir un accus\u00e9 de r\u00e9ception et une r\u00e9ponse \u00e9crite)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"courriel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"courriel\" \/><\/span>\n<\/p>\n<p>Vos t\u00e9l\u00e9phone(s) : <span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel\" \/><\/span>\n<\/p>\n<p>Les plages horaires o\u00f9 l'on peut vous t\u00e9l : <span class=\"wpcf7-form-control-wrap\" data-name=\"plaghortel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"plaghortel\" \/><\/span><br \/>\nVotre pays : <span class=\"wpcf7-form-control-wrap\" data-name=\"pays\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pays\" \/><\/span><br \/>\nVotre code postal : <span class=\"wpcf7-form-control-wrap\" data-name=\"codpost\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"codpost\" \/><\/span><br \/>\nVotre ville (ou la ville la + proche) : <span class=\"wpcf7-form-control-wrap\" data-name=\"ville\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ville\" \/><\/span><br \/>\nLes autres d\u00e9partements o\u00f9 vous pourriez \u00e9ventuellement venir : <span class=\"wpcf7-form-control-wrap\" data-name=\"otrdeparts\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"otrdeparts\" \/><\/span>\n<\/p>\n<p>Quels sont le(s) trouble(s) anxieux qui vous motivent \u00e0 nous contacter ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"typtroubles\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Agoraphobie (impossibilit\u00e9 de vous rendre seul(e) dans certains lieux)\" \/><span class=\"wpcf7-list-item-label\">Agoraphobie (impossibilit\u00e9 de vous rendre seul(e) dans certains lieux)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Attaques de Panique (crises d&#039;angoisse tr\u00e8s intenses)\" \/><span class=\"wpcf7-list-item-label\">Attaques de Panique (crises d&#039;angoisse tr\u00e8s intenses)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Anxi\u00e9t\u00e9 G\u00e9n\u00e9ralis\u00e9e ou TAG (l&#039;anxi\u00e9t\u00e9 a envahie toute votre vie)\" \/><span class=\"wpcf7-list-item-label\">Anxi\u00e9t\u00e9 G\u00e9n\u00e9ralis\u00e9e ou TAG (l&#039;anxi\u00e9t\u00e9 a envahie toute votre vie)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Phobie sociale (ou timidit\u00e9 profonde)\" \/><span class=\"wpcf7-list-item-label\">Phobie sociale (ou timidit\u00e9 profonde)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Personnalit\u00e9 \u00e9vitante\" \/><span class=\"wpcf7-list-item-label\">Personnalit\u00e9 \u00e9vitante<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Phobie sp\u00e9cifique\" \/><span class=\"wpcf7-list-item-label\">Phobie sp\u00e9cifique<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"typtroubles[]\" value=\"Stress post-traumatique\" \/><span class=\"wpcf7-list-item-label\">Stress post-traumatique<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Autre(s) trouble(s) (veuillez pr\u00e9ciser svp) : <span class=\"wpcf7-form-control-wrap\" data-name=\"otroubles\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"otroubles\" \/><\/span><br \/>\nQuelle est votre classe d'\u00e2ge ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"class-age\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"class-age\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"moins de 15\">moins de 15<\/option><option value=\"15-24\">15-24<\/option><option value=\"25-34\">25-34<\/option><option value=\"35-44\">35-44<\/option><option value=\"45-54\">45-54<\/option><option value=\"55-64\">55-64<\/option><option value=\"65-74\">65-74<\/option><option value=\"75 et +\">75 et +<\/option><\/select><\/span>\n<\/p>\n<p>Pour quelle(s) raison(s) prenez-vous contact ?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"corps-du-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"corps-du-message\"><\/textarea><\/span>\n<\/p>\n<p>Seriez-vous pr\u00eat(e) \u00e0 vous impliquer dans la cr\u00e9ation ou le fonctionnement de votre future Groupe local ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"typdengage\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"typdengage[]\" value=\"Juste participer aux r\u00e9unions\" \/><span class=\"wpcf7-list-item-label\">Juste participer aux r\u00e9unions<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typdengage[]\" value=\"Participer au comit\u00e9 fondateur\" \/><span class=\"wpcf7-list-item-label\">Participer au comit\u00e9 fondateur<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"typdengage[]\" value=\"Membre du bureau\" \/><span class=\"wpcf7-list-item-label\">Membre du bureau<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"typdengage[]\" value=\"Leader\" \/><span class=\"wpcf7-list-item-label\">Leader<\/span><\/span><\/span><\/span>\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=\"56\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p style=\"text-align: center\"><span style=\"color: #000000\">Pour finir n&rsquo;oubliez pas de cliquer sur le bouton \u00ab\u00a0Envoyer\u00a0\u00bb !<\/span><\/p>\n<p><span style=\"color: #000000\">Si vous ne recevez <strong>aucune confirmation automatique<\/strong> dans les minutes qui suivent votre envoi, v\u00e9rifiez bien votre dossier anti-spam. Si vous n&rsquo;avez vraiment rien re\u00e7u au bout de 2 ou 3 h, c&rsquo;est que probablement vous avez <strong>mal saisi<\/strong> (ou omis) votre adresse \u00e9lectronique. S&rsquo;il s&rsquo;agit d&rsquo;une omission volontaire, avez-vous pens\u00e9 \u00e0 nous laisser un N\u00b0 de t\u00e9l\u00e9phone pour vous joindre ?<\/span><\/p>\n<p><span style=\"color: #800080\"><strong>IMPORTANT !<\/strong> \u00a0Si vous ne recevez aucune r\u00e9ponse (autre qu&rsquo;automatique) dans les 10 jours, n&rsquo;h\u00e9sitez surtout pas \u00e0 nous recontacter (\u00e9ventuellement en utilisant un autre moyen).<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Derni\u00e8re mise \u00e0 jour de cette page 04 f\u00e9v\u00a02016 Pr\u00e8s de chez vous, il n&rsquo;existe encore ni association M\u00e9diagora d\u00e9j\u00e0 constitu\u00e9e, ni de correspondant ou bien vous n&rsquo;arrivez pas \u00e0 contacter celle ou celui qui vous int\u00e9resse ? Alors veuillez remplir le formulaire ci-dessous : Tous les champs sont optionnels, mais plus vous en remplirez, [&hellip;]<\/p>\n","protected":false},"author":38,"featured_media":0,"parent":507,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"onecolumn-page.php","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-197","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Contacter les associations M\u00e9diagora - Anxi\u00e9t\u00e9 - Peur - Phobies -<\/title>\n<meta name=\"description\" content=\"Formulaire de contact pour joindre une associations ou un correspondant du r\u00e9seau M\u00e9diagora, associations de ceux qui souffrent de phobie ou d&#039;anxi\u00e9t\u00e9 - Entraide\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/mediagoras.fr\/exemple\/nous-contacter\/formulaire-contact\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Contacter les associations M\u00e9diagora - 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