{"id":355,"date":"2026-05-06T09:49:02","date_gmt":"2026-05-06T07:49:02","guid":{"rendered":"https:\/\/viadomitia-meze.org\/?page_id=355"},"modified":"2026-08-11T14:08:07","modified_gmt":"2026-08-11T12:08:07","slug":"bulletin-adhesion-new","status":"publish","type":"page","link":"https:\/\/viadomitia-meze.org\/?page_id=355","title":{"rendered":"Adh\u00e9rer"},"content":{"rendered":"<form action=\"https:\/\/viadomitia-meze.org\/?page_id=355\" method=\"post\" data-fields-with-error=\"Erreurs trouv\u00e9es dans les champs suivants :\" class=\"avia_ajax_form av-form-labels-visible   avia-builder-el-0  avia-builder-el-no-sibling   \" data-avia-form-id=\"1\" data-avia-redirect='https:\/\/viadomitia-meze.org\/'  aria-label='Formulaire de contact' ><h3 class=''>Bulletin d\u2019adh\u00e9sion sept 2026-sept 2027  - 15\u20ac<\/h3><fieldset><p class='  first_form  form_element form_element_half' id='element_avia_1_1'><label for=\"avia_1_1\">Nom <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_1_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_1_1\" value=\"\" \/><\/p><p class='  form_element form_element_fourth' id='element_avia_2_1'><label for=\"avia_2_1\">Pr\u00e9nom <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_2_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_2_1\" value=\"\" \/><\/p><p class='  form_element form_element_fourth' id='element_avia_3_1'><label for=\"avia_3_1\">Date de naissance <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_3_1\" class=\"avia_datepicker text_input is_empty\" type=\"text\" id=\"avia_3_1\" value=\"\" placeholder=\"DD \/ MM \/ YY\" inputmode=\"none\" \/><\/p><p class='  first_form  form_element form_element_half' id='element_avia_4_1'><label for=\"avia_4_1\">Nom<\/label> <input name=\"avia_4_1\" class=\"text_input \" type=\"text\" id=\"avia_4_1\" value=\"\" \/><\/p><p class='  form_element form_element_fourth' id='element_avia_5_1'><label for=\"avia_5_1\">Pr\u00e9nom<\/label> <input name=\"avia_5_1\" class=\"text_input \" type=\"text\" id=\"avia_5_1\" value=\"\" \/><\/p><p class='  form_element form_element_fourth' id='element_avia_6_1'><label for=\"avia_6_1\">Date de naissance<\/label> <input name=\"avia_6_1\" class=\"avia_datepicker text_input \" type=\"text\" id=\"avia_6_1\" value=\"\" placeholder=\"DD \/ MM \/ YY\" inputmode=\"none\" \/><\/p><p class='  first_form  form_element form_element_half' id='element_avia_7_1'><label for=\"avia_7_1\">Adresse <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_7_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_7_1\" value=\"\" \/><\/p><p class='  form_element form_element_fourth' id='element_avia_8_1'><label for=\"avia_8_1\">Ville <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_8_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_8_1\" value=\"\" \/><\/p><p class='  form_element form_element_fourth' id='element_avia_9_1'><label for=\"avia_9_1\">Code postal <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_9_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_9_1\" value=\"\" \/><\/p><div id='avia_10_1' class='av-form-text'><\/p>\n<ul>\n<li>Ch\u00e8que \u00e0 envoyer : ViaDomitia 16, rue de la loge 34140 M\u00e8ze<\/li>\n<li>Ou faire un virement<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0Titulaire :\u00a0 Asso. si la via domitia m&rsquo;\u00e9tait cont\u00e9e<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 Iban : FR76 1350 6100 0085 1754 4612 045\u00a0 \u00a0 \u00a0 Bic\u00a0 : AGRIFRPP835<\/li>\n<\/ul>\n<p>\n<\/div><p class='  first_form  form_element form_element_third' id='element_avia_11_1'><label for=\"avia_11_1\">Mode de paiement <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label><select  name=\"avia_11_1\" class=\"select is_empty\" id=\"avia_11_1\"><option  selected=\"selected\" value=''><\/option><option   value='Ch\u00e8que'>Ch\u00e8que<\/option><option   value='Virement'>Virement<\/option><option   value='Liquide'>Liquide<\/option><\/select><\/p><p class='  form_element form_element_third' id='element_avia_12_1'><label for=\"avia_12_1\">E-Mail <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_12_1\" class=\"text_input is_email\" type=\"text\" id=\"avia_12_1\" value=\"\" \/><\/p><p class='  form_element form_element_third' id='element_avia_13_1'><label for=\"avia_13_1\">N\u00b0 de t\u00e9l\u00e9phone <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label> <input name=\"avia_13_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_13_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_element_half' id='element_avia_14_1'><input  name=\"avia_14_1\" class=\"input_checkbox is_empty\" type=\"checkbox\" id=\"avia_14_1\" value=\"true\"\/><label class=\"input_checkbox_label\" for=\"avia_14_1\">Accepte la diffusion d\u2019image <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label><\/p><p class='  form_element form_element_half av-last-visible-form-element' id='element_avia_15_1'><label for=\"avia_15_1\">S\u00e9lectionner un document obligatoire <abbr class=\"required\" title=\"requis(e)\">*<\/abbr><\/label><select  name=\"avia_15_1\" class=\"select is_empty\" id=\"avia_15_1\"><option  selected=\"selected\" value=''><\/option><option   value='Certificat m\u00e9dical autorisant les activit\u00e9s physiques'>Certificat m\u00e9dical autorisant les activit\u00e9s physiques<\/option><option   value='Attestation de d\u00e9charge de responsabilit\u00e9'>Attestation de d\u00e9charge de responsabilit\u00e9<\/option><\/select><\/p><p class=\"hidden\"><input type=\"text\" name=\"avia_16_1\" class=\"hidden \" id=\"avia_16_1\" value=\"\" \/><\/p><p class=\"form_element \"><input type=\"hidden\" value=\"1\" name=\"avia_generated_form1\" \/><input type=\"submit\" value=\"Valider\" class=\"button\"  data-sending-label=\"Envoi\"\/><\/p><\/fieldset><\/form><div id=\"ajaxresponse_1\" class=\"ajaxresponse ajaxresponse_1 hidden\"><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blank.php","meta":{"footnotes":""},"class_list":["post-355","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=\/wp\/v2\/pages\/355","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=355"}],"version-history":[{"count":34,"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=\/wp\/v2\/pages\/355\/revisions"}],"predecessor-version":[{"id":1375,"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=\/wp\/v2\/pages\/355\/revisions\/1375"}],"wp:attachment":[{"href":"https:\/\/viadomitia-meze.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=355"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}