{"id":20491,"date":"2021-11-17T14:19:00","date_gmt":"2021-11-17T13:19:00","guid":{"rendered":"https:\/\/www.srfb.be\/?page_id=20491"},"modified":"2025-12-09T16:31:21","modified_gmt":"2025-12-09T15:31:21","slug":"formularmitglied","status":"publish","type":"page","link":"https:\/\/srfb.be\/de\/devenir-membre\/formulaire-membre\/","title":{"rendered":"Formular f\u00fcr Mitglieder"},"content":{"rendered":"\n<div class=\"wp-block-group is-layout-constrained wp-block-group-is-layout-constrained\" style=\"margin-top:var(--wp--preset--spacing--80);margin-bottom:var(--wp--preset--spacing--80)\"><div class=\"yoast-breadcrumbs\"><span><span><a href=\"https:\/\/kbbm.be\/en\/\">Accueil<\/a><\/span> &gt; <span><a href=\"https:\/\/kbbm.be\/nl\/lid-worden\/\">Devenir membre<\/a><\/span> &gt; <span class=\"breadcrumb_last\" aria-current=\"page\"><strong>Formulaire membre<\/strong><\/span><\/span><\/div><\/div>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-48d0e691 wp-block-buttons-is-layout-flex\" style=\"margin-top:var(--wp--preset--spacing--60);margin-bottom:var(--wp--preset--spacing--60)\">\n<div class=\"wp-block-button is-style-fill\"><a class=\"wp-block-button__link has-vert-fonce-color-color has-grey-color-background-color has-text-color has-background has-link-color wp-element-button\" href=\"https:\/\/srfb.be\/wp-content\/uploads\/2024\/12\/AppelACotisation_FR_2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"wp-rich-text-font-awesome-icon wp-font-awesome-icon\"><svg aria-hidden=\"true\" focusable=\"false\" data-prefix=\"fas\" data-icon=\"tag\" class=\"svg-inline--fa fa-tag \" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 448 512\"><path fill=\"currentColor\" d=\"M0 80V229.5c0 17 6.7 33.3 18.7 45.3l176 176c25 25 65.5 25 90.5 0L418.7 317.3c25-25 25-65.5 0-90.5l-176-176c-12-12-28.3-18.7-45.3-18.7H48C21.5 32 0 53.5 0 80zm112 32a32 32 0 1 1 0 64 32 32 0 1 1 0-64z\"><\/path><\/svg><\/span> D\u00e9tails sur les tarifs et services<\/a><\/div>\n\n\n\n<div class=\"wp-block-button is-style-fill\"><a class=\"wp-block-button__link has-vert-fonce-color-color has-grey-color-background-color has-text-color has-background has-link-color wp-element-button\" href=\"https:\/\/srfb.be\/devenir-membre\/changer-de-formule-de-cotisation\/\"><span class=\"wp-rich-text-font-awesome-icon wp-font-awesome-icon\"><svg aria-hidden=\"true\" focusable=\"false\" data-prefix=\"fas\" data-icon=\"address-card\" class=\"svg-inline--fa fa-address-card \" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 576 512\"><path fill=\"currentColor\" d=\"M64 32C28.7 32 0 60.7 0 96V416c0 35.3 28.7 64 64 64H512c35.3 0 64-28.7 64-64V96c0-35.3-28.7-64-64-64H64zm80 256h64c44.2 0 80 35.8 80 80c0 8.8-7.2 16-16 16H80c-8.8 0-16-7.2-16-16c0-44.2 35.8-80 80-80zm-32-96a64 64 0 1 1 128 0 64 64 0 1 1 -128 0zm256-32H496c8.8 0 16 7.2 16 16s-7.2 16-16 16H368c-8.8 0-16-7.2-16-16s7.2-16 16-16zm0 64H496c8.8 0 16 7.2 16 16s-7.2 16-16 16H368c-8.8 0-16-7.2-16-16s7.2-16 16-16zm0 64H496c8.8 0 16 7.2 16 16s-7.2 16-16 16H368c-8.8 0-16-7.2-16-16s7.2-16 16-16z\"><\/path><\/svg><\/span> Changer de formule de cotisation<\/a><\/div>\n<\/div>\n\n\n<div class='fluentform ff-default fluentform_wrapper_175  ff_guten_block ff_guten_block-175 ffs_custom_wrap'><form data-form_id=\"175\" id=\"fluentform_175\" class=\"frm-fluent-form fluent_form_175 ff-el-form-top ff_form_instance_175_1 ff-form-loading ff-form-has-steps ffs_custom\" data-form_instance=\"ff_form_instance_175_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Devenir Membre 2025<\/legend><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"168\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><input type='hidden' name='__fluent_form_embded_post_id' value='20491' \/><input type=\"hidden\" id=\"_fluentform_175_fluentformnonce\" name=\"_fluentform_175_fluentformnonce\" value=\"0d922f8797\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/de\/wp-json\/wp\/v2\/pages\/20491\" \/><div class='ff-step-container' data-name=\"step_start-175_15\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"yes\" data-animation_type=\"slide\" ><div class='ff-step-header'><ul class='ff-step-titles'><li class='ff_active'><span>Informations membre<\/span><\/li><li><span>Patrimoine<\/span><\/li><li><span>Divers<\/span><\/li><\/ul><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-175_15\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"yes\" data-animation_type=\"slide\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_1\" ><h2 style=\"text-align: center\">Informations membre<\/h2>\n<p style=\"text-align: center\"><em>Ces donn\u00e9es resteront strictement confidentielles.<\/em><\/p><\/div><div class='ff-el-group ff-el-form-hide_label center pad-25 ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Je suis une...\">Je suis une&#8230;<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='type_fb63eb0905b41d5189ccee9d628ce29b'><input  type=\"radio\" name=\"type\" data-name=\"type\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"personne physique\"  id='type_fb63eb0905b41d5189ccee9d628ce29b' aria-label='personne physique' aria-invalid='false' aria-required=true> <span>personne physique<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='type_16802bbedded3944682eaa57a70c80d8'><input  type=\"radio\" name=\"type\" data-name=\"type\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"soci\u00e9t\u00e9\"  id='type_16802bbedded3944682eaa57a70c80d8' aria-label='soci\u00e9t\u00e9' aria-invalid='false' aria-required=true> <span>soci\u00e9t\u00e9<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-hide_label center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Civilit\u00e9\">Civilit\u00e9<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='civilite_b5d057d61ae692e1c32be31fde179f58'><input  type=\"radio\" name=\"civilite\" data-name=\"civilite\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Madame\"  id='civilite_b5d057d61ae692e1c32be31fde179f58' aria-label='Madame' aria-invalid='false' aria-required=true> <span>Madame<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='civilite_dc46a57d112b840634dacacfec51c3e9'><input  type=\"radio\" name=\"civilite\" data-name=\"civilite\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Monsieur\"  id='civilite_dc46a57d112b840634dacacfec51c3e9' aria-label='Monsieur' aria-invalid='false' aria-required=true> <span>Monsieur<\/span><\/label><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_first_name_' id='label_ff_175_names_first_name_' >Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" value=\"\" id=\"ff_175_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Pr\u00e9nom\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_last_name_' id='label_ff_175_names_last_name_' >Nom de famille<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" value=\"\" id=\"ff_175_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Nom de famille\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_email' id='label_ff_175_email' aria-label=\"E-mail\">E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" value=\"\" id=\"ff_175_email\" class=\"ff-el-form-control\" placeholder=\"E-mail\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_phone' id='label_ff_175_phone' aria-label=\"T\u00e9l\u00e9phone \/ GSM\">T\u00e9l\u00e9phone \/ GSM<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"Num\u00e9ro de portable\" data-name=\"phone\" id=\"ff_175_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_compagny_name' id='label_ff_175_compagny_name' >Nom de votre soci\u00e9t\u00e9<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"compagny_name\" class=\"ff-el-form-control\" placeholder=\"Soci\u00e9t\u00e9 Royale Foresti\u00e8re de Belgique\" data-name=\"compagny_name\" id=\"ff_175_compagny_name\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_input_text' id='label_ff_175_input_text' aria-label=\"N\u00b0 TVA\">N\u00b0 TVA<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"BE 0408 558 654\" data-name=\"input_text\" id=\"ff_175_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_address_line_1_' id='label_ff_175_address_1_address_line_1_' aria-label=\"Rue\">Rue<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_175_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Rue\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_address_line_2_' id='label_ff_175_address_1_address_line_2_' aria-label=\"Num\u00e9ro\">Num\u00e9ro<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_175_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_zip_' id='label_ff_175_address_1_zip_' aria-label=\"Code postal\">Code postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_175_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Code Postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_city_' id='label_ff_175_address_1_city_' aria-label=\"Ville\">Ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_175_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"Ville\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_1_country_' id='label_ff_175_address_1_country_' aria-label=\"Pays\">Pays<\/label><\/div><div class='ff-el-input--content'><select name=\"address_1[country]\" id=\"ff_175_address_1_country_\" class=\"ff-el-form-control\" placeholder=\"S\u00e9lectionner le pays\" data-key_name=\"country\" aria-invalid='false' aria-required=true><option value=''>S\u00e9lectionner le pays<\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albanien<\/option><option value='DZ' >Algerien<\/option><option value='AS' >Amerikanisch-Samoa<\/option><option value='VI' >Amerikanische Jungferninseln<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarktika<\/option><option value='AG' >Antigua und Barbuda<\/option><option value='AR' >Argentinien<\/option><option value='AM' >Armenien<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbaidschan<\/option><option value='AU' >Australien<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesch<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' selected>Belgien<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivien<\/option><option value='BQ' >Bonaire, Sint Eustatius und Saba<\/option><option value='BA' >Bosnien und Herzegowina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvetinsel<\/option><option value='BR' >Brasilien<\/option><option value='VG' >Britische Jungferninseln<\/option><option value='IO' >Britisches Territorium im Indischen Ozean<\/option><option value='BN' >Brunei<\/option><option value='BG' >Bulgarien<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CK' >Cookinseln<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CD' >Democratic Republic of the Congo (Kinshasa)<\/option><option value='DE' >Deutschland<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominikanische Republik<\/option><option value='DJ' >Dschibuti<\/option><option value='DK' >D\u00e4nemark<\/option><option value='EC' >Ecuador<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbeink\u00fcste<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='FK' >Falklandinseln<\/option><option value='FJ' >Fidschi<\/option><option value='FI' >Finnland<\/option><option value='FR' >Frankreich<\/option><option value='GF' >Franz\u00f6sisch-Guayana<\/option><option value='PF' >Franz\u00f6sisch-Polynesien<\/option><option value='TF' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='FO' >F\u00e4r\u00f6er<\/option><option value='GA' >Gabun<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgien<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griechenland<\/option><option value='GL' >Gr\u00f6nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard und McDonaldinseln<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hongkong<\/option><option value='IN' >Indien<\/option><option value='ID' >Indonesien<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italien<\/option><option value='JM' >Jamaika<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanien<\/option><option value='KY' >Kaimaninseln<\/option><option value='KH' >Kambodscha<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='KZ' >Kasachstan<\/option><option value='QA' >Katar<\/option><option value='KE' >Kenia<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='CC' >Kokosinseln (Keelinginseln)<\/option><option value='CO' >Kolumbien<\/option><option value='KM' >Komoren<\/option><option value='XK' >Kosovo<\/option><option value='HR' >Kroatien<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='LA' >Laos<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libyen<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macao, China<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Malediven<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshallinseln<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauretanien<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexiko<\/option><option value='FM' >Mikronesien<\/option><option value='MD' >Moldau<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolei<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NC' >Neukaledonien<\/option><option value='NZ' >Neuseeland<\/option><option value='NI' >Nicaragua<\/option><option value='NL' >Niederlande<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='KP' >Nordkorea<\/option><option value='NF' >Norfolkinsel<\/option><option value='MK' >North Macedonia<\/option><option value='NO' >Norwegen<\/option><option value='MP' >N\u00f6rdliche Marianen<\/option><option value='OM' >Oman<\/option><option value='TL' >Osttimor<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Pal\u00e4stinensische Autonomiegebiete<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua-Neuguinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippinen<\/option><option value='PN' >Pitcairninseln<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='CG' >Republic of the Congo (Brazzaville)<\/option><option value='RW' >Ruanda<\/option><option value='RO' >Rum\u00e4nien<\/option><option value='RU' >Russland<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SX' >Saint Martin (niederl\u00e4ndischer Teil)<\/option><option value='PM' >Saint-Pierre und Miquelon<\/option><option value='SB' >Salomonen<\/option><option value='ZM' >Sambia<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi-Arabien<\/option><option value='SE' >Schweden<\/option><option value='CH' >Schweiz<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbien<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='ZW' >Simbabwe<\/option><option value='SG' >Singapur<\/option><option value='SK' >Slowakei<\/option><option value='SI' >Slowenien<\/option><option value='SO' >Somalia<\/option><option value='ES' >Spanien<\/option><option value='SJ' >Spitzbergen und Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SH' >St. Helena<\/option><option value='KN' >St. Kitts und Nevis<\/option><option value='LC' >St. Lucia<\/option><option value='MF' >St. Martin (Frankreich)<\/option><option value='VC' >St. Vincent und die Grenadinen<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SY' >Syrien<\/option><option value='ZA' >S\u00fcdafrika<\/option><option value='GS' >S\u00fcdgeorgien\/Sandwichinseln<\/option><option value='KR' >S\u00fcdkorea<\/option><option value='SS' >S\u00fcdsudan<\/option><option value='TJ' >Tadschikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tansania<\/option><option value='TH' >Thailand<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad und Tobago<\/option><option value='TD' >Tschad<\/option><option value='CZ' >Tschechien<\/option><option value='TN' >Tunesien<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- und Caicosinseln<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='HU' >Ungarn<\/option><option value='UM' >United States (US) Minor Outlying Islands<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vatikanstadt<\/option><option value='VE' >Venezuela<\/option><option value='AE' >Vereinigte Arabische Emirate<\/option><option value='US' >Vereinigte Staaten von Amerika (USA)<\/option><option value='GB' >Vereinigtes K\u00f6nigreich<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis und Futuna<\/option><option value='CX' >Weihnachtsinsel<\/option><option value='EH' >Westsahara<\/option><option value='CF' >Zentralafrikanische Republik<\/option><option value='CY' >Zypern<\/option><option value='EG' >\u00c4gypten<\/option><option value='GQ' >\u00c4quatorialguinea<\/option><option value='ET' >\u00c4thiopien<\/option><option value='AX' >\u00c5landinseln<\/option><option value='AT' >\u00d6sterreich<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Souhaitez-vous que certaines communications (factures, courriers, revues) soient envoy\u00e9es \u00e0 une autre personne ou adresse ?\">Souhaitez-vous que certaines communications (factures, courriers, revues) soient envoy\u00e9es \u00e0 une autre personne ou adresse ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='other_person_eee32178dc22f7ccef7ac9f491dcf95f'><input  type=\"radio\" name=\"other_person\" data-name=\"other_person\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='other_person_eee32178dc22f7ccef7ac9f491dcf95f' aria-label='Oui' aria-invalid='false' aria-required=true> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='other_person_515ec9b6d4cc3a94fbafeee5ba13b5e5'><input  type=\"radio\" name=\"other_person\" data-name=\"other_person\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Non\"  id='other_person_515ec9b6d4cc3a94fbafeee5ba13b5e5' aria-label='Non' aria-invalid='false' aria-required=true> <span>Non<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_1 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group center ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Types d\u2019envois concern\u00e9s :\">Types d\u2019envois concern\u00e9s :<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='envoi_type_0d3477f31dd2479406c8be18975c4e0d'><input  type=\"checkbox\" name=\"envoi_type[]\" data-name=\"envoi_type\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"revues\"  id='envoi_type_0d3477f31dd2479406c8be18975c4e0d' aria-label='Les revues' aria-invalid='false' aria-required=true> <span>Les revues<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='envoi_type_09815f9d4fce7d72cdecd62a93cbae82'><input  type=\"checkbox\" name=\"envoi_type[]\" data-name=\"envoi_type\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"factures et courriers\"  id='envoi_type_09815f9d4fce7d72cdecd62a93cbae82' aria-label='Les factures et courriers' aria-invalid='false' aria-required=true> <span>Les factures et courriers<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-hide_label center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Civilit\u00e9\">Civilit\u00e9<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='civilite_contact_ba29249a3bf4876595030c11f6bcde89'><input  type=\"radio\" name=\"civilite_contact\" data-name=\"civilite_contact\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Madame\"  id='civilite_contact_ba29249a3bf4876595030c11f6bcde89' aria-label='Madame' aria-invalid='false' aria-required=true> <span>Madame<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='civilite_contact_25b6cd4ce6e238f4f552c9d9d3506478'><input  type=\"radio\" name=\"civilite_contact\" data-name=\"civilite_contact\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Monsieur\"  id='civilite_contact_25b6cd4ce6e238f4f552c9d9d3506478' aria-label='Monsieur' aria-invalid='false' aria-required=true> <span>Monsieur<\/span><\/label><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_contact\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_contact_first_name_' id='label_ff_175_names_contact_first_name_' >Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_contact[first_name]\" id=\"ff_175_names_contact_first_name_\" class=\"ff-el-form-control\" placeholder=\"Pr\u00e9nom\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_names_contact_last_name_' id='label_ff_175_names_contact_last_name_' >Nom de famille<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_contact[last_name]\" id=\"ff_175_names_contact_last_name_\" class=\"ff-el-form-control\" placeholder=\"Nom de famille\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"num_contact\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_num_contact_first_name_' id='label_ff_175_num_contact_first_name_' >E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"num_contact[first_name]\" id=\"ff_175_num_contact_first_name_\" class=\"ff-el-form-control\" placeholder=\"E-mail\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_num_contact_last_name_' id='label_ff_175_num_contact_last_name_' >T\u00e9l\u00e9phone \/ GSM<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"num_contact[last_name]\" id=\"ff_175_num_contact_last_name_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro de portable\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_contact\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_address_line_1_' id='label_ff_175_address_contact_address_line_1_' aria-label=\"Rue\">Rue<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[address_line_1]\" id=\"ff_175_address_contact_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Rue\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_address_line_2_' id='label_ff_175_address_contact_address_line_2_' aria-label=\"Num\u00e9ro\">Num\u00e9ro<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[address_line_2]\" id=\"ff_175_address_contact_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_zip_' id='label_ff_175_address_contact_zip_' aria-label=\"Code postal\">Code postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[zip]\" id=\"ff_175_address_contact_zip_\" class=\"ff-el-form-control\" placeholder=\"Code Postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_city_' id='label_ff_175_address_contact_city_' aria-label=\"Ville\">Ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_contact[city]\" id=\"ff_175_address_contact_city_\" class=\"ff-el-form-control\" placeholder=\"Ville\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_address_contact_country_' id='label_ff_175_address_contact_country_' aria-label=\"Pays\">Pays<\/label><\/div><div class='ff-el-input--content'><select name=\"address_contact[country]\" id=\"ff_175_address_contact_country_\" class=\"ff-el-form-control\" placeholder=\"S\u00e9lectionner le pays\" data-key_name=\"country\" aria-invalid='false' aria-required=true><option value=''>S\u00e9lectionner le pays<\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albanien<\/option><option value='DZ' >Algerien<\/option><option value='AS' >Amerikanisch-Samoa<\/option><option value='VI' >Amerikanische Jungferninseln<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarktika<\/option><option value='AG' >Antigua und Barbuda<\/option><option value='AR' >Argentinien<\/option><option value='AM' >Armenien<\/option><option value='AW' >Aruba<\/option><option value='AZ' >Aserbaidschan<\/option><option value='AU' >Australien<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesch<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' selected>Belgien<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivien<\/option><option value='BQ' >Bonaire, Sint Eustatius und Saba<\/option><option value='BA' >Bosnien und Herzegowina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvetinsel<\/option><option value='BR' >Brasilien<\/option><option value='VG' >Britische Jungferninseln<\/option><option value='IO' >Britisches Territorium im Indischen Ozean<\/option><option value='BN' >Brunei<\/option><option value='BG' >Bulgarien<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CK' >Cookinseln<\/option><option value='CR' >Costa Rica<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CD' >Democratic Republic of the Congo (Kinshasa)<\/option><option value='DE' >Deutschland<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominikanische Republik<\/option><option value='DJ' >Dschibuti<\/option><option value='DK' >D\u00e4nemark<\/option><option value='EC' >Ecuador<\/option><option value='SV' >El Salvador<\/option><option value='CI' >Elfenbeink\u00fcste<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='FK' >Falklandinseln<\/option><option value='FJ' >Fidschi<\/option><option value='FI' >Finnland<\/option><option value='FR' >Frankreich<\/option><option value='GF' >Franz\u00f6sisch-Guayana<\/option><option value='PF' >Franz\u00f6sisch-Polynesien<\/option><option value='TF' >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value='FO' >F\u00e4r\u00f6er<\/option><option value='GA' >Gabun<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgien<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griechenland<\/option><option value='GL' >Gr\u00f6nland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard und McDonaldinseln<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hongkong<\/option><option value='IN' >Indien<\/option><option value='ID' >Indonesien<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irland<\/option><option value='IS' >Island<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italien<\/option><option value='JM' >Jamaika<\/option><option value='JP' >Japan<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanien<\/option><option value='KY' >Kaimaninseln<\/option><option value='KH' >Kambodscha<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='KZ' >Kasachstan<\/option><option value='QA' >Katar<\/option><option value='KE' >Kenia<\/option><option value='KG' >Kirgisistan<\/option><option value='KI' >Kiribati<\/option><option value='CC' >Kokosinseln (Keelinginseln)<\/option><option value='CO' >Kolumbien<\/option><option value='KM' >Komoren<\/option><option value='XK' >Kosovo<\/option><option value='HR' >Kroatien<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwait<\/option><option value='LA' >Laos<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libyen<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litauen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macao, China<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Malediven<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshallinseln<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauretanien<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexiko<\/option><option value='FM' >Mikronesien<\/option><option value='MD' >Moldau<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolei<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mosambik<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NC' >Neukaledonien<\/option><option value='NZ' >Neuseeland<\/option><option value='NI' >Nicaragua<\/option><option value='NL' >Niederlande<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='KP' >Nordkorea<\/option><option value='NF' >Norfolkinsel<\/option><option value='MK' >North Macedonia<\/option><option value='NO' >Norwegen<\/option><option value='MP' >N\u00f6rdliche Marianen<\/option><option value='OM' >Oman<\/option><option value='TL' >Osttimor<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Pal\u00e4stinensische Autonomiegebiete<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua-Neuguinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippinen<\/option><option value='PN' >Pitcairninseln<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='CG' >Republic of the Congo (Brazzaville)<\/option><option value='RW' >Ruanda<\/option><option value='RO' >Rum\u00e4nien<\/option><option value='RU' >Russland<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SX' >Saint Martin (niederl\u00e4ndischer Teil)<\/option><option value='PM' >Saint-Pierre und Miquelon<\/option><option value='SB' >Salomonen<\/option><option value='ZM' >Sambia<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi-Arabien<\/option><option value='SE' >Schweden<\/option><option value='CH' >Schweiz<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbien<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='ZW' >Simbabwe<\/option><option value='SG' >Singapur<\/option><option value='SK' >Slowakei<\/option><option value='SI' >Slowenien<\/option><option value='SO' >Somalia<\/option><option value='ES' >Spanien<\/option><option value='SJ' >Spitzbergen und Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SH' >St. Helena<\/option><option value='KN' >St. Kitts und Nevis<\/option><option value='LC' >St. Lucia<\/option><option value='MF' >St. Martin (Frankreich)<\/option><option value='VC' >St. Vincent und die Grenadinen<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SY' >Syrien<\/option><option value='ZA' >S\u00fcdafrika<\/option><option value='GS' >S\u00fcdgeorgien\/Sandwichinseln<\/option><option value='KR' >S\u00fcdkorea<\/option><option value='SS' >S\u00fcdsudan<\/option><option value='TJ' >Tadschikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tansania<\/option><option value='TH' >Thailand<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad und Tobago<\/option><option value='TD' >Tschad<\/option><option value='CZ' >Tschechien<\/option><option value='TN' >Tunesien<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- und Caicosinseln<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='HU' >Ungarn<\/option><option value='UM' >United States (US) Minor Outlying Islands<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Usbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vatikanstadt<\/option><option value='VE' >Venezuela<\/option><option value='AE' >Vereinigte Arabische Emirate<\/option><option value='US' >Vereinigte Staaten von Amerika (USA)<\/option><option value='GB' >Vereinigtes K\u00f6nigreich<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis und Futuna<\/option><option value='CX' >Weihnachtsinsel<\/option><option value='EH' >Westsahara<\/option><option value='CF' >Zentralafrikanische Republik<\/option><option value='CY' >Zypern<\/option><option value='EG' >\u00c4gypten<\/option><option value='GQ' >\u00c4quatorialguinea<\/option><option value='ET' >\u00c4thiopien<\/option><option value='AX' >\u00c5landinseln<\/option><option value='AT' >\u00d6sterreich<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Pr\u00e9c\u00e9dent'>Pr\u00e9c\u00e9dent<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Suivant'>Suivant<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-175_2\" ><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-175_3\" ><h3 class='ff-el-section-title'>Votre patrimoine<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_4\" ><h3 style=\"text-align: center;text-transform:uppercase;color:var(--wpem-second-color)\">Non-propri\u00e9taire<\/h3>\n<p style=\"text-align: center;font-size: .85em\">Cette formule s\u2019adresse aux personnes<b>\u00a0int\u00e9ress\u00e9es par la for\u00eat<\/b>\u00a0sans \u00eatre propri\u00e9taires forestiers. Elle permet de soutenir les actions de la SRFB et de profiter de nos publications et activit\u00e9s de formation au tarif membre.<\/p><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_5\" ><h3 style=\"text-align: center;text-transform:uppercase;color:var(--wpem-second-color)\">Base<\/h3>\n<p style=\"text-align: center;font-size: .85em\">R\u00e9serv\u00e9e aux <strong>propri\u00e9taires forestiers<\/strong> souhaitant rejoindre la SRFB. Elle donne acc\u00e8s \u00e0 l\u2019ensemble de nos services : conseils techniques, informations r\u00e9glementaires, formation personnalis\u00e9es, revues.<\/p><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_6\" ><h3 style=\"text-align: center;text-transform:uppercase;color:var(--wpem-second-color)\">Premium<\/h3>\n<p style=\"text-align: center;font-size: .85em\">Cotisation suppl\u00e9mentaire \u00e0 la cotisation de base. Elle offre des r\u00e9ductions suppl\u00e9mentaires sur nos services et inclut l\u2019<b>acc\u00e8s au service RC For\u00eat<\/b>, une\u00a0<b>assurance collective<\/b>\u00a0en responsabilit\u00e9 civile couvrant le propri\u00e9taire en cas de d\u00e9g\u00e2ts caus\u00e9s \u00e0 des tiers par la chute d\u2019un arbre ou d\u2019une branche provenant de sa propri\u00e9t\u00e9.<\/p><\/div><\/div><\/div><div class='ff-el-group center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Type de cotisation\">Type de cotisation<\/label><div class=\"ff-el-tooltip\" data-content=\"Choisissez le type de cotisation que vous souhaitez souscrire.\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='cotisation_4a72ef0563b77ac030a4048237acec8d'><input  type=\"radio\" name=\"cotisation\" data-name=\"cotisation\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no-proprio\"  id='cotisation_4a72ef0563b77ac030a4048237acec8d' aria-label='Non-propri\u00e9taire' aria-invalid='false' aria-required=true> <span>Non-propri\u00e9taire<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='cotisation_90a9fd95ab85d2b8956b1becbcb84373'><input  type=\"radio\" name=\"cotisation\" data-name=\"cotisation\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"base\"  id='cotisation_90a9fd95ab85d2b8956b1becbcb84373' aria-label='Base' aria-invalid='false' aria-required=true> <span>Base<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='cotisation_6936a02a5450cedd99a7ac3cad06b2bb'><input  type=\"radio\" name=\"cotisation\" data-name=\"cotisation\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"premium\"  id='cotisation_6936a02a5450cedd99a7ac3cad06b2bb' aria-label='Premium' aria-invalid='false' aria-required=true> <span>Premium<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions tip-box' tabindex='-1' data-name=\"custom_html-175_7\" ><h3 style=\"text-align: center\">Les hectares \u00e0 assurer<\/h3>\n<p style=\"text-align: center\">\u00c9tant donn\u00e9 votre demande d\u2019adh\u00e9sion \u00e0 la cotisation Premium, nous vous invitons \u00e0 nous transmettre la d\u00e9claration de vos parcelles cadastrales sous forme de fichier Excel. <br \/><em>(possibilit\u00e9 de t\u00e9l\u00e9charger la liste de vos parcelles depuis votre <a href=\"https:\/\/www.minfin.fgov.be\/\" target=\"_blank\" rel=\"noopener\">espace MyMinfin<\/a>)<\/em><\/p><\/div><div class='ff-el-group has-conditions center ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Encoder mon patrimoine\">Encoder mon patrimoine<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='encodage_3fe072d21703f4f0c5b881cb20c7b275'><input  type=\"radio\" name=\"encodage\" data-name=\"encodage\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Manuellement\"  id='encodage_3fe072d21703f4f0c5b881cb20c7b275' aria-label='Manuellement' aria-invalid='false' aria-required=true> <span>Manuellement<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='encodage_e1d36e928645be69d72485c555b87a83'><input  type=\"radio\" name=\"encodage\" data-name=\"encodage\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Via un fichier Excel\"  id='encodage_e1d36e928645be69d72485c555b87a83' aria-label='Via un fichier Excel' aria-invalid='false' aria-required=true> <span>Via un fichier Excel<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_1 pad-25 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group ff-el-form-hide_label  ff-dropzone'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_175_file_total_hectare_1' id='label_ff_175_file_total_hectare_1' aria-label=\"T\u00e9l\u00e9chargement d\u2019un fichier hectare\">T\u00e9l\u00e9chargement d\u2019un fichier hectare<\/label><\/div><div class='ff-el-input--content'><label for='ff_175_file_total_hectare_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>D\u00e9posez la liste des parcelles<\/span> <input type=\"file\" name=\"file_total_hectare\" id=\"ff_175_file_total_hectare_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file_total_hectare\" multiple=\"1\"  aria-invalid='false' aria-required=true><\/label><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_8\" ><p style=\"text-align: center\"><em>Utilisez ce gabarit de fichier Excel (<a href=\"https:\/\/srfb.be\/wp-content\/uploads\/2025\/12\/Gabarit-Devenir-membre-Premium.xlsx\">lien t\u00e9l\u00e9chargeable<\/a>) pour nous fournir une liste vos parcelles compl\u00e8te.<\/em><\/p><\/div><\/div><\/div>        <div class=\"ff-repeater-container ff-el-repeater  ff_columns_total_3 all-parcelles-container\" data-name=\"parcelles_assurances\" data-root_name=\"parcelles_assurances\" data-type=\"repeater_container\" >\n            <div class='ff-el-input--label asterisk-right'><label aria-label='Listez vos parcelles' for=''>Listez vos parcelles<\/label><\/div>            <div class='ff-el-input--content'>\n                <div role=\"list\" aria-label=\"\" data-max_repeat=\"\" data-root_name=\"parcelles_assurances\" class=\"ff_repeater_container_list ff_flexible_list\">\n                    <div class=\"ff_repeater_body\" role=\"rowgroup\">\n                        <div class=\"ff_repeater_cont_row\" role=\"row\">\n                            <div class='ff-t-cell ff-t-column-1' style='flex-basis: 33%;'>\n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_0' id='label_ff_175_parcelles_assurances_0' aria-label=\"Commune\/INS\">Commune\/INS<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][0]\" class=\"ff-el-form-control\" placeholder=\"Gembloux 12345\" data-name=\"parcelles_assurances_0_0\" aria-label=\"repeater level 1 and field Commune\/INS\" id=\"ff_175_parcelles_assurances_0\" data-repeater_index=\"0\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[0]\" data-condition_field_name=\"parcelles_assurances_condition_0_0\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                \n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_1' id='label_ff_175_parcelles_assurances_1' aria-label=\"Exposant\">Exposant<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][1]\" class=\"ff-el-form-control\" placeholder=\"A\" data-name=\"parcelles_assurances_1_0\" aria-label=\"repeater level 1 and field Exposant\" id=\"ff_175_parcelles_assurances_1\" data-repeater_index=\"1\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[1]\" data-condition_field_name=\"parcelles_assurances_condition_0_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                \n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_2' id='label_ff_175_parcelles_assurances_2' aria-label=\"Puissance\">Puissance<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][2]\" class=\"ff-el-form-control\" placeholder=\"123\" data-name=\"parcelles_assurances_2_0\" aria-label=\"repeater level 1 and field Puissance\" id=\"ff_175_parcelles_assurances_2\" data-repeater_index=\"2\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[2]\" data-condition_field_name=\"parcelles_assurances_condition_0_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                <\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33%;'>\n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_3' id='label_ff_175_parcelles_assurances_3' aria-label=\"Division\">Division<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][3]\" class=\"ff-el-form-control\" placeholder=\"NAMUR 4 DIV\/GEMBLOUX\/\" data-name=\"parcelles_assurances_3_0\" aria-label=\"repeater level 1 and field Division\" id=\"ff_175_parcelles_assurances_3\" data-repeater_index=\"3\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[3]\" data-condition_field_name=\"parcelles_assurances_condition_1_0\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                \n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_4' id='label_ff_175_parcelles_assurances_4' aria-label=\"Radical\">Radical<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][4]\" class=\"ff-el-form-control\" placeholder=\"1234\" data-name=\"parcelles_assurances_4_0\" aria-label=\"repeater level 1 and field Radical\" id=\"ff_175_parcelles_assurances_4\" data-repeater_index=\"4\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[4]\" data-condition_field_name=\"parcelles_assurances_condition_1_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                \n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_5' id='label_ff_175_parcelles_assurances_5' aria-label=\"Type\">Type<\/label><\/div><div class='ff-el-input--content'><select name=\"parcelles_assurances[0][5]\" id=\"ff_175_parcelles_assurances_5\" class=\"ff-el-form-control\" data-name=\"parcelles_assurances_5_0\" aria-label=\"repeater level 1 and field Type\" data-repeater_index=\"5\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[5]\" data-condition_field_name=\"parcelles_assurances_condition_1_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_175_parcelles_assurances_5\"><option value=\"\">&#8211; S\u00e9lectionnez un type &#8211;<\/option><option value=\"For\u00eat\"  >For\u00eat<\/option><option value=\"Agricole\"  >Agricole<\/option><option value=\"Agricole arbor\u00e9\"  >Agricole arbor\u00e9<\/option><\/select><\/div><\/div>                <\/div>\n                <\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33%;'>\n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_6' id='label_ff_175_parcelles_assurances_6' aria-label=\"Section\">Section<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][6]\" class=\"ff-el-form-control\" placeholder=\"A\" data-name=\"parcelles_assurances_6_0\" aria-label=\"repeater level 1 and field Section\" id=\"ff_175_parcelles_assurances_6\" data-repeater_index=\"6\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[6]\" data-condition_field_name=\"parcelles_assurances_condition_2_0\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                \n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_7' id='label_ff_175_parcelles_assurances_7' aria-label=\"Bis\">Bis<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"parcelles_assurances[0][7]\" class=\"ff-el-form-control\" placeholder=\"00\" data-name=\"parcelles_assurances_7_0\" aria-label=\"repeater level 1 and field Bis\" id=\"ff_175_parcelles_assurances_7\" data-repeater_index=\"7\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[7]\" data-condition_field_name=\"parcelles_assurances_condition_2_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                <\/div>\n                \n                <div class=\"ff_repeater_cell\" role=\"cell\">\n<!--                    <div class=\"--><!--\">-->\n<!--                        <label for=\"--><!--\">-->\n<!--                            --><!--                        <\/label>-->\n<!--                    <\/div>-->\n            \n                    <div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_175_parcelles_assurances_8' id='label_ff_175_parcelles_assurances_8' aria-label=\"Nombre d&#039;hectare\">Nombre d&rsquo;hectare<\/label><div class=\"ff-el-tooltip\" data-content=\"Format avec virgule : 1,25\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"parcelles_assurances[0][8]\" id=\"ff_175_parcelles_assurances_8\" class=\"ff-el-form-control number-hectare\" placeholder=\"0\" data-name=\"parcelles_assurances_8_0\" aria-label=\"repeater level 1 and field Nombre d&#039;hectare\" data-repeater_index=\"8\" data-type=\"repeater_container\" data-error_index=\"parcelles_assurances[8]\" data-condition_field_name=\"parcelles_assurances_condition_2_2\" inputmode=\"numeric\" step=\"any\" min=\"0\" aria-valuemin=\"0\"  aria-invalid=\"false\" aria-required=false><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">ha<\/span><\/div><\/div><\/div><\/div>                <\/div>\n                <\/div><div class='ff_repeater_cell repeat_btn' role='cell' style='flex-basis: 1%;'><div class=\"ff-el-repeat-buttons-list js-container-repeat-buttons\"><span role=\"button\" aria-label=\"add repeater\" class=\"repeat-plus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-86 0 0 86-42 0 0-86-86 0 0-42 86 0 0-86 42 0 0 86 86 0z\"><\/path><\/svg><\/span><span role=\"button\" aria-label=\"remove repeater\" class=\"repeat-minus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-214 0 0-42 214 0z\"\"><\/path><\/svg><\/span><\/div><\/div>                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/div>\n        <\/div>\n        <div class='ff-el-group  ff-custom_html has-conditions tip-box' tabindex='-1' data-name=\"custom_html-175_9\" ><h3 style=\"text-align: center\">L&rsquo;assurance collective <a href=\"\/assurances\/\" target=\"_blank\" rel=\"noopener\">RC FOR\u00caT<\/a><\/h3>\n<p style=\"text-align: center\">Pour b\u00e9n\u00e9ficier de l&rsquo;assurance collective pour vos for\u00eats, bois, peupleraies, haies, arbres isol\u00e9s ou en alignements, s\u00e9lectionnez la <strong>cotisation premium<\/strong> ci-dessus.<\/p><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_1 pad-25 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Terms and Conditions: D\u00e9clare avoir pris connaissance du texte de la police collective RC For\u00eat et en accepter toutes les conditions g\u00e9n\u00e9rales et modalit\u00e9s de couvertures ; Contains 2 links. Use tab navigation to review.' class='ff-el-form-check-label ff_tc_label' for=terms_n_conditions_4dbf9202053c55e8b3b7e735370852b6><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms_n_conditions\" class=\"ff-el-form-check-input\" data-name=\"terms_n_conditions\" id=\"terms_n_conditions_4dbf9202053c55e8b3b7e735370852b6\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>D\u00e9clare avoir pris connaissance du texte de la police collective RC For\u00eat et en accepter toutes les <a href=\"https:\/\/srfb.be\/wp-content\/uploads\/2021\/05\/VIVIUM_ConditionsGenerales_FR.pdf\" target=\"_blank\" rel=\"noopener\">conditions g\u00e9n\u00e9rales<\/a> et <a href=\"https:\/\/srfb.be\/wp-content\/uploads\/2025\/11\/2.-MODALITES_RC_Foret_2026.pdf\" target=\"_blank\" rel=\"noopener\">modalit\u00e9s de couvertures<\/a> ;<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='D\u00e9clare avoir mentionn\u00e9 ci-dessus la superficie totale de mes propri\u00e9t\u00e9s bois\u00e9es en Belgique. Cette d\u00e9claration constitue un \u00e9l\u00e9ment essentiel de la police, sous peine de d\u00e9ch\u00e9ance ;' class='ff-el-form-check-label ff_tc_label' for=terms_n_parcelles_dc2d26705c3f9c024cd4055f94287aeb><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms_n_parcelles\" class=\"ff-el-form-check-input\" data-name=\"terms_n_parcelles\" id=\"terms_n_parcelles_dc2d26705c3f9c024cd4055f94287aeb\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>D\u00e9clare avoir mentionn\u00e9 ci-dessus la superficie totale de mes propri\u00e9t\u00e9s bois\u00e9es en Belgique. Cette d\u00e9claration constitue un \u00e9l\u00e9ment essentiel de la police, sous peine de d\u00e9ch\u00e9ance ;<\/p><\/div><\/label><\/div><\/div><\/div><\/div><div class='ff-el-group center pad-25 ff_list_buttons'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Je souhaite devenir aussi membre des syndicats de propri\u00e9taires ruraux...\">Je souhaite devenir aussi membre des syndicats de propri\u00e9taires ruraux&#8230;<\/label><div class=\"ff-el-tooltip\" data-content=\"Plusieurs choix possibles (optionnel)\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='membre_base_649b782a271709d5214e47b2e515a783'><input  type=\"checkbox\" name=\"membre_base[]\" data-name=\"membre_base\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"NTF\" data-calc_value=\"1\"  id='membre_base_649b782a271709d5214e47b2e515a783' aria-label='NTF' aria-invalid='false' aria-required=false> <span>NTF<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='membre_base_f0bd27cce764ea15b75abf306507b459'><input  type=\"checkbox\" name=\"membre_base[]\" data-name=\"membre_base\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"LV\" data-calc_value=\"1\"  id='membre_base_f0bd27cce764ea15b75abf306507b459' aria-label='LV' aria-invalid='false' aria-required=false> <span>LV<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Pr\u00e9c\u00e9dent'>Pr\u00e9c\u00e9dent<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Suivant'>Suivant<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-175_10\" ><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-175_11\" ><h3 class='ff-el-section-title'>Divers<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Je deviens membre gr\u00e2ce...\">Je deviens membre gr\u00e2ce&#8230;<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_dca1f106b145319f792b92dab8ecaa5d'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"au bouche \u00e0 oreille\"  id='communication_dca1f106b145319f792b92dab8ecaa5d' aria-label='au bouche \u00e0 oreille' aria-invalid='false' aria-required=false> <span>au bouche \u00e0 oreille<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_f8b745438875d8ef4700461eb8a0cf6d'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u00e0 la newsletter\"  id='communication_f8b745438875d8ef4700461eb8a0cf6d' aria-label='\u00e0 la newsletter' aria-invalid='false' aria-required=false> <span>\u00e0 la newsletter<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_7b0b895c0883c6f92f2c2e89f0d16d8c'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"au site internet\"  id='communication_7b0b895c0883c6f92f2c2e89f0d16d8c' aria-label='au site internet' aria-invalid='false' aria-required=false> <span>au site internet<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='communication_1757e5c952a92506fe086929914f9d80'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"\u00e0 la participation \u00e0 une journ\u00e9e de terrain\/formation\"  id='communication_1757e5c952a92506fe086929914f9d80' aria-label='\u00e0 la participation \u00e0 une journ\u00e9e de terrain\/formation' aria-invalid='false' aria-required=false> <span>\u00e0 la participation \u00e0 une journ\u00e9e de terrain\/formation<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label ff-other-option' for='communication_6bdfe7f45ce2960012c0f18f09cc75d5'><input  type=\"checkbox\" name=\"communication[]\" data-name=\"communication\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"__ff_other_communication__\"  id='communication_6bdfe7f45ce2960012c0f18f09cc75d5' aria-label='autres' aria-invalid='false' aria-required=false> <span>autres<\/span><\/label><\/div><div class='ff-other-input-wrapper' style='display: none; margin-top: 8px;' data-field='communication'><input type='text' name='communication__ff_other_input__' class='ff-el-form-control' placeholder='Sp\u00e9cifiez votre raison...' value=''><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_12\" ><p><em>En devenant membre de la SRFB, vous recevrez automatiquement notre newsletter, qui vous permet de rester inform\u00e9(e) de nos activit\u00e9s de formation et des informations relatives \u00e0 la vie de l\u2019association.<\/em><br \/><em>Vous pouvez \u00e0 tout moment vous d\u00e9sinscrire de ces communications.<\/em><\/p><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-175_13\" ><p><i>En devenant membre, vous affirmez avoir lu et acceptez la <a href=\"https:\/\/srfb.be\/declaration-de-confidentialite\" target=\"_blank\" rel=\"noopener\">d\u00e9claration de confidentialit\u00e9<\/a>\u00a0et \u00eates conscient d&rsquo;avoir le droit \u00e0 tout moment de vous r\u00e9tracter en faisant part de votre d\u00e9cision \u00e0 la SRFB Boulevard Bischoffsheim, 1-8 \u00e0 1000 Bruxelles ou par mail \u00e0\u00a0<a id=\"OWAb79d679b-bcaa-5714-6911-22a5d7fae149\" class=\"x_OWAAutoLink\" title=\"mailto:secretariat@srfb-kbbm.be\" href=\"mailto:secretariat@srfb-kbbm.be\" data-linkindex=\"2\">secretariat@srfb-kbbm.be<\/a><\/i><\/p><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper ff_submit_btn_wrapper_custom'><button class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" type=\"submit\" name=\"custom_submit_button-175_14\" data-name=\"custom_submit_button-175_14\"  aria-label=\"Devenir membre\">Devenir membre<\/button><style>form.fluent_form_175 .ff-btn-submit { background-color: #1a7efb; color: #ffffff; }<\/style><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell ff-t-column-1\"><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Pr\u00e9c\u00e9dent'>Pr\u00e9c\u00e9dent<\/button><\/div><\/div>\n            <div class=\"ff-t-cell ff-t-column-2\">\n       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