{"id":2471,"date":"2026-08-07T08:28:57","date_gmt":"2026-08-07T12:28:57","guid":{"rendered":"https:\/\/ha-mtl.org\/faire-un-don\/"},"modified":"2026-08-12T16:56:13","modified_gmt":"2026-08-12T20:56:13","slug":"faire-un-don","status":"publish","type":"page","link":"https:\/\/ha-mtl.org\/fr\/faire-un-don\/","title":{"rendered":"Faire un don"},"content":{"rendered":"<div class=\"et_pb_section_0 et_pb_section et_section_regular et_flex_section\">\n<div class=\"et_pb_row_0 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_0 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_16_24 et_flex_column_16_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_image_0 et_pb_image et_pb_image_sticky_phone et_animated et_pb_module et_flex_module en-t\u00eate de page\"><span class=\"et_pb_image_wrap\"><img decoding=\"async\" src=\"https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/06\/title-board.jpg\" width=\"2000\" height=\"1000\" srcset=\"https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/06\/title-board.jpg 2000w, https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/06\/title-board-1280x640.jpg 1280w, https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/06\/title-board-980x490.jpg 980w, https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/06\/title-board-480x240.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) and (max-width: 1280px) 1280px, (min-width: 1281px) 2000px, 100vw\" class=\"wp-image-1673\" \/><\/span><\/div>\n<\/div>\n\n<div class=\"et_pb_column_1 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_8_24 et_flex_column_8_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_cta_0 et_pb_promo et_pb_bg_layout_dark et_animated et_pb_module et_flex_module\"><div class=\"et_pb_promo_description\"><h1 class=\"et_pb_module_header\">Faire un don<\/h1><div class=\"et_pb_promo_content\"><p>Votre don contribue \u00e0 financer un enseignement d'exception, des bourses d'\u00e9tudes indispensables et des exp\u00e9riences p\u00e9dagogiques enrichissantes. Rejoignez-nous pour assurer un avenir solide et dynamique \u00e0 nos \u00e9l\u00e8ves et \u00e0 notre communaut\u00e9. <\/p>\n<\/div><\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_1 et_pb_section et_section_regular et_flex_section\" id=\"visit\">\n<div class=\"et_pb_row_1 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_2 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_code_0 et_pb_code et_pb_module\"><div class=\"et_pb_code_inner\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_21' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_21' id='gform_21'  action='\/fr\/wp-json\/wp\/v2\/pages\/2471#gf_21' data-formid='21' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_21_36\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_36' id='input_21_36' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Faire un don' \/><\/div><\/div><div id=\"field_21_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations sur les dons<\/h3><\/div><div id=\"field_21_25\" class=\"gfield gfield--type-product gfield--input-type-price gfield--width-full gfield_price gfield_price_21_25 gfield_product_21_25 gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_25'><span class='gform-field-label__text'>Quel montant souhaitez-vous donner ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_25' id='input_21_25' type='text' value='' class='medium ginput_amount'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><fieldset id=\"field_21_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je souhaiterais affecter mon don au fonds suivant :<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_26'>\n\t\t\t<div class='gchoice gchoice_21_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Campagne annuelle'  id='choice_21_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_0' id='label_21_26_0' class='gform-field-label gform-field-label--type-inline'><h5>Campagne annuelle<\/h5>C\u00e9l\u00e8bre le c\u0153ur de l\u2019Acad\u00e9mie H\u00e9bra\u00efque : l\u2019exp\u00e9rience exceptionnelle de l\u2019AH, tant en classe qu\u2019\u00e0 l\u2019ext\u00e9rieur.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Campagne Hakarat Hatov des anciens'  id='choice_21_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_1' id='label_21_26_1' class='gform-field-label gform-field-label--type-inline'><h5>Campagne Hakarat Hatov des anciens<\/h5>Une occasion pour les anciens de redonner avec gratitude et d\u2019aider \u00e0 renforcer l\u2019\u00e9cole qui a jou\u00e9 un r\u00f4le important dans leur parcours.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='HAPA'  id='choice_21_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_2' id='label_21_26_2' class='gform-field-label gform-field-label--type-inline'><h5>HAPA | Association des parents de l\u2019Acad\u00e9mie H\u00e9bra\u00efque<\/h5>Soutenez l\u2019Association des parents de l\u2019Acad\u00e9mie H\u00e9bra\u00efque ainsi que les programmes, \u00e9v\u00e9nements et initiatives qui enrichissent la vie scolaire et renforcent notre communaut\u00e9.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Lab d\u2019excellence'  id='choice_21_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_3' id='label_21_26_3' class='gform-field-label gform-field-label--type-inline'><h5>Lab d\u2019excellence<\/h5>Aidez les \u00e9l\u00e8ves ayant des besoins d\u2019apprentissage divers \u00e0 s\u2019\u00e9panouir en offrant un soutien p\u00e9dagogique sp\u00e9cialis\u00e9, du personnel d\u00e9vou\u00e9 et des ressources \u00e9ducatives adapt\u00e9es.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_26_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Fonds Chessed'  id='choice_21_26_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_4' id='label_21_26_4' class='gform-field-label gform-field-label--type-inline'><h5>Fonds Chessed<\/h5>Aidez \u00e0 garantir que les \u00e9l\u00e8ves dans le besoin aient acc\u00e8s aux articles scolaires essentiels, y compris les uniformes, les fournitures scolaires et les d\u00eeners chauds nutritifs.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_26_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Fonds d\u2019athl\u00e9tisme'  id='choice_21_26_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_5' id='label_21_26_5' class='gform-field-label gform-field-label--type-inline'><h5>Fonds d\u2019athl\u00e9tisme<\/h5>Soutenez nos \u00e9l\u00e8ves-athl\u00e8tes et aidez \u00e0 faire cro\u00eetre le programme d\u2019athl\u00e9tisme de l\u2019AH gr\u00e2ce \u00e0 une programmation \u00e9largie, des entra\u00eenements, des tournois et des occasions de comp\u00e9tition au-del\u00e0 de notre \u00e9cole.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_26_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Fonds comm\u00e9moratifs'  id='choice_21_26_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_26_6' id='label_21_26_6' class='gform-field-label gform-field-label--type-inline'><h5>Fonds comm\u00e9moratifs<\/h5><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_3\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_3'><span class='gform-field-label__text'>Choisissez un fonds comm\u00e9moratif<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_21_3' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Veuillez choisir --<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Jessica Assayag \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Jessica Assayag \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Simon Bouganim \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Simon Bouganim \u05d6\u201d\u05dc<\/option><option value='Fonds de bourses d&#039;\u00e9tudes \u00ab Nina Cass \u00bb (z&quot;l)' >Fonds de bourses d&#039;\u00e9tudes \u00ab Nina Cass \u00bb (z&quot;l)<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire d\u2019Herman Davis \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire d\u2019Herman Davis \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Lynn Eltes \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Lynn Eltes \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Molly Erdstein \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Molly Erdstein \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Eva Felder \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Eva Felder \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif du sergent-chef Maoz Fenigstein \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif du sergent-chef Maoz Fenigstein \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Benjamin Freedman \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Benjamin Freedman \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Oren Grunbaum \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Oren Grunbaum \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Lajos Guttman \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Lajos Guttman \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Sarafina Haim \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Sarafina Haim \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Moritz Hasen \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Moritz Hasen \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Barbara Hayes \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Barbara Hayes \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif du rabbin Joseph Deitcher \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif du rabbin Joseph Deitcher \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Pnina Kizelnik \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Pnina Kizelnik \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Moshe Hasenfratz \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Moshe Hasenfratz \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Violet Horvath \u05d6&quot;\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Violet Horvath \u05d6&quot;\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Mirko Kohn \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Mirko Kohn \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de David Lehrer \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de David Lehrer \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Ludvig Lehrer \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Ludvig Lehrer \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Samuel Lesser \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Samuel Lesser \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Jo\u00eblle Lewandowski \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Jo\u00eblle Lewandowski \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Joseph Liber \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Joseph Liber \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Pearl Ludvig \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Pearl Ludvig \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Ben &amp; Rose Nadler \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Ben &amp; Rose Nadler \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Herbert Pastor \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Herbert Pastor \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Miriam Peerless \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Miriam Peerless \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Marty Penn \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Marty Penn \u05d6\u201d\u05dc<\/option><option value='Fonds de bourses d&#039;\u00e9tudes Moshe Pollack \u05d6\u201d\u05dc' >Fonds de bourses d&#039;\u00e9tudes Moshe Pollack \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif David Reiss \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif David Reiss \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire d\u2019Estelle Rose \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire d\u2019Estelle Rose \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Jack Rosen \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Jack Rosen \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Schloma Rosenzweig \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Schloma Rosenzweig \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Reuven Salit \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Reuven Salit \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Riva Schwartz \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif Riva Schwartz \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif J. Steinwald \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif J. Steinwald \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif Jacob Suissa \u05d6&quot;\u05dc' >Fonds comm\u00e9moratif Jacob Suissa \u05d6&quot;\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Bella Taichman \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Bella Taichman \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Danielle Zagury \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Danielle Zagury \u05d6\u201d\u05dc<\/option><option value='Fonds comm\u00e9moratif en m\u00e9moire de Leslie Zukor \u05d6\u201d\u05dc' >Fonds comm\u00e9moratif en m\u00e9moire de Leslie Zukor \u05d6\u201d\u05dc<\/option><\/select><\/div><\/div><div id=\"field_21_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_24'><span class='gform-field-label__text'>Commentaires (facultatif)<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_21_24' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_21_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations sur les donateurs<\/h3><\/div><fieldset id=\"field_21_9\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_9'>\n                            \n                            <span id='input_21_9_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_9.3' id='input_21_9_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_9_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_9_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_9.6' id='input_21_9_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_9_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_21_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_10'><span class='gform-field-label__text'>Affiliation<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_21_10' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Veuillez choisir --<\/option><option value='Alumni' >Alumni<\/option><option value='Current parent' >Current parent<\/option><option value='Incoming parent' >Incoming parent<\/option><option value='Former parent' >Former parent<\/option><option value='Staff \/ Teacher' >Staff \/ Teacher<\/option><option value='Grandparent' >Grandparent<\/option><option value='Parent of alumni' >Parent of alumni<\/option><option value='Friend of the school' >Friend of the school<\/option><\/select><\/div><\/div><fieldset id=\"field_21_12\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_21_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_21_12_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_12_1' id='input_21_12_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_21_12_2_container' >\n                                        <input type='text' name='input_12.2' id='input_21_12_2' value=''     aria-required='false'   \/>\n                                        <label for='input_21_12_2' id='input_21_12_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_21_12_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_12_3' id='input_21_12_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_21_12_4' value=''      aria-required='true'    \/>\n                                        <label for='input_21_12_4' id='input_21_12_4_label' class='gform-field-label gform-field-label--type-sub '>\u00c9tat \/ Province \/ R\u00e9gion<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_21_12_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_12_5' id='input_21_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Code postal<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_21_12_6_container' >\n                                        <select name='input_12.6' id='input_21_12_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='ZA' >Afrique du Sud<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='DE' >Allemagne<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua-et-Barbuda<\/option><option value='SA' >Arabie Saoudite<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerba\u00efdjan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahre\u00efn<\/option><option value='BD' >Bangladesh<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BJ' >B\u00e9nin<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie-Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BR' >Br\u00e9sil<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='CV' >Cap-Vert<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CY' >Chypre<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='CG' >Congo<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d\u2019Ivoire<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='EG' >\u00c9gypte<\/option><option value='AE' >\u00c9mirats arabes unis<\/option><option value='EC' >\u00c9quateur<\/option><option value='ER' >\u00c9rythr\u00e9e<\/option><option value='ES' >Espagne<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='PS' >\u00c9tat palestinien<\/option><option value='US' >\u00c9tats-Unis<\/option><option value='ET' >\u00c9thiopie<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GE' >G\u00e9orgie<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GD' >Grenade<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernesey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='GF' >Guin\u00e9e Fran\u00e7aise<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GY' >Guyane<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='IM' >\u00cele de Man<\/option><option value='CX' >\u00cele de No\u00ebl<\/option><option value='NF' >\u00cele de Norfolk<\/option><option value='MU' >\u00cele Maurice<\/option><option value='AX' >Iles Aland<\/option><option value='KY' >\u00celes Cayman<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CK' >\u00celes Cook<\/option><option value='FK' >\u00celes Falkland<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='MP' >\u00celes Mariannes du Nord<\/option><option value='MH' >\u00celes Marshall<\/option><option value='UM' >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><option value='SB' >\u00celes Salomon<\/option><option value='TC' >\u00celes Turques-et-Ca\u00efques<\/option><option value='VI' >\u00celes Vierges am\u00e9ricaines<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlande<\/option><option value='IS' >Islande<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KG' >Kirghizistan<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kowe\u00eft<\/option><option value='BB' >La Barbade<\/option><option value='RE' >La R\u00e9union<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MY' >Malaisie<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MA' >Maroc<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritanie<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='ME' >Mont\u00e9n\u00e9gro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NP' >N\u00e9pal<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niue<\/option><option value='MK' >North Macedonia<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='NC' >Nouvelle Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='OM' >Oman<\/option><option value='UG' >Ouganda<\/option><option value='UZ' >Ouzb\u00e9kistan<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='NL' >Pays-Bas<\/option><option value='PE' >P\u00e9rou<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Pologne<\/option><option value='PF' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='PR' >Porto Rico<\/option><option value='PT' >Portugal<\/option><option value='QA' >Qatar<\/option><option value='CF' >R\u00e9publique centrafricaine<\/option><option value='CD' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='LA' >R\u00e9publique d\u00e9mocratique populaire Lao<\/option><option value='DO' >R\u00e9publique Dominicaine<\/option><option value='RO' >Roumanie<\/option><option value='GB' >Royaume-Uni<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara occidental<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='MF' >Saint Martin<\/option><option value='KN' >Saint-Christophe-et-Nevis<\/option><option value='SM' >Saint-Marin<\/option><option value='SX' >Saint-Martin<\/option><option value='PM' >Saint-Pierre-et-Miquelon<\/option><option value='VA' >Saint-Si\u00e8ge<\/option><option value='VC' >Saint-Vincent-et-les Grenadines<\/option><option value='LC' >Sainte-Lucie<\/option><option value='SV' >Salvador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa am\u00e9ricaines<\/option><option value='ST' >Sao Tom\u00e9 et Principe<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SO' >Somalie<\/option><option value='SD' >Soudan<\/option><option value='SS' >Soudan du Sud<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='LK' >Sri Lanka<\/option><option value='SE' >Su\u00e8de<\/option><option value='CH' >Suisse<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TJ' >Tadjikistan<\/option><option value='TW' >Ta\u00efwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TD' >Tchad<\/option><option value='TF' >Terres australes Fran\u00e7aises<\/option><option value='IO' >Territoire britannique de l&#039;oc\u00e9an Indien<\/option><option value='TH' >Tha\u00eflande<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9 et Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TV' >Tuvalu<\/option><option value='UA' >Ukraine<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis et Futuna<\/option><option value='YE' >Y\u00e9men<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_21_12_6' id='input_21_12_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_13'><span class='gform-field-label__text'>Adresse courriel<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_21_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_11'><span class='gform-field-label__text'>Ann\u00e9e d&#039;obtention du dipl\u00f4me (le cas \u00e9ch\u00e9ant)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_21_11' type='text' value='' class='large'    placeholder='9999'  aria-invalid=\"false\"   data-mask=\"9999\"\/><\/div><\/div><div id=\"field_21_33\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">D\u00e9dicace<\/h3><\/div><fieldset id=\"field_21_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ce don est-il effectu\u00e9 en l&#039;honneur ou \u00e0 la m\u00e9moire de quelqu&#039;un ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_18'>\n\t\t\t<div class='gchoice gchoice_21_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Oui'  id='choice_21_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_18_0' id='label_21_18_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Non'  id='choice_21_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_18_1' id='label_21_18_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_19'><span class='gform-field-label__text'>Nom complet de la personne mise \u00e0 l&#039;honneur<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_21_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_20\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_20'><span class='gform-field-label__text'>Adresse e-mail du destinataire<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_20' id='input_21_20' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_21\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_21'><span class='gform-field-label__text'>Note personnalis\u00e9e \u00e0 l&#039;attention du destinataire<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_21_21' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_21_22\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse du destinataire<\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_21_22' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_22_1_container' >\n                                        <input type='text' name='input_22.1' id='input_21_22_1' value=''    aria-required='false'    \/>\n                                        <label for='input_21_22_1' id='input_21_22_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_21_22_2_container' >\n                                        <input type='text' name='input_22.2' id='input_21_22_2' value=''     aria-required='false'   \/>\n                                        <label for='input_21_22_2' id='input_21_22_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_22_3_container' >\n                                    <input type='text' name='input_22.3' id='input_21_22_3' value=''    aria-required='false'    \/>\n                                    <label for='input_21_22_3' id='input_21_22_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_22_4_container' >\n                                        <input type='text' name='input_22.4' id='input_21_22_4' value=''      aria-required='false'    \/>\n                                        <label for='input_21_22_4' id='input_21_22_4_label' class='gform-field-label gform-field-label--type-sub '>\u00c9tat \/ Province \/ R\u00e9gion<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_22_5_container' >\n                                    <input type='text' name='input_22.5' id='input_21_22_5' value=''    aria-required='false'    \/>\n                                    <label for='input_21_22_5' id='input_21_22_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Code postal<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_21_22_6_container' >\n                                        <select name='input_22.6' id='input_21_22_6'   aria-required='false'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='ZA' >Afrique du Sud<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='DE' >Allemagne<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua-et-Barbuda<\/option><option value='SA' >Arabie Saoudite<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerba\u00efdjan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahre\u00efn<\/option><option value='BD' >Bangladesh<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BJ' >B\u00e9nin<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie-Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BR' >Br\u00e9sil<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='CV' >Cap-Vert<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CY' >Chypre<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='CG' >Congo<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d\u2019Ivoire<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='EG' >\u00c9gypte<\/option><option value='AE' >\u00c9mirats arabes unis<\/option><option value='EC' >\u00c9quateur<\/option><option value='ER' >\u00c9rythr\u00e9e<\/option><option value='ES' >Espagne<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='PS' >\u00c9tat palestinien<\/option><option value='US' >\u00c9tats-Unis<\/option><option value='ET' >\u00c9thiopie<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GE' >G\u00e9orgie<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GD' >Grenade<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernesey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='GF' >Guin\u00e9e Fran\u00e7aise<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GY' >Guyane<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='IM' >\u00cele de Man<\/option><option value='CX' >\u00cele de No\u00ebl<\/option><option value='NF' >\u00cele de Norfolk<\/option><option value='MU' >\u00cele Maurice<\/option><option value='AX' >Iles Aland<\/option><option value='KY' >\u00celes Cayman<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CK' >\u00celes Cook<\/option><option value='FK' >\u00celes Falkland<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='MP' >\u00celes Mariannes du Nord<\/option><option value='MH' >\u00celes Marshall<\/option><option value='UM' >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><option value='SB' >\u00celes Salomon<\/option><option value='TC' >\u00celes Turques-et-Ca\u00efques<\/option><option value='VI' >\u00celes Vierges am\u00e9ricaines<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlande<\/option><option value='IS' >Islande<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KG' >Kirghizistan<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kowe\u00eft<\/option><option value='BB' >La Barbade<\/option><option value='RE' >La R\u00e9union<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MY' >Malaisie<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MA' >Maroc<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritanie<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='ME' >Mont\u00e9n\u00e9gro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NP' >N\u00e9pal<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niue<\/option><option value='MK' >North Macedonia<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='NC' >Nouvelle Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='OM' >Oman<\/option><option value='UG' >Ouganda<\/option><option value='UZ' >Ouzb\u00e9kistan<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='NL' >Pays-Bas<\/option><option value='PE' >P\u00e9rou<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Pologne<\/option><option value='PF' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='PR' >Porto Rico<\/option><option value='PT' >Portugal<\/option><option value='QA' >Qatar<\/option><option value='CF' >R\u00e9publique centrafricaine<\/option><option value='CD' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='LA' >R\u00e9publique d\u00e9mocratique populaire Lao<\/option><option value='DO' >R\u00e9publique Dominicaine<\/option><option value='RO' >Roumanie<\/option><option value='GB' >Royaume-Uni<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara occidental<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='MF' >Saint Martin<\/option><option value='KN' >Saint-Christophe-et-Nevis<\/option><option value='SM' >Saint-Marin<\/option><option value='SX' >Saint-Martin<\/option><option value='PM' >Saint-Pierre-et-Miquelon<\/option><option value='VA' >Saint-Si\u00e8ge<\/option><option value='VC' >Saint-Vincent-et-les Grenadines<\/option><option value='LC' >Sainte-Lucie<\/option><option value='SV' >Salvador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa am\u00e9ricaines<\/option><option value='ST' >Sao Tom\u00e9 et Principe<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SO' >Somalie<\/option><option value='SD' >Soudan<\/option><option value='SS' >Soudan du Sud<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='LK' >Sri Lanka<\/option><option value='SE' >Su\u00e8de<\/option><option value='CH' >Suisse<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TJ' >Tadjikistan<\/option><option value='TW' >Ta\u00efwan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TD' >Tchad<\/option><option value='TF' >Terres australes Fran\u00e7aises<\/option><option value='IO' >Territoire britannique de l&#039;oc\u00e9an Indien<\/option><option value='TH' >Tha\u00eflande<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9 et Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TV' >Tuvalu<\/option><option value='UA' >Ukraine<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis et Futuna<\/option><option value='YE' >Y\u00e9men<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_21_22_6' id='input_21_22_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                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class='gform_hidden ginput_tax_input' \n                    onchange='jQuery( this ).prev( \"span\" ).text( gformFormatMoney( this.value, true ) );' \n                    data-amount='2.5' data-amounttype='percent'\n                    data-productstype='all' data-products='[]' \/>\n            <\/div><\/div><div id=\"field_21_30\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_21_ gfield_total gfield_total_21_ field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_21_30'><span class='gform-field-label__text'>Total<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_30' id='input_21_30' value='$ 0.00 CAD' class='gform-text-input-reset ginput_total ginput_total_21' 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