{"id":3777,"date":"2026-09-16T10:57:17","date_gmt":"2026-09-16T14:57:17","guid":{"rendered":"https:\/\/ha-mtl.org\/form\/dons-a-la-bibliotheque\/"},"modified":"2026-09-16T11:40:46","modified_gmt":"2026-09-16T15:40:46","slug":"dons-a-la-bibliotheque","status":"publish","type":"page","link":"https:\/\/ha-mtl.org\/fr\/form\/dons-a-la-bibliotheque\/","title":{"rendered":"Dons \u00e0 la biblioth\u00e8que"},"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\"><span class=\"et_pb_image_wrap\"><img decoding=\"async\" src=\"https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/09\/library-donations-main.jpg\" width=\"2000\" height=\"1000\" srcset=\"https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/09\/library-donations-main.jpg 2000w, https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/09\/library-donations-main-1280x640.jpg 1280w, https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/09\/library-donations-main-980x490.jpg 980w, https:\/\/ha-mtl.org\/wp-content\/uploads\/2026\/09\/library-donations-main-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-3775\" \/><\/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\">Dons \u00e0 la biblioth\u00e8que<\/h1><div class=\"et_pb_promo_content\"><p>Faites un don \u00e0 la biblioth\u00e8que de l'Acad\u00e9mie H\u00e9bra\u00efque.<\/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\">\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 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class='gform-body gform_body'><div id='gform_fields_29' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_29_28\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_28' id='input_29_28' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Dons \u00e0 la biblioth\u00e8que' \/><\/div><\/div><fieldset id=\"field_29_3\" 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'>Quel type de don souhaitez-vous faire ?<\/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_29_3'>\n\t\t\t<div class='gchoice gchoice_29_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Don d\u2019anniversaire'  id='choice_29_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_3_0' id='label_29_3_0' class='gform-field-label gform-field-label--type-inline'>Don d\u2019anniversaire<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_29_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Don \u00e0 la m\u00e9moire \/ en l\u2019honneur'  id='choice_29_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_3_1' id='label_29_3_1' class='gform-field-label gform-field-label--type-inline'>Don \u00e0 la m\u00e9moire \/ en l\u2019honneur<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_29_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Don d\u2019anniversaire<\/h3><\/div><div id=\"field_29_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_1'><span class='gform-field-label__text'>Nom du\/de la destinataire<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_29_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_2'><span class='gform-field-label__text'>\u00c2ge<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_29_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_4\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_4'><span class='gform-field-label__text'>Date de naissance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_29_4'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_4'\n\t\t\t\t value=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_29_4' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_29_4' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_29_4' aria-label='Date de naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_29_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_6'><span class='gform-field-label__text'>Niveau et classe<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_29_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_7'><span class='gform-field-label__text'>Nom du donateur\/de la donatrice \u2013 pour le re\u00e7u fiscal<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_29_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_25\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_25'><span class='gform-field-label__text'>Nom du\/des donateur(s) \u2013 \u00e0 inscrire sur l\u2019ex-libris<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_29_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_10\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Don \u00e0 la m\u00e9moire \/ en l\u2019honneur<\/h3><\/div><div id=\"field_29_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_11'><span class='gform-field-label__text'>Nom de la personne honor\u00e9e<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_29_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_13'><span class='gform-field-label__text'>Motif du don<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_29_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_12\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_12'><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_29_12'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_12'\n\t\t\t\t value=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_29_12' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_29_12' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_29_12' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_29_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_14'><span class='gform-field-label__text'>Nom du donateur\/de la donatrice \u2013 pour le re\u00e7u fiscal<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_29_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_26'><span class='gform-field-label__text'>Nom du\/des donateur(s) \u2013 \u00e0 inscrire sur l\u2019ex-libris<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_29_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_22\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations de paiement<\/h3><\/div><div id=\"field_29_24\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_29_24 gfield_product_29_24 gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_24'><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='gfield_description' id='gfield_description_29_24'>25&nbsp;$ par livre offert<\/div><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_24' id='input_29_24' type='text' value='' class='small ginput_amount'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_29_24\" \/>\n\t\t\t\t<\/div><\/div><fieldset id=\"field_29_17\" 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'>Mode de paiement<\/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_29_17'>\n\t\t\t<div class='gchoice gchoice_29_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Credit card (online)'  id='choice_29_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_17_0' id='label_29_17_0' class='gform-field-label gform-field-label--type-inline'>Carte de cr\u00e9dit (en ligne)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_29_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Esp\u00e8ces ou ch\u00e8que'  id='choice_29_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_17_1' id='label_29_17_1' class='gform-field-label gform-field-label--type-inline'>Esp\u00e8ces ou ch\u00e8que<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_29_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_23'><span class='gform-field-label__text'>Votre nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_29_23' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_20\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_29_20'><span class='gform-field-label__text'>Votre 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_20' id='input_29_20' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_29_21\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Votre 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_29_21' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_29_21_1_container' >\n                                        <input type='text' name='input_21.1' id='input_29_21_1' value=''    aria-required='true'    \/>\n                                        <label for='input_29_21_1' id='input_29_21_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_29_21_2_container' >\n                                        <input type='text' name='input_21.2' id='input_29_21_2' value=''     aria-required='false'   \/>\n                                        <label for='input_29_21_2' id='input_29_21_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_29_21_3_container' >\n                                    <input type='text' name='input_21.3' id='input_29_21_3' value=''    aria-required='true'    \/>\n                                    <label for='input_29_21_3' id='input_29_21_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_29_21_4_container' >\n                                        <input type='text' name='input_21.4' id='input_29_21_4' value=''      aria-required='true'    \/>\n                                        <label for='input_29_21_4' id='input_29_21_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_29_21_5_container' >\n                                    <input type='text' name='input_21.5' id='input_29_21_5' value=''    aria-required='true'    \/>\n                                    <label for='input_29_21_5' id='input_29_21_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_29_21_6_container' >\n                                        <select name='input_21.6' id='input_29_21_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' selected='selected'>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_29_21_6' id='input_29_21_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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