{"id":1259,"date":"2022-07-14T23:54:49","date_gmt":"2022-07-15T03:54:49","guid":{"rendered":"https:\/\/forms.csi.ca\/?page_id=1259"},"modified":"2022-10-26T14:25:55","modified_gmt":"2022-10-26T18:25:55","slug":"information-release-consent-agreement-fr","status":"publish","type":"page","link":"https:\/\/forms.csi.ca\/?page_id=1259","title":{"rendered":"Entente relative au consentement"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-block\" id=\"wpforms-1246\"><form id=\"wpforms-form-1246\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1246\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1259\" data-token=\"43a2c115161c80fb98fe24379dc7f99e\" data-token-time=\"1785645476\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1246-field_41-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"41\"><h3 id=\"wpforms-1246-field_41\">RENSEIGNEMENTS G\u00c9N\u00c9RAUX<\/h3><\/div><div id=\"wpforms-1246-field_1-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first\" data-field-type=\"number\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_1\">Num\u00e9ro de dossier <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1246-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" step=\"any\" required><\/div><div id=\"wpforms-1246-field_32-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-type=\"date-time\" data-field-id=\"32\"><label class=\"wpforms-field-label\">V\u00e9rification de l\u2019identit\u00e9  &#8211; Date de naissance <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-small\"><select name=\"wpforms[fields][32][date][d]\" id=\"wpforms-1246-field_32-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][32][date][m]\" id=\"wpforms-1246-field_32-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][32][date][y]\" id=\"wpforms-1246-field_32-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-1246-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_3\">Nom <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1246-field_3\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][3][first]\" placeholder=\"Pr\u00e9nom\" required><label for=\"wpforms-1246-field_3\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-1246-field_3-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][3][middle]\" placeholder=\"Initiale\" ><label for=\"wpforms-1246-field_3-middle\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1246-field_3-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][3][last]\" placeholder=\"Nom\" required><label for=\"wpforms-1246-field_3-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1246-field_4-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"4\"><label class=\"wpforms-field-label\">Genre <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1246-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_4_1\" name=\"wpforms[fields][4]\" value=\"F\u00e9minin\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_4_1\">F\u00e9minin<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_4_2\" name=\"wpforms[fields][4]\" value=\"Masculin\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_4_2\">Masculin<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_4_3\" name=\"wpforms[fields][4]\" value=\"Non binaire\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_4_3\">Non binaire<\/label><\/li><\/ul><\/div><div id=\"wpforms-1246-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Langue de correspondance <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1246-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_28_1\" name=\"wpforms[fields][28]\" value=\"Fran\u00e7ais\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_28_1\">Fran\u00e7ais<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_28_2\" name=\"wpforms[fields][28]\" value=\"Anglais\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_28_2\">Anglais<\/label><\/li><\/ul><\/div><div id=\"wpforms-1246-field_7-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_7\">Courriel principal <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1246-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1246-field_8-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-type=\"email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_8\">Autre courriel<\/label><input type=\"email\" id=\"wpforms-1246-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-1246-field_79-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"79\"><label class=\"wpforms-field-label\">Num\u00e9ro de t\u00e9l\u00e9phone pour vous joindre <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1246-field_79\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_79_1\" name=\"wpforms[fields][79]\" value=\"Personnel\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_79_1\">Personnel<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_79_2\" name=\"wpforms[fields][79]\" value=\"Professionnel\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_79_2\">Professionnel<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_79_3\" name=\"wpforms[fields][79]\" value=\"Les deux\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_79_3\">Les deux<\/label><\/li><\/ul><\/div><div id=\"wpforms-1246-field_21-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"21\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_21\">T\u00e9l\u00e9phone au domicile <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1246-field_21\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][21]\" aria-label=\"T\u00e9l\u00e9phone au domicile\" required><\/div><div id=\"wpforms-1246-field_10-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_10\">T\u00e9l\u00e9phone au bureau <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1246-field_10\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][10]\" aria-label=\"T\u00e9l\u00e9phone au bureau\" required><\/div><div id=\"wpforms-1246-field_80-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"80\"><label class=\"wpforms-field-label\">Adresse <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1246-field_80\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_80_1\" name=\"wpforms[fields][80]\" value=\"Domicile\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_80_1\">Domicile<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_80_2\" name=\"wpforms[fields][80]\" value=\"Bureau\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_80_2\">Bureau<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1246-field_80_3\" name=\"wpforms[fields][80]\" value=\"Les deux\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_80_3\">Les deux<\/label><\/li><\/ul><\/div><div id=\"wpforms-1246-field_14-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_14\">Adresse au domicile <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1246-field_14\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][14][address1]\" placeholder=\"Adresse, bo\u00eete postale\" required><label for=\"wpforms-1246-field_14\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1246-field_14-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][14][address2]\" placeholder=\"No d&#039;appartement, de bureau ou d&#039;unit\u00e9, \u00e9tage, etc.\" ><label for=\"wpforms-1246-field_14-address2\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1246-field_14-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][14][city]\" placeholder=\"Ville\" required><label for=\"wpforms-1246-field_14-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1246-field_14-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][14][state]\" placeholder=\"Province\" required><label for=\"wpforms-1246-field_14-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1246-field_14-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][14][postal]\" placeholder=\"Code postal\" required><label for=\"wpforms-1246-field_14-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1246-field_14-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][14][country]\" value=\"Canada\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/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 Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/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=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/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\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1246-field_14-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-1246-field_43-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_43\">( S&#039;il y a lieu ) No de transit ou de succursale<\/label><input type=\"number\" id=\"wpforms-1246-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\" step=\"any\" ><\/div><div id=\"wpforms-1246-field_44-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_44\">Num\u00e9ro d\u2019employ\u00e9<\/label><input type=\"number\" id=\"wpforms-1246-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" step=\"any\" ><\/div><div id=\"wpforms-1246-field_11-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"11\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_11\">Adresse au bureau <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1246-field_11\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][11][address1]\" placeholder=\"Adresse, bo\u00eete postale\" required><label for=\"wpforms-1246-field_11\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1246-field_11-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11][address2]\" placeholder=\"No d&#039;appartement, de bureau ou d&#039;unit\u00e9, \u00e9tage, etc.\" ><label for=\"wpforms-1246-field_11-address2\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1246-field_11-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][11][city]\" placeholder=\"Ville\" required><label for=\"wpforms-1246-field_11-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1246-field_11-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][11][state]\" placeholder=\"Province\" required><label for=\"wpforms-1246-field_11-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1246-field_11-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][11][postal]\" placeholder=\"Code postal\" required><label for=\"wpforms-1246-field_11-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1246-field_11-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][11][country]\" value=\"Canada\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/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 Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/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=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/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\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1246-field_11-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-1246-field_15-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"15\"><h3 id=\"wpforms-1246-field_15\">POLITIQUE<\/h3><\/div><div id=\"wpforms-1246-field_70-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"70\"><div id=\"wpforms-1246-field_70\"><p>CSI ne divulgue pas les renseignements personnels concernant un \u00e9tudiant (c\u2019est-\u00e0-dire les renseignements sur l\u2019inscription, les notes et les r\u00e9sultats de l\u2019\u00e9tudiant) \u00e0 qui\r\nque ce soit, y compris son employeur, sans le consentement \u00e9crit pr\u00e9alable de cet \u00e9tudiant. Il existe trois exceptions \u00e0 cette politique :\r\n\r\n<ol>\r\n<li>CSI peut fournir des renseignements concernant un \u00e9tudiant \u00e0 des organismes de r\u00e9glementation, notamment les commissions provinciales des valeurs\r\nmobili\u00e8res, les bourses et l\u2019Organisme canadien de r\u00e9glementation du commerce des valeurs mobili\u00e8res (les \u00ab organismes de r\u00e9glementation \u00bb), qui ont\r\nd\u00e9j\u00e0 le droit d\u2019obtenir des renseignements sur les \u00e9tudiants.\r\n<\/li>\r\n<li>CSI peut informer l\u2019employeur d\u2019un \u00e9tudiant ou les organismes de r\u00e9glementation des d\u00e9tails pertinents, en fonction de l\u2019issue d\u2019une proc\u00e9dure disciplinaire\r\nvisant un \u00e9tudiant de CSI, lorsque cet \u00e9tudiant a particip\u00e9 \u00e0 des pratiques contraires \u00e0 la d\u00e9ontologie, telles que la tricherie \u00e0 un examen.<\/li>\r\n<li>Dans le cas o\u00f9 une loi, un r\u00e8glement, un mandat de perquisition, une assignation \u00e0 compara\u00eetre ou une ordonnance judiciaire exige la divulgation par CSI de\r\nrenseignements sur des \u00e9tudiants.\r\n<\/li>\r\n<\/ol>\r\n<\/p><\/div><\/div><div id=\"wpforms-1246-field_71-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"71\"><h3 id=\"wpforms-1246-field_71\">ENTENTE<\/h3><\/div><div id=\"wpforms-1246-field_72-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"72\"><div id=\"wpforms-1246-field_72\"><p>Je consens \u00e0 ce que CSI recueille, utilise et divulgue des renseignements personnels me concernant aux fins suivantes : (i) me fournir les services; (ii) communiquer\r\navec mon employeur au sujet de mon admissibilit\u00e9 au tarif pr\u00e9f\u00e9rentiel; et (iii) divulguer \u00e0 mon employeur mon statut aupr\u00e8s de CSI et mes r\u00e9sultats aux cours offerts\r\npar CSI.\r\n<br \/><br \/>\r\nDe plus, je consens \u00e0 ce que, de temps \u00e0 autre, mon employeur ou CSI communique avec moi afin que : (i) je fournisse des renseignements personnels \u00e0 CSI pour lui\r\npermettre d\u2019\u00e9tablir ma conformit\u00e9 aux exigences en mati\u00e8re de formation continue des organismes de r\u00e9glementation auxquelles je suis assujetti(e), et que (ii) je divulgue\r\nces renseignements \u00e0 mon employeur afin de faciliter la gestion de sa conformit\u00e9 aux exigences aupr\u00e8s des organismes de r\u00e9glementation\r\n<br \/><br \/>\r\nLe consentement pr\u00e9vu aux pr\u00e9sentes peut \u00eatre r\u00e9voqu\u00e9, en totalit\u00e9 ou en partie, moyennant un pr\u00e9avis \u00e9crit de 10 jours ouvrables de ma part \u00e0 l\u2019intention de CSI,\r\nlequel pr\u00e9avis est remis au 625, boul. Ren\u00e9-L\u00e9vesque Ouest, 4e \u00e9tage, Montr\u00e9al (Qu\u00e9bec) H3B 1R2, CANADA, \u00e0 l\u2019attention du Service \u00e0 la client\u00e8le. En ce faisant, je\r\nreconnais que je peux continuer \u00e0 m\u2019inscrire et \u00e0 m\u2019abonner aux services, mais que ceux-ci ne me seront pas offerts \u00e0 un tarif r\u00e9duit. Les \u00e9tudiants qui r\u00e9voquent leur\r\nconsentement abandonnent tout droit \u00e0 la tarification pr\u00e9f\u00e9rentielle et il leur incombe de payer les frais additionnels applicables aux \u00e9tudiants ind\u00e9pendants.\r\n<\/p>\r\n<\/div><\/div><div id=\"wpforms-1246-field_73-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"73\"><label class=\"wpforms-field-label wpforms-label-hide\">Confirm <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1246-field_73\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1246-field_73_1\" name=\"wpforms[fields][73][]\" value=\"En signant ci-dessous, je confirme avoir lu les modalit\u00e9s de la pr\u00e9sente entente et y consentir\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1246-field_73_1\">En signant ci-dessous, je confirme avoir lu les modalit\u00e9s de la pr\u00e9sente entente et y consentir<\/label><\/li><\/ul><\/div><div id=\"wpforms-1246-field_18-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_18\">Signature de l\u2019\u00e9tudiant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1246-field_18\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][18]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\" data-input-method=\"draw\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1246-field_18-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-1246-field_74-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_74\">Employeur\/\u00c9tablissement d\u2019enseignement <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1246-field_74\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][74]\" required><\/div><div id=\"wpforms-1246-field_49-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-type=\"name\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_49\">Nom du sup\u00e9rieur ou de l\u2019instructeur <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1246-field_49\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][49]\" required><\/div><div id=\"wpforms-1246-field_50-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-type=\"phone\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_50\">Son num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1246-field_50\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][50]\" aria-label=\"Son num\u00e9ro de t\u00e9l\u00e9phone\" required><\/div><div id=\"wpforms-1246-field_75-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"75\"><div id=\"wpforms-1246-field_75\"><p>Veuillez indiquer ces renseignements, si votre employeur vous les demande :<\/p><\/div><\/div><div id=\"wpforms-1246-field_76-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_76\">No d\u2019employ\u00e9<\/label><input type=\"text\" id=\"wpforms-1246-field_76\" class=\"wpforms-field-medium\" name=\"wpforms[fields][76]\" ><\/div><div id=\"wpforms-1246-field_77-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half\" data-field-type=\"number\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-1246-field_77\">No de transit ou de succursale<\/label><input type=\"number\" id=\"wpforms-1246-field_77\" class=\"wpforms-field-medium\" name=\"wpforms[fields][77]\" step=\"any\" ><\/div><div id=\"wpforms-1246-field_81-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"81\"><div id=\"wpforms-1246-field_81\">NOTE : Pour obtenir le remboursement auquel vous pourrez avoir droit, vous devez aviser CSI dans les 30 jours suivant votre inscription.<\/div><\/div><div id=\"wpforms-1246-field_78-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"78\"><input type=\"hidden\" id=\"wpforms-1246-field_78\" name=\"wpforms[fields][78]\" value=\"Entente relative au consentement\"><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1246\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages\/1259\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1246\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Soumettre\" aria-live=\"assertive\" value=\"wpforms-submit\">Soumettre<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/forms.csi.ca\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":50,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1259","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages\/1259","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/users\/50"}],"replies":[{"embeddable":true,"href":"https:\/\/forms.csi.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1259"}],"version-history":[{"count":0,"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages\/1259\/revisions"}],"wp:attachment":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1259"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}