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S'inscrire - Acrimed
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Toutes nos excuses. <span> </div> </noscript> <div class="header row"> <h1 class="logo container"> <a href="https://boutique.acrimed.org" title="Acrimed"> <img src="https://boutique.acrimed.org/assets/frontOffice/acrimed/template-assets/assets/dist/img/8d008f4.png" alt="Acrimed"> </a> </h1> <!-- <a class="btn-header-cta btn btn-lg btn-primary" href="/don-soutien"><i class="fa fa-heart"></i> Vous souhaitez nous soutenir ? Faites un don !</a> <br/> --> <a class="btn-header-cta btn btn-lg btn-info" href="/contact"><i class="fa fa-question-circle"></i> Un probl猫me ? Une question ? Contactez-nous !</a> <br/><br/> </div> </header><!-- /.header --> </div><!-- /.header-container --> <main class="main-container" role="main"> <div class="container"> <nav class="nav-breadcrumb" role="navigation" aria-labelledby="breadcrumb-label"> <strong id="breadcrumb-label" class="sr-only">Vous 锚tes ici聽:</strong> <ul class="breadcrumb" itemscope itemtype="http://schema.org/BreadcrumbList" > <li itemscope itemtype="http://schema.org/ListItem" itemprop="itemListElement" ><a href="https://boutique.acrimed.org" itemprop="item"> <span itemprop="name">Accueil</span></a> <meta itemprop="position" content="1"> </li> <li itemscope itemtype="http://schema.org/ListItem" itemprop="itemListElement" class="active"><span itemprop="name">S'inscrire</span></li> </ul> </nav><!-- /.nav-breadcrumb --> <div id="content"> <div class="main"> <article class="col-main" role="main" aria-labelledby="main-label"> <h1 id="main-label" class="page-header">Cr茅er un nouveau compte</h1> <form id="form-register" class="form-horizontal" action="https://boutique.acrimed.org/register" method="post"> <input type="hidden" name="thelia_customer_create[success_url]" value="https://boutique.acrimed.org" /> <input type="hidden" name="thelia_customer_create[error_message]" value="Information erron茅e ou incompl猫te" /> <input type="hidden" name="thelia_customer_create[_token]" value="1dC_DqE1NtQt2vnq2IyXA_XElwC58xOAC0pnWRioiRA" > <fieldset id="register-info" class="panel panel-default"> <div class="panel-heading"> 1. Informations personnelles </div> <div class="panel-body"> <div class="form-group group-title" style="display:none"> <label class="control-label col-sm-3" for="title">Titre <span class="required">*</span></label> <div class="control-input col-sm-5"> <select name="thelia_customer_create[title]" id="title" class="form-control" aria-required="true" required autofocus> <option value="">-- Civilit茅 --</option> <option value="1" selected >Monsieur</option> <option value="2" >Madame</option> <option value="3" >Mademoiselle</option> </select> </div> </div><!--/.form-group--> <div class="form-group group-firstname"> <label class="control-label col-sm-3" for="firstname">Pr茅nom <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[firstname]" id="firstname" class="form-control" maxlength="255" placeholder="Pr茅nom" value="" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-lastname"> <label class="control-label col-sm-3" for="lastname">Nom <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[lastname]" id="lastname" class="form-control" maxlength="255" placeholder="Nom de famille" value="" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-email"> <label class="control-label col-sm-3" for="email">Adresse mail <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="email" name="thelia_customer_create[email]" id="email" class="form-control" maxlength="255" placeholder="Adresse e-mail" value="" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-email"> <label class="control-label col-sm-3" for="email_confirm">Confirmez votre adresse e-mail <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="email" name="thelia_customer_create[email_confirm]" id="email_confirm" class="form-control" maxlength="255" placeholder="Confirmation email" value="" aria-required="true" required> </div> </div><!--/.form-group--> </div> </fieldset> <fieldset id="register-delivery" class="panel panel-default"> <div class="panel-heading"> 2. Information de livraison </div> <div class="panel-body"> <div class="form-group group-company"> <label class="control-label col-sm-3" for="company">Nom de la soci茅t茅</label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[company]" id="company" class="form-control" maxlength="255" placeholder="Compagnie" value=""> </div> </div><!--/.form-group--> <div class="form-group group-address1"> <label class="control-label col-sm-3" for="address1">Adresse <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[address1]" id="address1" class="form-control" maxlength="255" placeholder="Adresse" value="" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-address2"> <label class="control-label col-sm-3" for="address2">Adresse suite</label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[address2]" id="address2" class="form-control" maxlength="255" placeholder="Adresse" value=""> </div> </div><!--/.form-group--> <div class="form-group group-address3"> <label class="control-label col-sm-3" for="address3">Adresse suite</label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[address3]" id="address3" class="form-control" maxlength="255" placeholder="Adresse" value=""> </div> </div><!--/.form-group--> <div class="form-group group-zip"> <label class="control-label col-sm-3" for="zipcode">Code postal <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[zipcode]" id="zipcode" class="form-control" maxlength="10" placeholder="Code postal" value="" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-city"> <label class="control-label col-sm-3" for="city">Ville <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="text" name="thelia_customer_create[city]" id="city" class="form-control" maxlength="255" placeholder="New York" value="" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-country"> <label class="control-label col-sm-3" for="country">Pays <span class="required">*</span></label> <div class="control-input col-sm-5"> <select name="thelia_customer_create[country]" id="country" class="form-control" aria-required="true" required> <option value="">-- Choisissez un pays --</option> <option value="1" >Afghanistan</option> <option value="2" >Afrique du Sud</option> <option value="3" >Albanie</option> <option value="4" >Alg茅rie</option> <option value="5" >Allemagne</option> <option value="6" >Andorre</option> <option value="7" >Angola</option> <option value="8" >Antigua-et-Barbuda</option> <option value="9" >Arabie saoudite</option> <option value="10" >Argentine</option> <option value="11" >Arm茅nie</option> <option value="12" >Australie</option> <option value="13" >Autriche</option> <option value="14" >Azerba茂djan</option> <option value="15" >Bahamas</option> <option value="16" >Bahre茂n</option> <option value="17" >Bangladesh</option> <option value="18" >Barbade</option> <option value="19" >Belarus</option> <option value="20" >Belgique</option> <option value="21" >Belize</option> <option value="22" >B茅nin</option> <option value="23" >Bhoutan</option> <option value="24" >Bi茅lorussie</option> <option value="25" >Birmanie</option> <option value="26" >Bolivie</option> <option value="27" >Bosnie-Herz茅govine</option> <option value="28" >Botswana</option> <option value="29" >Br茅sil</option> <option value="30" >Brunei</option> <option value="31" >Bulgarie</option> <option value="32" >Burkina</option> <option value="33" >Burundi</option> <option value="34" >Cambodge</option> <option value="35" >Cameroun</option> <option value="36" >Canada</option> <option value="37" >Cap-Vert</option> <option value="38" >Chili</option> <option value="39" >Chine</option> <option value="40" >Chypre</option> <option value="41" >Colombie</option> <option value="42" >Comores</option> <option value="43" >Congo</option> <option value="44" >Cook</option> <option value="45" >Cor茅e du Nord</option> <option value="46" >Cor茅e du Sud</option> <option value="47" >Costa Rica</option> <option value="48" >C么te dIvoire</option> <option value="49" >Croatie</option> <option value="50" >Cuba</option> <option value="51" >Danemark</option> <option value="52" >Djibouti</option> <option value="53" >Dominique</option> <option value="54" >脡gypte</option> <option value="55" >脡mirats arabes unis</option> <option value="56" >脡quateur</option> <option value="57" >脡rythr茅e</option> <option value="58" >Espagne</option> <option value="59" >Estonie</option> <option value="60" >脡tats-Unis</option> <option value="61" >脡thiopie</option> <option value="62" >Fidji</option> <option value="63" >Finlande</option> <option value="64" selected >France m茅tropolitaine</option> <option value="65" >Gabon</option> <option value="66" >Gambie</option> <option value="67" >G茅orgie</option> <option value="68" >Ghana</option> <option value="69" >Gr猫ce</option> <option value="70" >Grenade</option> <option value="259" >Guadeloupe</option> <option value="71" >Guatemala</option> <option value="72" >Guin茅e</option> <option value="74" >Guin茅e 茅quatoriale</option> <option value="73" >Guin茅e-Bissao</option> <option value="75" >Guyane</option> <option value="260" >Guyane Fran莽aise</option> <option value="76" >Ha茂ti</option> <option value="77" >Honduras</option> <option value="269" >Hong Kong</option> <option value="78" >Hongrie</option> <option value="177" >脦les Tonga</option> <option value="79" >Inde</option> <option value="80" >Indon茅sie</option> <option value="81" >Iran</option> <option value="82" >Iraq</option> <option value="83" >Irlande</option> <option value="84" >Islande</option> <option value="85" >Isra毛l</option> <option value="86" >Italie</option> <option value="87" >Jama茂que</option> <option value="88" >Japon</option> <option value="89" >Jordanie</option> <option value="90" >Kazakhstan</option> <option value="91" >Kenya</option> <option value="92" >Kirghizistan</option> <option value="93" >Kiribati</option> <option value="94" >Kowe茂t</option> <option value="95" >Laos</option> <option value="96" >Lesotho</option> <option value="97" >Lettonie</option> <option value="98" >Liban</option> <option value="99" >Liberia</option> <option value="100" >Libye</option> <option value="101" >Liechtenstein</option> <option value="102" >Lituanie</option> <option value="103" >Luxembourg</option> <option value="104" >Mac茅doine</option> <option value="105" >Madagascar</option> <option value="106" >Malaisie</option> <option value="107" >Malawi</option> <option value="108" >Maldives</option> <option value="109" >Mali</option> <option value="110" >Malte</option> <option value="111" >Maroc</option> <option value="112" >Marshall</option> <option value="261" >Martinique</option> <option value="113" >Maurice</option> <option value="114" >Mauritanie</option> <option value="262" >Mayotte</option> <option value="115" >Mexique</option> <option value="116" >Micron茅sie</option> <option value="117" >Moldavie</option> <option value="119" >Mongolie</option> <option value="120" >Mozambique</option> <option value="121" >Namibie</option> <option value="122" >Nauru</option> <option value="123" >N茅pal</option> <option value="124" >Nicaragua</option> <option value="125" >Niger</option> <option value="126" >Nigeria</option> <option value="127" >Niue</option> <option value="128" >Norv猫ge</option> <option value="265" >Nouvelle-Cal茅donie</option> <option value="129" >Nouvelle-Z茅lande</option> <option value="130" >Oman</option> <option value="131" >Ouganda</option> <option value="132" >Ouzb茅kistan</option> <option value="133" >Pakistan</option> <option value="134" >Panama</option> <option value="135" >Papouasie</option> <option value="136" >Paraguay</option> <option value="137" >Pays-Bas</option> <option value="138" >P茅rou</option> <option value="139" >Philippines</option> <option value="140" >Pologne</option> <option value="266" >Polyn茅sie fran莽aise</option> <option value="141" >Portugal</option> <option value="118" >Principaut茅 de Monaco</option> <option value="142" >Qatar</option> <option value="143" >R茅publique centrafricaine</option> <option value="144" >R茅publique dominicaine</option> <option value="145" >R茅publique tch猫que</option> <option value="263" >R茅union(La)</option> <option value="146" >Roumanie</option> <option value="147" >Royaume-Uni</option> <option value="148" >Russie</option> <option value="149" >Rwanda</option> <option value="270" >Saint-Barth茅lemy</option> <option value="150" >Saint-Christophe-et-Ni茅v猫s</option> <option value="152" >Saint-Marin</option> <option value="271" >Saint-Martin (Antilles fran莽aises)</option> <option value="153" >Saint-Vincent-et-les Grenadines</option> <option value="151" >Sainte-Lucie</option> <option value="154" >Salomon</option> <option value="155" >Salvador</option> <option value="156" >Samoa occidentales</option> <option value="157" >Sao Tom茅-et-Principe</option> <option value="158" >S茅n茅gal</option> <option value="159" >Seychelles</option> <option value="160" >Sierra L茅one</option> <option value="161" >Singapour</option> <option value="162" >Slovaquie</option> <option value="163" >Slov茅nie</option> <option value="164" >Somalie</option> <option value="165" >Soudan</option> <option value="166" >Sri Lanka</option> <option value="264" >St Pierre et Miquelon</option> <option value="167" >Su猫de</option> <option value="168" >Suisse</option> <option value="169" >Suriname</option> <option value="170" >Swaziland</option> <option value="171" >Syrie</option> <option value="172" >Tadjikistan</option> <option value="173" >Tanzanie</option> <option value="174" >Tchad</option> <option value="272" >Terres australes et antarctiques fran莽aises</option> <option value="175" >Tha茂lande</option> <option value="176" >Togo</option> <option value="178" >Trinit茅-et-Tobago</option> <option value="179" >Tunisie</option> <option value="180" >Turkm茅nistan</option> <option value="181" >Turquie</option> <option value="182" >Tuvalu</option> <option value="183" >Ukraine</option> <option value="184" >Uruguay</option> <option value="186" >Vanuatu</option> <option value="185" >Vatican</option> <option value="187" >V茅n茅zuela</option> <option value="188" >Vi锚t Nam</option> <option value="267" >Wallis-et-Futuna</option> <option value="189" >Y茅men</option> <option value="191" >Za茂re</option> <option value="192" >Zambie</option> <option value="193" >Zimbabwe</option> </select> </div> </div><!--/.form-group--> <div class="form-group group-state"> <label class="control-label col-sm-3" for="state">脡tat/r茅gion *</label> <div class="control-input col-sm-5"> <select name="thelia_customer_create[state]" id="state" data-thelia-state="1" data-thelia-country="#country" data-thelia-toggle=".group-state" class="form-control"> <option value="">-- S茅lectionnez un Etat --</option> <option value="1" data-country="60" >Alabama</option> <option value="2" data-country="60" >Alaska</option> <option value="3" data-country="60" >Arizona</option> <option value="4" data-country="60" >Arkansas</option> <option value="5" data-country="60" >Californie</option> <option value="6" data-country="60" >Colorado</option> <option value="7" data-country="60" >Connecticut</option> <option value="8" data-country="60" >Delaware</option> <option value="9" data-country="60" >Floride</option> <option value="10" data-country="60" >G茅orgie</option> <option value="11" data-country="60" >Hawaii</option> <option value="12" data-country="60" >Idaho</option> <option value="13" data-country="60" >Illinois</option> <option value="14" data-country="60" >Indiana</option> <option value="15" data-country="60" >Iowa</option> <option value="16" data-country="60" >Kansas</option> <option value="17" data-country="60" >Kentucky</option> <option value="18" data-country="60" >Louisiane</option> <option value="19" data-country="60" >Maine</option> <option value="20" data-country="60" >Maryland</option> <option value="21" data-country="60" >Massachusetts</option> <option value="22" data-country="60" >Michigan</option> <option value="23" data-country="60" >Minnesota</option> <option value="24" data-country="60" >Mississippi</option> <option value="25" data-country="60" >Missouri</option> <option value="26" data-country="60" >Montana</option> <option value="27" data-country="60" >Nebraska</option> <option value="28" data-country="60" >Nevada</option> <option value="29" data-country="60" >New Hampshire</option> <option value="30" data-country="60" >New Jersey</option> <option value="31" data-country="60" >Nouveau-Mexique</option> <option value="32" data-country="60" >New York</option> <option value="33" data-country="60" >Caroline du Nord</option> <option value="34" data-country="60" >Dakota du Nord</option> <option value="35" data-country="60" >Ohio</option> <option value="36" data-country="60" >Oklahoma</option> <option value="37" data-country="60" >Oregon</option> <option value="38" data-country="60" >Pennsylvanie</option> <option value="39" data-country="60" >Rhode Island</option> <option value="40" data-country="60" >Caroline du Sud</option> <option value="41" data-country="60" >Dakota du Sud</option> <option value="42" data-country="60" >Tennessee</option> <option value="43" data-country="60" >Texas</option> <option value="44" data-country="60" >Utah</option> <option value="45" data-country="60" >Vermont</option> <option value="46" data-country="60" >Virginie</option> <option value="47" data-country="60" >Washington</option> <option value="48" data-country="60" >Virginie-occidentale</option> <option value="49" data-country="60" >Wisconsin</option> <option value="50" data-country="60" >Wyoming</option> <option value="51" data-country="60" >Porto Rico</option> <option value="52" data-country="60" >脦les Vierges am茅ricaines</option> <option value="53" data-country="60" >District de Columbia</option> <option value="54" data-country="115" >Aguascalientes</option> <option value="55" data-country="115" >Baja California</option> <option value="56" data-country="115" >Baja California Sur</option> <option value="57" data-country="115" >Campeche</option> <option value="58" data-country="115" >Chiapas</option> <option value="59" data-country="115" >Chihuahua</option> <option value="60" data-country="115" >Coahuila</option> <option value="61" data-country="115" >Colima</option> <option value="62" data-country="115" >Distrito Federal</option> <option value="63" data-country="115" >Durango</option> <option value="64" data-country="115" >Guanajuato</option> <option value="65" data-country="115" >Guerrero</option> <option value="66" data-country="115" >Hidalgo</option> <option value="67" data-country="115" >Jalisco</option> <option value="68" data-country="115" >Estado de M茅xico</option> <option value="69" data-country="115" >Michoac谩n</option> <option value="70" data-country="115" >Morelos</option> <option value="71" data-country="115" >Nayarit</option> <option value="72" data-country="115" >Nuevo Le贸n</option> <option value="73" data-country="115" >Oaxaca</option> <option value="74" data-country="115" >Puebla</option> <option value="75" data-country="115" >Quer茅taro</option> <option value="76" data-country="115" >Quintana Roo</option> <option value="77" data-country="115" >San Luis Potos铆</option> <option value="78" data-country="115" >Sinaloa</option> <option value="79" data-country="115" >Sonora</option> <option value="80" data-country="115" >Tabasco</option> <option value="81" data-country="115" >Tamaulipas</option> <option value="82" data-country="115" >Tlaxcala</option> <option value="83" data-country="115" >Veracruz</option> <option value="84" data-country="115" >Yucat谩n</option> <option value="85" data-country="115" >Zacatecas</option> <option value="86" data-country="36" >Ontario</option> <option value="87" data-country="36" >Qu茅bec</option> <option value="88" data-country="36" >Colombie-Britannique</option> <option value="89" data-country="36" >Alberta</option> <option value="90" data-country="36" >Manitoba</option> <option value="91" data-country="36" >Saskatchewan</option> <option value="92" data-country="36" >Nouvelle-脡cosse</option> <option value="93" data-country="36" >Nouveau-Brunswick</option> <option value="94" data-country="36" >Terre Neuve et Labrador</option> <option value="95" data-country="36" >脦le-du-Prince-脡douard</option> <option value="96" data-country="36" >Territoires du Nord-Ouest</option> <option value="97" data-country="36" >Yukon</option> <option value="98" data-country="36" >Nunavut</option> <option value="99" data-country="10" >Buenos Aires</option> <option value="100" data-country="10" >Catamarca</option> <option value="101" data-country="10" >Chaco</option> <option value="102" data-country="10" >Chubut</option> <option value="103" data-country="10" >Ciudad de Buenos Aires</option> <option value="104" data-country="10" >Cordoba</option> <option value="105" data-country="10" >Corrientes</option> <option value="106" data-country="10" >Entre R铆os</option> <option value="107" data-country="10" >Formosa</option> <option value="108" data-country="10" >Jujuy</option> <option value="109" data-country="10" >La Pampa</option> <option value="110" data-country="10" >La Rioja</option> <option value="111" data-country="10" >Mendoza</option> <option value="112" data-country="10" >Misiones</option> <option value="113" data-country="10" >Neuqu茅n</option> <option value="114" data-country="10" >Rio Negro</option> <option value="115" data-country="10" >Salta</option> <option value="116" data-country="10" >San Juan</option> <option value="117" data-country="10" >San Luis</option> <option value="118" data-country="10" >Santa Cruz</option> <option value="119" data-country="10" >Santa Fe</option> <option value="120" data-country="10" >Santiago del Estero</option> <option value="121" data-country="10" >Tierra del Fuego</option> <option value="122" data-country="10" >Tucuman</option> <option value="123" data-country="86" >Agrigento</option> <option value="124" data-country="86" >Alessandria</option> <option value="125" data-country="86" >Ancona</option> <option value="126" data-country="86" >Aosta</option> <option value="127" data-country="86" >Arezzo</option> <option value="128" data-country="86" >Ascoli Piceno</option> <option value="129" data-country="86" >Asti</option> <option value="130" data-country="86" >Avellino</option> <option value="131" data-country="86" >Bari</option> <option value="132" data-country="86" >Barletta-Andria-Trani</option> <option value="133" data-country="86" >Belluno</option> <option value="134" data-country="86" >Benevento</option> <option value="135" data-country="86" >Bergamo</option> <option value="136" data-country="86" >Biella</option> <option value="137" data-country="86" >Bologne</option> <option value="138" data-country="86" >Bolzano</option> <option value="139" data-country="86" >Brescia</option> <option value="140" data-country="86" >Brindisi</option> <option value="141" data-country="86" >Cagliari</option> <option value="142" data-country="86" >Caltanissetta</option> <option value="143" data-country="86" >Campobasso</option> <option value="144" data-country="86" >Carbonia-Iglesias</option> <option value="145" data-country="86" >Caserta</option> <option value="146" data-country="86" >Catane</option> <option value="147" data-country="86" >Catanzaro</option> <option value="148" data-country="86" >Chieti</option> <option value="149" data-country="86" >Como</option> <option value="150" data-country="86" >Cosenza</option> <option value="151" data-country="86" >Cremona</option> <option value="152" data-country="86" >Crotone</option> <option value="153" data-country="86" >Cuneo</option> <option value="154" data-country="86" >Enna</option> <option value="155" data-country="86" >Fermo</option> <option value="156" data-country="86" >Ferrara</option> <option value="157" data-country="86" >Firenze</option> <option value="158" data-country="86" >Foggia</option> <option value="159" data-country="86" >Forl矛-Cesena</option> <option value="160" data-country="86" >Frosinone</option> <option value="161" data-country="86" >Genova</option> <option value="162" data-country="86" >Gorizia</option> <option value="163" data-country="86" >Grosseto</option> <option value="164" data-country="86" >Imperia</option> <option value="165" data-country="86" >Isernia</option> <option value="166" data-country="86" >L'Aquila</option> <option value="167" data-country="86" >La Spezia</option> <option value="168" data-country="86" >Latina</option> <option value="169" data-country="86" >Lecce</option> <option value="170" data-country="86" >Lecco</option> <option value="171" data-country="86" >Livourne</option> <option value="172" data-country="86" >Lodi</option> <option value="173" data-country="86" >Lucca</option> <option value="174" data-country="86" >Macerata</option> <option value="175" data-country="86" >Mantova</option> <option value="176" data-country="86" >Massa</option> <option value="177" data-country="86" >Matera</option> <option value="178" data-country="86" >Medio Campidano</option> <option value="179" data-country="86" >Messina</option> <option value="180" data-country="86" >Milano</option> <option value="181" data-country="86" >Modena</option> <option value="182" data-country="86" >Monza e della Brianza</option> <option value="183" data-country="86" >Napoli</option> <option value="184" data-country="86" >Novara</option> <option value="185" data-country="86" >Nuoro</option> <option value="186" data-country="86" >Ogliastra</option> <option value="187" data-country="86" >Olbia-Tempio</option> <option value="188" data-country="86" >Oristano</option> <option value="189" data-country="86" >Padova</option> <option value="190" data-country="86" >Palerme</option> <option value="191" data-country="86" >Parma</option> <option value="192" data-country="86" >Pavie</option> <option value="193" data-country="86" >P茅rouse</option> <option value="194" data-country="86" >Pesaro-Urbino</option> <option value="195" data-country="86" >Pescara</option> <option value="196" data-country="86" >Piacenza</option> <option value="197" data-country="86" >Pise</option> <option value="198" data-country="86" >Pistoia</option> <option value="199" data-country="86" >Pordenone</option> <option value="200" data-country="86" >Potenza</option> <option value="201" data-country="86" >Prato</option> <option value="202" data-country="86" >Ragusa</option> <option value="203" data-country="86" >Ravenne</option> <option value="204" data-country="86" >Reggio de Calabre</option> <option value="205" data-country="86" >Reggio d'脡milie</option> <option value="206" data-country="86" >Rieti</option> <option value="207" data-country="86" >Rimini</option> <option value="208" data-country="86" >Rome</option> <option value="209" data-country="86" >Rovigo</option> <option value="210" data-country="86" >Salerno</option> <option value="211" data-country="86" >Sassari</option> <option value="212" data-country="86" >Savona</option> <option value="213" data-country="86" >Siena</option> <option value="214" data-country="86" >Siracusa</option> <option value="215" data-country="86" >Sondrio</option> <option value="216" data-country="86" >Taranto</option> <option value="217" data-country="86" >Teramo</option> <option value="218" data-country="86" >Terni</option> <option value="219" data-country="86" >Torino</option> <option value="220" data-country="86" >Trapani</option> <option value="221" data-country="86" >Trento</option> <option value="222" data-country="86" >Treviso</option> <option value="223" data-country="86" >Trieste</option> <option value="224" data-country="86" >Udine</option> <option value="225" data-country="86" >Varese</option> <option value="226" data-country="86" >Venezia</option> <option value="227" data-country="86" >Verbano-Cusio-Ossola</option> <option value="228" data-country="86" >Vercelli</option> <option value="229" data-country="86" >V茅rone</option> <option value="230" data-country="86" >Vibo Valentia</option> <option value="231" data-country="86" >Vicenza</option> <option value="232" data-country="86" >Viterbo</option> <option value="233" data-country="80" >Aceh</option> <option value="234" data-country="80" >Bali</option> <option value="235" data-country="80" >Bangka</option> <option value="236" data-country="80" >Banten</option> <option value="237" data-country="80" >Bengkulu</option> <option value="238" data-country="80" >Central Java</option> <option value="239" data-country="80" >Kalimantan occidental</option> <option value="240" data-country="80" >Sulawesi central</option> <option value="241" data-country="80" >Coat of arms of East Java</option> <option value="242" data-country="80" >Kalimantan oriental</option> <option value="243" data-country="80" >Nusa Tenggara oriental</option> <option value="244" data-country="80" >Lambang propinsi</option> <option value="245" data-country="80" >Jakarta</option> <option value="246" data-country="80" >Jambi</option> <option value="247" data-country="80" >Lampung</option> <option value="248" data-country="80" >Maluku</option> <option value="249" data-country="80" >Maluku du Nord</option> <option value="250" data-country="80" >Sulawesi du Nord</option> <option value="251" data-country="80" >Sumatra-Nord</option> <option value="252" data-country="80" >Papouasie</option> <option value="253" data-country="80" >Riau</option> <option value="254" data-country="80" >Lambang Riau</option> <option value="255" data-country="80" >Sulawesi du sud-est</option> <option value="256" data-country="80" >Kalimantan du Sud</option> <option value="257" data-country="80" >Sulawesi du Sud</option> <option value="258" data-country="80" >Sumatra du Sud</option> <option value="259" data-country="80" >Java-Ouest</option> <option value="260" data-country="80" >Kalimantan occidental</option> <option value="261" data-country="80" >Nusa Tenggara occidental</option> <option value="262" data-country="80" >Lambang Provinsi Papua Barat</option> <option value="263" data-country="80" >Sulawesi occidental</option> <option value="264" data-country="80" >Sumatra occidental</option> <option value="265" data-country="80" >Yogyakarta</option> <option value="266" data-country="88" >Aichi</option> <option value="267" data-country="88" >Akita</option> <option value="268" data-country="88" >Aomori</option> <option value="269" data-country="88" >Chiba</option> <option value="270" data-country="88" >Ehime</option> <option value="271" data-country="88" >Fukui</option> <option value="272" data-country="88" >Fukuoka</option> <option value="273" data-country="88" >Fukushima</option> <option value="274" data-country="88" >Gifu</option> <option value="275" data-country="88" >Gunma</option> <option value="276" data-country="88" >Hiroshima</option> <option value="277" data-country="88" >Hokkaido</option> <option value="278" data-country="88" >Hyogo</option> <option value="279" data-country="88" >Ibaraki</option> <option value="280" data-country="88" >Ishikawa</option> <option value="281" data-country="88" >Iwate</option> <option value="282" data-country="88" >Kagawa</option> <option value="283" data-country="88" >Kagoshima</option> <option value="284" data-country="88" >Kanagawa</option> <option value="285" data-country="88" >Kochi</option> <option value="286" data-country="88" >Kumamoto</option> <option value="287" data-country="88" >Kyoto</option> <option value="288" data-country="88" >Mie</option> <option value="289" data-country="88" >Miyagi</option> <option value="290" data-country="88" >Miyazaki</option> <option value="291" data-country="88" >Nagano</option> <option value="292" data-country="88" >Nagasaki</option> <option value="293" data-country="88" >Nara</option> <option value="294" data-country="88" >Niigata</option> <option value="295" data-country="88" >Oita</option> <option value="296" data-country="88" >Okayama</option> <option value="297" data-country="88" >Okinawa</option> <option value="298" data-country="88" >Osaka</option> <option value="299" data-country="88" >Saga</option> <option value="300" data-country="88" >Saitama</option> <option value="301" data-country="88" >Shiga</option> <option value="302" data-country="88" >Shimane</option> <option value="303" data-country="88" >Shizuoka</option> <option value="304" data-country="88" >Tochigi</option> <option value="305" data-country="88" >Tokushima</option> <option value="306" data-country="88" >Tokyo</option> <option value="307" data-country="88" >Tottori</option> <option value="308" data-country="88" >Toyama</option> <option value="309" data-country="88" >Wakayama</option> <option value="310" data-country="88" >Yamagata</option> <option value="311" data-country="88" >Yamaguchi</option> <option value="312" data-country="88" >Yamanashi</option> </select> </div> </div><!--/.form-group--> </div> </fieldset> <fieldset id="register-login" class="panel panel-info"> <div class="panel-heading"> 3. Informations de connexion </div> <div class="panel-body"> <div class="form-group group-password"> <label class="control-label col-sm-3" for="password">Mot de passe <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="password" name="thelia_customer_create[password]" id="password" class="form-control" autocomplete="off" aria-required="true" required> </div> </div><!--/.form-group--> <div class="form-group group-password_confirm"> <label class="control-label col-sm-3" for="password_confirmation">Confirmation du mot de passe. <span class="required">*</span></label> <div class="control-input col-sm-5"> <input type="password" name="thelia_customer_create[password_confirm]" id="password_confirmation" class="form-control" autocomplete="off" aria-required="true" required> </div> </div><!--/.form-group--> </div> </fieldset> <div class="form-group group-newsletter" style="display:none"> <div class="control-input col-xs-11 col-sm-9 col-xs-offset-1 col-md-offset-3"> <div class="checkbox"> <label class="control-label" for="newsletter"> <input type="checkbox" name="thelia_customer_create[newsletter]" id="newsletter" value="1" >Je souhaite recevoir l'infolettre d鈥橝crimed. </label> </div> </div> </div><!--/.form-group--> <div class="form-group group-btn"> <div class="control-btn col-sm-5 col-sm-offset-3"> <button type="submit" class="btn btn-primary"><i class="fa fa-chevron-right"></i> S'inscrire</button> </div> </div><!--/.form-group--> </form> </article> </div><!-- /.layout --> <script>/* another ugly hack by alni */ var mademoiselle = document.querySelector('#title option[value="3"]'); mademoiselle.parentNode.removeChild(mademoiselle); </script> </div> </div><!-- /.container --> </main><!-- /.main-container --> <section class="footer-container" itemscope itemtype="http://schema.org/WPFooter"> <section class="footer-block"> <div class="container"> <div class="blocks row"> <br> </div> </div> </section> <section class="footer-block"> <div class="container"> <div class="blocks row"> <div class="col col-sm-3"> <section id="contact-footer-body" class="block block-contact"> <div class="block-heading"><h3 class="block-title">Contact</h3></div> <div class="block-content"> <div itemscope itemtype="http://schema.org/Organization"> <meta itemprop="name" content="Acrimed"> <ul> <li class="contact-address"> <address class="adr" itemprop="address" itemscope itemtype="http://schema.org/PostalAddress"> <span class="street-address" itemprop="streetAddress">Maison des associations 6 cours des Alli茅s </span><br> <span class="postal-code" itemprop="postalCode">35000</span> <span class="locality" itemprop="addressLocality"> Rennes , <span class="country-name">France m茅tropolitaine</span> </span> </address> </li> <li class="contact-contact"> <a href="https://boutique.acrimed.org/contact">Nous trouver, Nous contacter</a> </li> </ul> </div> </div> </section> </div> <div class="col col-sm-3"> <section id="links-footer-body" class="block 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