{"id":1331,"date":"2022-03-10T11:54:28","date_gmt":"2022-03-10T16:54:28","guid":{"rendered":"https:\/\/ladroit.org\/ladroit\/?page_id=1331"},"modified":"2022-03-17T12:32:51","modified_gmt":"2022-03-17T16:32:51","slug":"inscriptiondrsm","status":"publish","type":"page","link":"https:\/\/ladroit.org\/ladroit\/inscriptiondrsm\/","title":{"rendered":"Formulaire d&rsquo;inscription ou de modification de ressource sur DRSM"},"content":{"rendered":"\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1330-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"1330\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ladroit\/wp-json\/wp\/v2\/pages\/1331#wpcf7-f1330-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1330\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.2\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1330-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><label><br \/>\nVous voulez ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"intention\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"intention\"><option value=\"Entrer une nouvelle ressource\">Entrer une nouvelle ressource<\/option><option value=\"Modifier une ressource existante\">Modifier une ressource existante<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label><br \/>\nNote : S'il s'agit d'une nouvelle ressource, il est important d'avoir une adresse postale valide. S'il s'agit d'un changement \u00e0 une ressource existante, vous pouvez laisser les champs qui ne n\u00e9cessitent pas de changement vides. Normalement, les changements seront effectu\u00e9s dans un d\u00e9lai d'une semaine.<br \/>\n<\/label><br \/>\n<label> Nom de la ressource :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nomressource\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nomressource\" \/><\/span> <\/label>\n<\/p>\n<p><label> Courriel de la ressource (aussi le courriel o\u00f9 nous communiquerons avec vous):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"courrielressource\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"courrielressource\" \/><\/span> <\/label>\n<\/p>\n<p><label> R\u00e9gion Administrative :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"regionadministrative\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"regionadministrative\"><option value=\"01 Bas-du-Fleuve\">01 Bas-du-Fleuve<\/option><option value=\"02 Saguenay\/Lac-Saint-Jean\">02 Saguenay\/Lac-Saint-Jean<\/option><option value=\"03 Capitale-Nationale\">03 Capitale-Nationale<\/option><option value=\"04-17 Mauricie\/Centre-du-Qu\u00e9bec\">04-17 Mauricie\/Centre-du-Qu\u00e9bec<\/option><option value=\"05 Estrie\">05 Estrie<\/option><option value=\"06 Montr\u00e9al\">06 Montr\u00e9al<\/option><option value=\"07 Outaouais\">07 Outaouais<\/option><option value=\"08 Abitibi\/T\u00e9miscamingue\">08 Abitibi\/T\u00e9miscamingue<\/option><option value=\"09 C\u00f4te-Nord\">09 C\u00f4te-Nord<\/option><option value=\"10 Nord-du-Qu\u00e9bec\">10 Nord-du-Qu\u00e9bec<\/option><option value=\"11 Gasp\u00e9sie\/\u00celes-de-la-Madeleine\">11 Gasp\u00e9sie\/\u00celes-de-la-Madeleine<\/option><option value=\"12 Chaudi\u00e8re-Appalaches\">12 Chaudi\u00e8re-Appalaches<\/option><option value=\"13 Laval\">13 Laval<\/option><option value=\"14 Lanaudi\u00e8re\">14 Lanaudi\u00e8re<\/option><option value=\"15 Laurentides\">15 Laurentides<\/option><option value=\"16 Mont\u00e9r\u00e9gie\">16 Mont\u00e9r\u00e9gie<\/option><\/select><\/span><br \/>\n<\/label><br \/>\n<label> Adresse Postale Compl\u00e8te (vous pouvez entrer plusieurs adresses) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adresse\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"adresse\"><\/textarea><\/span><br \/>\n<\/label><br \/>\n<label> Num\u00e9ro de t\u00e9l\u00e9phone :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telephone1\" \/><\/span><br \/>\n<\/label><br \/>\n<label> Deuxi\u00e8me num\u00e9ro de t\u00e9l\u00e9phone :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telephone2\" \/><\/span><br \/>\n<\/label><br \/>\n<label> Num\u00e9ro de fax :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fax\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"fax\" \/><\/span><br \/>\n<\/label><br \/>\n<label> Site Web :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"siteweb\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-url wpcf7-text wpcf7-validates-as-url\" aria-invalid=\"false\" value=\"\" type=\"url\" name=\"siteweb\" \/><\/span><br \/>\n<\/label><br \/>\n<label> Page Facebook :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"facebook\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-url wpcf7-text wpcf7-validates-as-url\" aria-invalid=\"false\" value=\"\" type=\"url\" name=\"facebook\" \/><\/span><br \/>\n<\/label><br \/>\n<label> Cat\u00e9gories d'organisme (vous pouvez s\u00e9lectionner plusieurs cat\u00e9gories):<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"categories\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est une groupe de d\u00e9fense de droits\" \/><span class=\"wpcf7-list-item-label\">Est une groupe de d\u00e9fense de droits<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est un groupe alternatif r\u00e9gulier (membre du RRASMQ)\" \/><span class=\"wpcf7-list-item-label\">Est un groupe alternatif r\u00e9gulier (membre du RRASMQ)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est un groupe alternatif affili\u00e9 (membre du RRASMQ)\" \/><span class=\"wpcf7-list-item-label\">Est un groupe alternatif affili\u00e9 (membre du RRASMQ)<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est un groupe pour parents et proches\" \/><span class=\"wpcf7-list-item-label\">Est un groupe pour parents et proches<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Offre des services de crise\" \/><span class=\"wpcf7-list-item-label\">Offre des services de crise<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est un centre d&#039;appel\" \/><span class=\"wpcf7-list-item-label\">Est un centre d&#039;appel<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est un groupe d&#039;entraide\" \/><span class=\"wpcf7-list-item-label\">Est un groupe d&#039;entraide<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est une groupe promotion\/vigilance en droits\" \/><span class=\"wpcf7-list-item-label\">Est une groupe promotion\/vigilance en droits<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Pratique la Gestion autonome de la m\u00e9dication\" \/><span class=\"wpcf7-list-item-label\">Pratique la Gestion autonome de la m\u00e9dication<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Offre de l&#039;h\u00e9bergement de courte dur\u00e9e\" \/><span class=\"wpcf7-list-item-label\">Offre de l&#039;h\u00e9bergement de courte dur\u00e9e<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Offre de l&#039;h\u00e9bergement de longue dur\u00e9e\" \/><span class=\"wpcf7-list-item-label\">Offre de l&#039;h\u00e9bergement de longue dur\u00e9e<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"categories[]\" value=\"Offre des services d&#039;int\u00e9gration socioprofessionnel\" \/><span class=\"wpcf7-list-item-label\">Offre des services d&#039;int\u00e9gration socioprofessionnel<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"categories[]\" value=\"Est membre SMQ\" \/><span class=\"wpcf7-list-item-label\">Est membre SMQ<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label> Description de votre organisme (maximum 200 lignes) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"description\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"description\"><\/textarea><\/span><br \/>\n<\/label><br \/>\n<label> Toutes autres questions ou commentaires:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"questioncommentaire\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"questioncommentaire\"><\/textarea><\/span><br \/>\n<\/label><br \/>\n<label>Note : Veuillez attendre quelque instants apr\u00e8s avoir press\u00e9 le bouton \"Envoyer\". Un encadr\u00e9 vert appara\u00eetra pour confirmer l'envoi de votre formulaire. Vous devriez recevoir un avis de confirmation au courriel que vous avez donn\u00e9 pour votre organisme.<\/label><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"112\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"two_page_speed":[],"footnotes":""},"class_list":["post-1331","page","type-page","status-publish","czr-hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/pages\/1331","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/comments?post=1331"}],"version-history":[{"count":1,"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/pages\/1331\/revisions"}],"predecessor-version":[{"id":1332,"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/pages\/1331\/revisions\/1332"}],"wp:attachment":[{"href":"https:\/\/ladroit.org\/ladroit\/wp-json\/wp\/v2\/media?parent=1331"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}