{"id":432,"date":"2025-09-07T23:20:04","date_gmt":"2025-09-07T23:20:04","guid":{"rendered":"https:\/\/agir.ca\/?page_id=432"},"modified":"2026-01-30T20:15:25","modified_gmt":"2026-01-30T20:15:25","slug":"formulaires","status":"publish","type":"page","link":"https:\/\/agir.ca\/index.php\/formulaires\/","title":{"rendered":"Adh\u00e9sion"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"432\" class=\"elementor elementor-432\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ec76d55 e-flex e-con-boxed e-con e-child\" data-id=\"ec76d55\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-c87178e e-con-full e-flex e-con e-child\" data-id=\"c87178e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-71dbeea e-con-full e-flex e-con e-child\" data-id=\"71dbeea\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-75456d9 elementor-widget elementor-widget-heading\" data-id=\"75456d9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Formulaire <br>d'adh\u00e9sion<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1602e21 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"1602e21\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Merci de votre int\u00e9r\u00eat \u00e0 rejoindre notre organisation ! Pour finaliser votre inscription en tant que membre, veuillez suivre les \u00e9tapes ci-dessous :<\/p><ol><li><p><strong>Remplissez le formulaire d&rsquo;adh\u00e9sion<\/strong>\u00a0: Vous trouverez ci-joint le formulaire \u00e0 compl\u00e9ter. Merci de remplir toutes les informations demand\u00e9es avec pr\u00e9cision.<\/p><\/li><li><p><strong>Effectuez le paiement<\/strong>\u00a0: Une cotisation annuelle de 10$ est requise pour devenir membre. Veuillez envoyer votre paiement par : Interac ou un ch\u00e8que.<\/p><\/li><li><p><strong>Recevez votre carte de membre<\/strong>\u00a0: Une fois le formulaire compl\u00e9t\u00e9 et le paiement re\u00e7u, vous recevrez votre carte de membre annuelle, qui vous permettra de profiter de tous les avantages r\u00e9serv\u00e9s aux membres.<\/p><\/li><\/ol><p>Si vous avez des questions ou des difficult\u00e9s, n\u2019h\u00e9sitez pas \u00e0 nous contacter \u00e0 <a href=\"mailto:reins@agir.ca\">reins@agir.ca<\/a> ou (514) 852-9297.<\/p><p>Bienvenue parmi nous !<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e3710d4 e-flex e-con-boxed e-con e-parent\" data-id=\"e3710d4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-851e87b elementor-widget elementor-widget-text-editor\" data-id=\"851e87b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>\u00ab\u00a0Je soussign\u00e9(e) d\u00e9sire devenir membre de l&rsquo;Association G\u00e9n\u00e9rale des Insuffisants R\u00e9naux.<br \/>Je joins \u00e0 ma demande un ch\u00e8que libell\u00e9 \u00e0 l&rsquo;Association G\u00e9n\u00e9rale des Insuffisants R\u00e9naux.<br \/>Interac \u00e0 reins@agir.ca, indiquer ce mot de passe en minuscule \u00ab\u00a0agir\u00a0\u00bb, au montant de DIX dollars (10 $)<br \/>en paiement de la cotisation annuelle, COCHEZ S.V.P. (<img decoding=\"async\" class=\"emoji\" role=\"img\" draggable=\"false\" src=\"https:\/\/s.w.org\/images\/core\/emoji\/16.0.1\/svg\/2714.svg\" alt=\"\u2714\" \/>)\u00a0\u00bb<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e831822 e-flex e-con-boxed e-con e-parent\" data-id=\"e831822\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9016cf5 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"9016cf5\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Nouveau formulaire\" aria-label=\"Nouveau formulaire\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"432\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9016cf5\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Adh\u00e9sion\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"432\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_95c7ce2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_95c7ce2\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tType de membre\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" H\u00e9modialyse hospitali\u00e8re\" id=\"form-field-field_95c7ce2-0\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-0\"> H\u00e9modialyse hospitali\u00e8re<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"H\u00e9modialyse \u00e0 domicile\" id=\"form-field-field_95c7ce2-1\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-1\">H\u00e9modialyse \u00e0 domicile<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dialyse p\u00e9riton\u00e9ale\" id=\"form-field-field_95c7ce2-2\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-2\">Dialyse p\u00e9riton\u00e9ale<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Protection r\u00e9nale\" id=\"form-field-field_95c7ce2-3\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-3\">Protection r\u00e9nale<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Greff\u00e9(e)\" id=\"form-field-field_95c7ce2-4\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-4\">Greff\u00e9(e)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Donneur vivant\" id=\"form-field-field_95c7ce2-5\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-5\">Donneur vivant<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sympathisan\" id=\"form-field-field_95c7ce2-6\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-6\">Sympathisan<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Autre\" id=\"form-field-field_95c7ce2-7\" name=\"form_fields[field_95c7ce2][]\"> <label for=\"form-field-field_95c7ce2-7\">Autre<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPr\u00e9nom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Pr\u00e9nom\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tNom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_48f4855 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_48f4855\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tHopital\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_48f4855]\" id=\"form-field-field_48f4855\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Quel est le nom de votre centre hospitalier:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_44d3283 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_44d3283\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tD\u00e9but Dialyse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_44d3283]\" id=\"form-field-field_44d3283\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\" Depuis quand \u00eates-vous dialys\u00e9(e):\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ace1ff6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ace1ff6\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDate greffe\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ace1ff6]\" id=\"form-field-field_ace1ff6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\" Depuis quel ann\u00e9e avez-vous \u00e9t\u00e9 greff\u00e9:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_fc7a56e elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fc7a56e\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAdresse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_fc7a56e]\" id=\"form-field-field_fc7a56e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adresse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_19c7e2f elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_19c7e2f\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tVille\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_19c7e2f]\" id=\"form-field-field_19c7e2f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ville:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c5d1c33 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c5d1c33\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tProvince\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c5d1c33]\" id=\"form-field-field_c5d1c33\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Province:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e3ca3e0 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e3ca3e0\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCode Postal\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e3ca3e0]\" id=\"form-field-field_e3ca3e0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Code postal:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_099c8ff elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_099c8ff\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tTel Residence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_099c8ff]\" id=\"form-field-field_099c8ff\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"T\u00e9l\u00e9phone r\u00e9sidence:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f8710cd elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f8710cd\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tTel Travail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f8710cd]\" id=\"form-field-field_f8710cd\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\" T\u00e9l\u00e9phone travail:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_81afe59 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_81afe59\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tTel Cellulaire\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_81afe59]\" id=\"form-field-field_81afe59\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"T\u00e9l\u00e9phone cellulaire:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_033021e elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_033021e\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCourriel\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_033021e]\" id=\"form-field-field_033021e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\" Courriel:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_100da1b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_100da1b\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDate Naissance\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_100da1b]\" id=\"form-field-field_100da1b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Date de naissance:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0f3b053 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0f3b053\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tOccupation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0f3b053]\" id=\"form-field-field_0f3b053\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Occupation:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Formulaire d&rsquo;adh\u00e9sion Merci de votre int\u00e9r\u00eat \u00e0 rejoindre notre organisation ! Pour finaliser votre inscription en tant que membre, veuillez suivre les \u00e9tapes ci-dessous : Remplissez le formulaire d&rsquo;adh\u00e9sion\u00a0: Vous trouverez ci-joint le formulaire \u00e0 compl\u00e9ter. Merci de remplir toutes les informations demand\u00e9es avec pr\u00e9cision. 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