{"id":3922,"date":"2026-08-06T16:08:27","date_gmt":"2026-08-06T16:08:27","guid":{"rendered":"https:\/\/unde-uedn.com\/?page_id=3922"},"modified":"2026-09-01T18:58:54","modified_gmt":"2026-09-01T18:58:54","slug":"demande-de-remboursement-des-depenses-dun-membre","status":"publish","type":"page","link":"https:\/\/unde-uedn.com\/fr\/demande-de-remboursement-des-depenses-dun-membre\/","title":{"rendered":"Demande de remboursement des d\u00e9penses d&rsquo;un membre"},"content":{"rendered":"<style id=\"wpforms-css-vars-3902\">\n\t\t\t\t#wpforms-3902 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3902\"><form id=\"wpforms-form-3902\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3902\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/3922?wpforms_form_id=3902\" data-token=\"e763e2dafac106fba12a4a4a788f94ea\" data-token-time=\"1792702746\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3902-field_3-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"3\"><div id=\"wpforms-3902-field_3\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_3-error\"><h2><strong>Veuillez lire attentivement<\/strong><\/h2>\n<h3>Num\u00e9ro d\u2019assurance sociale (NAS)<\/h3>\n<p>Lorsque vous demandez le remboursement d\u2019un salaire, nous avons besoin de votre\u00a0<strong>num\u00e9ro d\u2019assurance sociale<\/strong>\u00a0pour la v\u00e9rification et aux fins de l\u2019imp\u00f4t sur le revenu. Veuillez noter que nous ne pouvons pas utiliser votre num\u00e9ro CIDP. \u00a0De ne pas indiquer votre num\u00e9ro d\u2019assurance sociale lors de la r\u00e9clamation d\u2019un salaire entra\u00eenera un retard dans le traitement de votre r\u00e9clamation.\u00a0 Si vous avez d\u00e9j\u00e0 fourni votre num\u00e9ro d\u2019assurance sociale, vous pouvez laisser cette section vide.<\/p>\n<h3>Sp\u00e9cimen de ch\u00e8que annul\u00e9<\/h3>\n<p>Si vous demandez le d\u00e9p\u00f4t direct de votre r\u00e9clamation, vous devrez fournir un sp\u00e9cimen de ch\u00e8que annul\u00e9. Si vous avez d\u00e9j\u00e0 fourni ces informations, il n\u2019est pas n\u00e9cessaire de resoumettre le sp\u00e9cimen.<\/p>\n<p>Si vous ne voulez pas soumettre votre NAS ou votre information bancaire en ligne, veuillez contacter Amanda Agnew au 1-866-594-4505, poste 27 ou \u00e0 l\u2019adresse suivante: aagnew@unde.org<\/p>\n<h3>Re\u00e7us<\/h3>\n<p>Tous les re\u00e7us (taxi, h\u00f4tel, stationnement, etc.) doivent \u00eatre joints; \u00e0 d\u00e9faut, le traitement de votre demande sera retard\u00e9. Cela ne s\u2019applique pas aux repas, car des indemnit\u00e9s journali\u00e8res sont pr\u00e9vues \u00e0 cet effet.<\/p>\n<h3>Politique de voyage de l\u2019UEDN<\/h3>\n<p>Assurez-vous de bien conna\u00eetre <a href=\"https:\/\/unde-uedn.com\/wp-content\/uploads\/2026\/08\/UNDE_politque_sur_les_voyages_FR_avril-2018-1.pdf\">la politique de l\u2019UEDN sur les voyages.<\/a><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_5\">Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3902-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-3902-field_5-error\" required><\/div><div id=\"wpforms-3902-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_4\">Nom de famille <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3902-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-3902-field_4-error\" required><\/div><div id=\"wpforms-3902-field_6-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Addresse <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3902-field_6\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][6][address1]\" aria-errormessage=\"wpforms-3902-field_6-error\" required><label for=\"wpforms-3902-field_6\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3902-field_6-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][6][address2]\" aria-errormessage=\"wpforms-3902-field_6-address2-error\" ><label for=\"wpforms-3902-field_6-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 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-3902-field_6-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][6][city]\" aria-errormessage=\"wpforms-3902-field_6-city-error\" required><label for=\"wpforms-3902-field_6-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3902-field_6-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][6][state]\" aria-errormessage=\"wpforms-3902-field_6-state-error\" required><label for=\"wpforms-3902-field_6-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/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-3902-field_6-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][6][postal]\" aria-errormessage=\"wpforms-3902-field_6-postal-error\" required><label for=\"wpforms-3902-field_6-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-3902-field_6-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][6][country]\" aria-errormessage=\"wpforms-3902-field_6-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- S\u00e9lectionner\u00a0: country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/option><option value=\"DE\" >Allemagne<\/option><option value=\"AD\" >Andorre<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctique<\/option><option value=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"SA\" >Arabie saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint-Eustache et Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BN\" >Brun\u00e9i Darussalam<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\" >France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration de Russie<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud-et-les \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordanie<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KG\" >Kirghizistan<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malaisie<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malte<\/option><option value=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palaos<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint-Barth\u00e9lemy<\/option><option value=\"KN\" >Saint-Christophe-et-Ni\u00e9v\u00e8s<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (Antilles fran\u00e7aises)<\/option><option value=\"SX\" >Saint-Martin (royaume des Pays-Bas)<\/option><option value=\"PM\" >Saint-Pierre-et-Miquelon<\/option><option value=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9-et-Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"TR\" >Turquie<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis-et-Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la Cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard-et-MacDonald<\/option><option value=\"FK\" >\u00celes Malouines<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><label for=\"wpforms-3902-field_6-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3902-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_7\">Locale <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3902-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-3902-field_7-error\" required><\/div><div id=\"wpforms-3902-field_62-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_62\">NAS<\/label><input type=\"text\" id=\"wpforms-3902-field_62\" class=\"wpforms-field-medium\" name=\"wpforms[fields][62]\" aria-errormessage=\"wpforms-3902-field_62-error\" aria-describedby=\"wpforms-3902-field_62-description\" ><div id=\"wpforms-3902-field_62-description\" class=\"wpforms-field-description\">If you are not comfortable submitting your SIN information online, please contact Amanda Agnew at 1-866-594-4505 x 27 or at claims@unde.org<\/div><\/div><div id=\"wpforms-3902-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_8\">T\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-3902-field_8\" class=\"wpforms-field-medium wpforms-field-required\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][8]\" aria-label=\"T\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-3902-field_8-error\" required><\/div><div id=\"wpforms-3902-field_9-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_9\">Courriel <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3902-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3902-field_9-error\" required><\/div><div id=\"wpforms-3902-field_10-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">R\u00e9clamer son salaire?<\/legend><ul id=\"wpforms-3902-field_10\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3902-field_10_1\" name=\"wpforms[fields][10]\" value=\"Yes\" aria-errormessage=\"wpforms-3902-field_10_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3902-field_10_2\" name=\"wpforms[fields][10]\" value=\"No\" aria-errormessage=\"wpforms-3902-field_10_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_10_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3902-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">D\u00e9p\u00f4t direct?<\/legend><ul id=\"wpforms-3902-field_11\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3902-field_11_1\" name=\"wpforms[fields][11]\" value=\"Yes\" aria-errormessage=\"wpforms-3902-field_11_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_11_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3902-field_11_2\" name=\"wpforms[fields][11]\" value=\"No\" aria-errormessage=\"wpforms-3902-field_11_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_11_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3902-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_12\">Activit\u00e9 li\u00e9e \u00e0 la r\u00e9clamation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-3902-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Select Choice ---<\/option><option value=\"R\u00e9union\"  class=\"choice-1 depth-1\"  >R\u00e9union<\/option><option value=\"Conf\u00e9rence\"  class=\"choice-2 depth-1\"  >Conf\u00e9rence<\/option><option value=\"Formation\"  class=\"choice-3 depth-1\"  >Formation<\/option><\/select><\/div><div id=\"wpforms-3902-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_13\">Nom de l&#039;activit\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3902-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-3902-field_13-error\" required><\/div><div id=\"wpforms-3902-field_14-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"14\"><div id=\"wpforms-3902-field_14\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_14-error\"><h1>D\u00e9pense<\/h1>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_28-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"28\"><div id=\"wpforms-3902-field_28\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_28-error\"><h3>Voyages<\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_15-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">D\u00e9placements (cochez toutes les cases qui s\u2019appliquent) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3902-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3902-field_15_1\" name=\"wpforms[fields][15][]\" value=\"Kilom\u00e9trage\" aria-errormessage=\"wpforms-3902-field_15_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_15_1\">Kilom\u00e9trage<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3902-field_15_2\" name=\"wpforms[fields][15][]\" value=\"Stationnement\" aria-errormessage=\"wpforms-3902-field_15_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_15_2\">Stationnement<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3902-field_15_3\" name=\"wpforms[fields][15][]\" value=\"Taxi\" aria-errormessage=\"wpforms-3902-field_15_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_15_3\">Taxi<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3902-field_15_4\" name=\"wpforms[fields][15][]\" value=\"Autres\" aria-errormessage=\"wpforms-3902-field_15_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_15_4\">Autres<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3902-field_17-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-conditional-field wpforms-conditional-show wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"17\" style=\"display:none;\"><label class=\"wpforms-field-label\">Kilom\u00e9trage<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">Prix : <span class=\"wpforms-price\">&#036;0.66<\/span><\/div><select id=\"wpforms-3902-field_17-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][17]\"><option value=\"0\"  selected='selected' >0<\/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><option value=\"32\"  >32<\/option><option value=\"33\"  >33<\/option><option value=\"34\"  >34<\/option><option value=\"35\"  >35<\/option><option value=\"36\"  >36<\/option><option value=\"37\"  >37<\/option><option value=\"38\"  >38<\/option><option value=\"39\"  >39<\/option><option value=\"40\"  >40<\/option><option value=\"41\"  >41<\/option><option value=\"42\"  >42<\/option><option value=\"43\"  >43<\/option><option value=\"44\"  >44<\/option><option value=\"45\"  >45<\/option><option value=\"46\"  >46<\/option><option value=\"47\"  >47<\/option><option value=\"48\"  >48<\/option><option value=\"49\"  >49<\/option><option value=\"50\"  >50<\/option><option value=\"51\"  >51<\/option><option value=\"52\"  >52<\/option><option value=\"53\"  >53<\/option><option value=\"54\"  >54<\/option><option value=\"55\"  >55<\/option><option value=\"56\"  >56<\/option><option value=\"57\"  >57<\/option><option value=\"58\"  >58<\/option><option value=\"59\"  >59<\/option><option value=\"60\"  >60<\/option><option value=\"61\"  >61<\/option><option value=\"62\"  >62<\/option><option value=\"63\"  >63<\/option><option value=\"64\"  >64<\/option><option value=\"65\"  >65<\/option><option value=\"66\"  >66<\/option><option value=\"67\"  >67<\/option><option value=\"68\"  >68<\/option><option value=\"69\"  >69<\/option><option value=\"70\"  >70<\/option><option value=\"71\"  >71<\/option><option value=\"72\"  >72<\/option><option value=\"73\"  >73<\/option><option value=\"74\"  >74<\/option><option value=\"75\"  >75<\/option><option value=\"76\"  >76<\/option><option value=\"77\"  >77<\/option><option value=\"78\"  >78<\/option><option value=\"79\"  >79<\/option><option value=\"80\"  >80<\/option><option value=\"81\"  >81<\/option><option value=\"82\"  >82<\/option><option value=\"83\"  >83<\/option><option value=\"84\"  >84<\/option><option value=\"85\"  >85<\/option><option value=\"86\"  >86<\/option><option value=\"87\"  >87<\/option><option value=\"88\"  >88<\/option><option value=\"89\"  >89<\/option><option value=\"90\"  >90<\/option><option value=\"91\"  >91<\/option><option value=\"92\"  >92<\/option><option value=\"93\"  >93<\/option><option value=\"94\"  >94<\/option><option value=\"95\"  >95<\/option><option value=\"96\"  >96<\/option><option value=\"97\"  >97<\/option><option value=\"98\"  >98<\/option><option value=\"99\"  >99<\/option><option value=\"100\"  >100<\/option><option value=\"101\"  >101<\/option><option value=\"102\"  >102<\/option><option value=\"103\"  >103<\/option><option value=\"104\"  >104<\/option><option value=\"105\"  >105<\/option><option value=\"106\"  >106<\/option><option value=\"107\"  >107<\/option><option value=\"108\"  >108<\/option><option value=\"109\"  >109<\/option><option value=\"110\"  >110<\/option><option value=\"111\"  >111<\/option><option value=\"112\"  >112<\/option><option value=\"113\"  >113<\/option><option value=\"114\"  >114<\/option><option value=\"115\"  >115<\/option><option value=\"116\"  >116<\/option><option value=\"117\"  >117<\/option><option value=\"118\"  >118<\/option><option value=\"119\"  >119<\/option><option value=\"120\"  >120<\/option><option value=\"121\"  >121<\/option><option value=\"122\"  >122<\/option><option value=\"123\"  >123<\/option><option value=\"124\"  >124<\/option><option value=\"125\"  >125<\/option><option value=\"126\"  >126<\/option><option value=\"127\"  >127<\/option><option value=\"128\"  >128<\/option><option value=\"129\"  >129<\/option><option value=\"130\"  >130<\/option><option value=\"131\"  >131<\/option><option value=\"132\"  >132<\/option><option value=\"133\"  >133<\/option><option value=\"134\"  >134<\/option><option value=\"135\"  >135<\/option><option value=\"136\"  >136<\/option><option value=\"137\"  >137<\/option><option value=\"138\"  >138<\/option><option value=\"139\"  >139<\/option><option value=\"140\"  >140<\/option><option value=\"141\"  >141<\/option><option value=\"142\"  >142<\/option><option value=\"143\"  >143<\/option><option value=\"144\"  >144<\/option><option value=\"145\"  >145<\/option><option value=\"146\"  >146<\/option><option value=\"147\"  >147<\/option><option value=\"148\"  >148<\/option><option value=\"149\"  >149<\/option><option value=\"150\"  >150<\/option><option value=\"151\"  >151<\/option><option value=\"152\"  >152<\/option><option value=\"153\"  >153<\/option><option value=\"154\"  >154<\/option><option value=\"155\"  >155<\/option><option value=\"156\"  >156<\/option><option value=\"157\"  >157<\/option><option value=\"158\"  >158<\/option><option value=\"159\"  >159<\/option><option value=\"160\"  >160<\/option><option value=\"161\"  >161<\/option><option value=\"162\"  >162<\/option><option value=\"163\"  >163<\/option><option value=\"164\"  >164<\/option><option value=\"165\"  >165<\/option><option value=\"166\"  >166<\/option><option value=\"167\"  >167<\/option><option value=\"168\"  >168<\/option><option value=\"169\"  >169<\/option><option value=\"170\"  >170<\/option><option value=\"171\"  >171<\/option><option value=\"172\"  >172<\/option><option value=\"173\"  >173<\/option><option value=\"174\"  >174<\/option><option value=\"175\"  >175<\/option><option value=\"176\"  >176<\/option><option value=\"177\"  >177<\/option><option value=\"178\"  >178<\/option><option value=\"179\"  >179<\/option><option value=\"180\"  >180<\/option><option value=\"181\"  >181<\/option><option value=\"182\"  >182<\/option><option value=\"183\"  >183<\/option><option value=\"184\"  >184<\/option><option value=\"185\"  >185<\/option><option value=\"186\"  >186<\/option><option value=\"187\"  >187<\/option><option value=\"188\"  >188<\/option><option value=\"189\"  >189<\/option><option value=\"190\"  >190<\/option><option value=\"191\"  >191<\/option><option value=\"192\"  >192<\/option><option value=\"193\"  >193<\/option><option value=\"194\"  >194<\/option><option value=\"195\"  >195<\/option><option value=\"196\"  >196<\/option><option value=\"197\"  >197<\/option><option value=\"198\"  >198<\/option><option value=\"199\"  >199<\/option><option value=\"200\"  >200<\/option><option value=\"201\"  >201<\/option><option value=\"202\"  >202<\/option><option value=\"203\"  >203<\/option><option value=\"204\"  >204<\/option><option value=\"205\"  >205<\/option><option value=\"206\"  >206<\/option><option value=\"207\"  >207<\/option><option value=\"208\"  >208<\/option><option value=\"209\"  >209<\/option><option value=\"210\"  >210<\/option><option value=\"211\"  >211<\/option><option value=\"212\"  >212<\/option><option value=\"213\"  >213<\/option><option value=\"214\"  >214<\/option><option value=\"215\"  >215<\/option><option value=\"216\"  >216<\/option><option value=\"217\"  >217<\/option><option value=\"218\"  >218<\/option><option value=\"219\"  >219<\/option><option value=\"220\"  >220<\/option><option value=\"221\"  >221<\/option><option value=\"222\"  >222<\/option><option value=\"223\"  >223<\/option><option value=\"224\"  >224<\/option><option value=\"225\"  >225<\/option><option value=\"226\"  >226<\/option><option value=\"227\"  >227<\/option><option value=\"228\"  >228<\/option><option value=\"229\"  >229<\/option><option value=\"230\"  >230<\/option><option value=\"231\"  >231<\/option><option value=\"232\"  >232<\/option><option value=\"233\"  >233<\/option><option value=\"234\"  >234<\/option><option value=\"235\"  >235<\/option><option value=\"236\"  >236<\/option><option value=\"237\"  >237<\/option><option value=\"238\"  >238<\/option><option value=\"239\"  >239<\/option><option value=\"240\"  >240<\/option><option value=\"241\"  >241<\/option><option value=\"242\"  >242<\/option><option value=\"243\"  >243<\/option><option value=\"244\"  >244<\/option><option value=\"245\"  >245<\/option><option value=\"246\"  >246<\/option><option value=\"247\"  >247<\/option><option value=\"248\"  >248<\/option><option value=\"249\"  >249<\/option><option value=\"250\"  >250<\/option><option value=\"251\"  >251<\/option><option value=\"252\"  >252<\/option><option value=\"253\"  >253<\/option><option value=\"254\"  >254<\/option><option value=\"255\"  >255<\/option><option value=\"256\"  >256<\/option><option value=\"257\"  >257<\/option><option value=\"258\"  >258<\/option><option value=\"259\"  >259<\/option><option value=\"260\"  >260<\/option><option value=\"261\"  >261<\/option><option value=\"262\"  >262<\/option><option value=\"263\"  >263<\/option><option value=\"264\"  >264<\/option><option value=\"265\"  >265<\/option><option value=\"266\"  >266<\/option><option value=\"267\"  >267<\/option><option value=\"268\"  >268<\/option><option value=\"269\"  >269<\/option><option value=\"270\"  >270<\/option><option value=\"271\"  >271<\/option><option value=\"272\"  >272<\/option><option value=\"273\"  >273<\/option><option value=\"274\"  >274<\/option><option value=\"275\"  >275<\/option><option value=\"276\"  >276<\/option><option value=\"277\"  >277<\/option><option value=\"278\"  >278<\/option><option value=\"279\"  >279<\/option><option value=\"280\"  >280<\/option><option value=\"281\"  >281<\/option><option value=\"282\"  >282<\/option><option value=\"283\"  >283<\/option><option value=\"284\"  >284<\/option><option value=\"285\"  >285<\/option><option value=\"286\"  >286<\/option><option value=\"287\"  >287<\/option><option value=\"288\"  >288<\/option><option value=\"289\"  >289<\/option><option value=\"290\"  >290<\/option><option value=\"291\"  >291<\/option><option value=\"292\"  >292<\/option><option value=\"293\"  >293<\/option><option value=\"294\"  >294<\/option><option value=\"295\"  >295<\/option><option value=\"296\"  >296<\/option><option value=\"297\"  >297<\/option><option value=\"298\"  >298<\/option><option value=\"299\"  >299<\/option><option value=\"300\"  >300<\/option><option value=\"301\"  >301<\/option><option value=\"302\"  >302<\/option><option value=\"303\"  >303<\/option><option value=\"304\"  >304<\/option><option value=\"305\"  >305<\/option><option value=\"306\"  >306<\/option><option value=\"307\"  >307<\/option><option value=\"308\"  >308<\/option><option value=\"309\"  >309<\/option><option value=\"310\"  >310<\/option><option value=\"311\"  >311<\/option><option value=\"312\"  >312<\/option><option value=\"313\"  >313<\/option><option value=\"314\"  >314<\/option><option value=\"315\"  >315<\/option><option value=\"316\"  >316<\/option><option value=\"317\"  >317<\/option><option value=\"318\"  >318<\/option><option value=\"319\"  >319<\/option><option value=\"320\"  >320<\/option><option value=\"321\"  >321<\/option><option value=\"322\"  >322<\/option><option value=\"323\"  >323<\/option><option value=\"324\"  >324<\/option><option value=\"325\"  >325<\/option><option value=\"326\"  >326<\/option><option value=\"327\"  >327<\/option><option value=\"328\"  >328<\/option><option value=\"329\"  >329<\/option><option value=\"330\"  >330<\/option><option value=\"331\"  >331<\/option><option value=\"332\"  >332<\/option><option value=\"333\"  >333<\/option><option value=\"334\"  >334<\/option><option value=\"335\"  >335<\/option><option value=\"336\"  >336<\/option><option value=\"337\"  >337<\/option><option value=\"338\"  >338<\/option><option value=\"339\"  >339<\/option><option value=\"340\"  >340<\/option><option value=\"341\"  >341<\/option><option value=\"342\"  >342<\/option><option value=\"343\"  >343<\/option><option value=\"344\"  >344<\/option><option value=\"345\"  >345<\/option><option value=\"346\"  >346<\/option><option value=\"347\"  >347<\/option><option value=\"348\"  >348<\/option><option value=\"349\"  >349<\/option><option value=\"350\"  >350<\/option><option value=\"351\"  >351<\/option><option value=\"352\"  >352<\/option><option value=\"353\"  >353<\/option><option value=\"354\"  >354<\/option><option value=\"355\"  >355<\/option><option value=\"356\"  >356<\/option><option value=\"357\"  >357<\/option><option value=\"358\"  >358<\/option><option value=\"359\"  >359<\/option><option value=\"360\"  >360<\/option><option value=\"361\"  >361<\/option><option value=\"362\"  >362<\/option><option value=\"363\"  >363<\/option><option value=\"364\"  >364<\/option><option value=\"365\"  >365<\/option><option value=\"366\"  >366<\/option><option value=\"367\"  >367<\/option><option value=\"368\"  >368<\/option><option value=\"369\"  >369<\/option><option value=\"370\"  >370<\/option><option value=\"371\"  >371<\/option><option value=\"372\"  >372<\/option><option value=\"373\"  >373<\/option><option value=\"374\"  >374<\/option><option value=\"375\"  >375<\/option><option value=\"376\"  >376<\/option><option value=\"377\"  >377<\/option><option value=\"378\"  >378<\/option><option value=\"379\"  >379<\/option><option value=\"380\"  >380<\/option><option value=\"381\"  >381<\/option><option value=\"382\"  >382<\/option><option value=\"383\"  >383<\/option><option value=\"384\"  >384<\/option><option value=\"385\"  >385<\/option><option value=\"386\"  >386<\/option><option value=\"387\"  >387<\/option><option value=\"388\"  >388<\/option><option value=\"389\"  >389<\/option><option value=\"390\"  >390<\/option><option value=\"391\"  >391<\/option><option value=\"392\"  >392<\/option><option value=\"393\"  >393<\/option><option value=\"394\"  >394<\/option><option value=\"395\"  >395<\/option><option value=\"396\"  >396<\/option><option value=\"397\"  >397<\/option><option value=\"398\"  >398<\/option><option value=\"399\"  >399<\/option><option value=\"400\"  >400<\/option><option value=\"401\"  >401<\/option><option value=\"402\"  >402<\/option><option value=\"403\"  >403<\/option><option value=\"404\"  >404<\/option><option value=\"405\"  >405<\/option><option value=\"406\"  >406<\/option><option value=\"407\"  >407<\/option><option value=\"408\"  >408<\/option><option value=\"409\"  >409<\/option><option value=\"410\"  >410<\/option><option value=\"411\"  >411<\/option><option value=\"412\"  >412<\/option><option value=\"413\"  >413<\/option><option value=\"414\"  >414<\/option><option value=\"415\"  >415<\/option><option value=\"416\"  >416<\/option><option value=\"417\"  >417<\/option><option value=\"418\"  >418<\/option><option value=\"419\"  >419<\/option><option value=\"420\"  >420<\/option><option value=\"421\"  >421<\/option><option value=\"422\"  >422<\/option><option value=\"423\"  >423<\/option><option 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value=\"1527\"  >1527<\/option><option value=\"1528\"  >1528<\/option><option value=\"1529\"  >1529<\/option><option value=\"1530\"  >1530<\/option><option value=\"1531\"  >1531<\/option><option value=\"1532\"  >1532<\/option><option value=\"1533\"  >1533<\/option><option value=\"1534\"  >1534<\/option><option value=\"1535\"  >1535<\/option><option value=\"1536\"  >1536<\/option><option value=\"1537\"  >1537<\/option><option value=\"1538\"  >1538<\/option><option value=\"1539\"  >1539<\/option><option value=\"1540\"  >1540<\/option><option value=\"1541\"  >1541<\/option><option value=\"1542\"  >1542<\/option><option value=\"1543\"  >1543<\/option><option value=\"1544\"  >1544<\/option><option value=\"1545\"  >1545<\/option><option value=\"1546\"  >1546<\/option><option value=\"1547\"  >1547<\/option><option value=\"1548\"  >1548<\/option><option value=\"1549\"  >1549<\/option><option value=\"1550\"  >1550<\/option><option value=\"1551\"  >1551<\/option><option value=\"1552\"  >1552<\/option><option value=\"1553\"  >1553<\/option><option value=\"1554\"  >1554<\/option><option value=\"1555\"  >1555<\/option><option value=\"1556\"  >1556<\/option><option value=\"1557\"  >1557<\/option><option value=\"1558\"  >1558<\/option><option value=\"1559\"  >1559<\/option><option value=\"1560\"  >1560<\/option><option value=\"1561\"  >1561<\/option><option value=\"1562\"  >1562<\/option><option value=\"1563\"  >1563<\/option><option value=\"1564\"  >1564<\/option><option value=\"1565\"  >1565<\/option><option value=\"1566\"  >1566<\/option><option value=\"1567\"  >1567<\/option><option value=\"1568\"  >1568<\/option><option value=\"1569\"  >1569<\/option><option value=\"1570\"  >1570<\/option><option value=\"1571\"  >1571<\/option><option value=\"1572\"  >1572<\/option><option value=\"1573\"  >1573<\/option><option value=\"1574\"  >1574<\/option><option value=\"1575\"  >1575<\/option><option value=\"1576\"  >1576<\/option><option value=\"1577\"  >1577<\/option><option value=\"1578\"  >1578<\/option><option value=\"1579\"  >1579<\/option><option value=\"1580\"  >1580<\/option><option value=\"1581\"  >1581<\/option><option value=\"1582\"  >1582<\/option><option value=\"1583\"  >1583<\/option><option value=\"1584\"  >1584<\/option><option value=\"1585\"  >1585<\/option><option value=\"1586\"  >1586<\/option><option value=\"1587\"  >1587<\/option><option value=\"1588\"  >1588<\/option><option value=\"1589\"  >1589<\/option><option value=\"1590\"  >1590<\/option><option value=\"1591\"  >1591<\/option><option value=\"1592\"  >1592<\/option><option value=\"1593\"  >1593<\/option><option value=\"1594\"  >1594<\/option><option value=\"1595\"  >1595<\/option><option value=\"1596\"  >1596<\/option><option value=\"1597\"  >1597<\/option><option value=\"1598\"  >1598<\/option><option value=\"1599\"  >1599<\/option><option value=\"1600\"  >1600<\/option><option value=\"1601\"  >1601<\/option><option value=\"1602\"  >1602<\/option><option value=\"1603\"  >1603<\/option><option value=\"1604\"  >1604<\/option><option value=\"1605\"  >1605<\/option><option value=\"1606\"  >1606<\/option><option value=\"1607\"  >1607<\/option><option value=\"1608\"  >1608<\/option><option value=\"1609\"  >1609<\/option><option value=\"1610\"  >1610<\/option><option value=\"1611\"  >1611<\/option><option value=\"1612\"  >1612<\/option><option value=\"1613\"  >1613<\/option><option value=\"1614\"  >1614<\/option><option value=\"1615\"  >1615<\/option><option value=\"1616\"  >1616<\/option><option value=\"1617\"  >1617<\/option><option value=\"1618\"  >1618<\/option><option value=\"1619\"  >1619<\/option><option value=\"1620\"  >1620<\/option><option value=\"1621\"  >1621<\/option><option value=\"1622\"  >1622<\/option><option value=\"1623\"  >1623<\/option><option value=\"1624\"  >1624<\/option><option value=\"1625\"  >1625<\/option><option value=\"1626\"  >1626<\/option><option value=\"1627\"  >1627<\/option><option value=\"1628\"  >1628<\/option><option value=\"1629\"  >1629<\/option><option value=\"1630\"  >1630<\/option><option value=\"1631\"  >1631<\/option><option value=\"1632\"  >1632<\/option><option value=\"1633\"  >1633<\/option><option value=\"1634\"  >1634<\/option><option value=\"1635\"  >1635<\/option><option value=\"1636\"  >1636<\/option><option value=\"1637\"  >1637<\/option><option value=\"1638\"  >1638<\/option><option value=\"1639\"  >1639<\/option><option value=\"1640\"  >1640<\/option><option value=\"1641\"  >1641<\/option><option value=\"1642\"  >1642<\/option><option value=\"1643\"  >1643<\/option><option value=\"1644\"  >1644<\/option><option value=\"1645\"  >1645<\/option><option value=\"1646\"  >1646<\/option><option value=\"1647\"  >1647<\/option><option value=\"1648\"  >1648<\/option><option value=\"1649\"  >1649<\/option><option value=\"1650\"  >1650<\/option><option value=\"1651\"  >1651<\/option><option value=\"1652\"  >1652<\/option><option value=\"1653\"  >1653<\/option><option value=\"1654\"  >1654<\/option><option value=\"1655\"  >1655<\/option><option value=\"1656\"  >1656<\/option><option value=\"1657\"  >1657<\/option><option value=\"1658\"  >1658<\/option><option value=\"1659\"  >1659<\/option><option value=\"1660\"  >1660<\/option><option value=\"1661\"  >1661<\/option><option value=\"1662\"  >1662<\/option><option value=\"1663\"  >1663<\/option><option value=\"1664\"  >1664<\/option><option value=\"1665\"  >1665<\/option><option value=\"1666\"  >1666<\/option><option value=\"1667\"  >1667<\/option><option value=\"1668\"  >1668<\/option><option value=\"1669\"  >1669<\/option><option value=\"1670\"  >1670<\/option><option value=\"1671\"  >1671<\/option><option value=\"1672\"  >1672<\/option><option value=\"1673\"  >1673<\/option><option value=\"1674\"  >1674<\/option><option value=\"1675\"  >1675<\/option><option value=\"1676\"  >1676<\/option><option value=\"1677\"  >1677<\/option><option value=\"1678\"  >1678<\/option><option value=\"1679\"  >1679<\/option><option value=\"1680\"  >1680<\/option><option value=\"1681\"  >1681<\/option><option value=\"1682\"  >1682<\/option><option value=\"1683\"  >1683<\/option><option value=\"1684\"  >1684<\/option><option value=\"1685\"  >1685<\/option><option value=\"1686\"  >1686<\/option><option value=\"1687\"  >1687<\/option><option value=\"1688\"  >1688<\/option><option value=\"1689\"  >1689<\/option><option value=\"1690\"  >1690<\/option><option value=\"1691\"  >1691<\/option><option value=\"1692\"  >1692<\/option><option value=\"1693\"  >1693<\/option><option value=\"1694\"  >1694<\/option><option value=\"1695\"  >1695<\/option><option value=\"1696\"  >1696<\/option><option value=\"1697\"  >1697<\/option><option value=\"1698\"  >1698<\/option><option value=\"1699\"  >1699<\/option><option value=\"1700\"  >1700<\/option><option value=\"1701\"  >1701<\/option><option value=\"1702\"  >1702<\/option><option value=\"1703\"  >1703<\/option><option value=\"1704\"  >1704<\/option><option value=\"1705\"  >1705<\/option><option value=\"1706\"  >1706<\/option><option value=\"1707\"  >1707<\/option><option value=\"1708\"  >1708<\/option><option value=\"1709\"  >1709<\/option><option value=\"1710\"  >1710<\/option><option value=\"1711\"  >1711<\/option><option value=\"1712\"  >1712<\/option><option value=\"1713\"  >1713<\/option><option value=\"1714\"  >1714<\/option><option value=\"1715\"  >1715<\/option><option value=\"1716\"  >1716<\/option><option value=\"1717\"  >1717<\/option><option value=\"1718\"  >1718<\/option><option value=\"1719\"  >1719<\/option><option value=\"1720\"  >1720<\/option><option value=\"1721\"  >1721<\/option><option value=\"1722\"  >1722<\/option><option value=\"1723\"  >1723<\/option><option value=\"1724\"  >1724<\/option><option value=\"1725\"  >1725<\/option><option value=\"1726\"  >1726<\/option><option value=\"1727\"  >1727<\/option><option value=\"1728\"  >1728<\/option><option value=\"1729\"  >1729<\/option><option value=\"1730\"  >1730<\/option><option value=\"1731\"  >1731<\/option><option value=\"1732\"  >1732<\/option><option value=\"1733\"  >1733<\/option><option value=\"1734\"  >1734<\/option><option value=\"1735\"  >1735<\/option><option value=\"1736\"  >1736<\/option><option value=\"1737\"  >1737<\/option><option value=\"1738\"  >1738<\/option><option value=\"1739\"  >1739<\/option><option value=\"1740\"  >1740<\/option><option value=\"1741\"  >1741<\/option><option value=\"1742\"  >1742<\/option><option value=\"1743\"  >1743<\/option><option value=\"1744\"  >1744<\/option><option value=\"1745\"  >1745<\/option><option value=\"1746\"  >1746<\/option><option value=\"1747\"  >1747<\/option><option value=\"1748\"  >1748<\/option><option value=\"1749\"  >1749<\/option><option value=\"1750\"  >1750<\/option><option value=\"1751\"  >1751<\/option><option value=\"1752\"  >1752<\/option><option value=\"1753\"  >1753<\/option><option value=\"1754\"  >1754<\/option><option value=\"1755\"  >1755<\/option><option value=\"1756\"  >1756<\/option><option value=\"1757\"  >1757<\/option><option value=\"1758\"  >1758<\/option><option value=\"1759\"  >1759<\/option><option value=\"1760\"  >1760<\/option><option value=\"1761\"  >1761<\/option><option value=\"1762\"  >1762<\/option><option value=\"1763\"  >1763<\/option><option value=\"1764\"  >1764<\/option><option value=\"1765\"  >1765<\/option><option value=\"1766\"  >1766<\/option><option value=\"1767\"  >1767<\/option><option value=\"1768\"  >1768<\/option><option value=\"1769\"  >1769<\/option><option value=\"1770\"  >1770<\/option><option value=\"1771\"  >1771<\/option><option value=\"1772\"  >1772<\/option><option value=\"1773\"  >1773<\/option><option value=\"1774\"  >1774<\/option><option value=\"1775\"  >1775<\/option><option value=\"1776\"  >1776<\/option><option value=\"1777\"  >1777<\/option><option value=\"1778\"  >1778<\/option><option value=\"1779\"  >1779<\/option><option value=\"1780\"  >1780<\/option><option value=\"1781\"  >1781<\/option><option value=\"1782\"  >1782<\/option><option value=\"1783\"  >1783<\/option><option value=\"1784\"  >1784<\/option><option value=\"1785\"  >1785<\/option><option value=\"1786\"  >1786<\/option><option value=\"1787\"  >1787<\/option><option value=\"1788\"  >1788<\/option><option value=\"1789\"  >1789<\/option><option value=\"1790\"  >1790<\/option><option value=\"1791\"  >1791<\/option><option value=\"1792\"  >1792<\/option><option value=\"1793\"  >1793<\/option><option value=\"1794\"  >1794<\/option><option value=\"1795\"  >1795<\/option><option value=\"1796\"  >1796<\/option><option value=\"1797\"  >1797<\/option><option value=\"1798\"  >1798<\/option><option value=\"1799\"  >1799<\/option><option value=\"1800\"  >1800<\/option><option value=\"1801\"  >1801<\/option><option value=\"1802\"  >1802<\/option><option value=\"1803\"  >1803<\/option><option value=\"1804\"  >1804<\/option><option value=\"1805\"  >1805<\/option><option value=\"1806\"  >1806<\/option><option value=\"1807\"  >1807<\/option><option value=\"1808\"  >1808<\/option><option value=\"1809\"  >1809<\/option><option value=\"1810\"  >1810<\/option><option value=\"1811\"  >1811<\/option><option value=\"1812\"  >1812<\/option><option value=\"1813\"  >1813<\/option><option value=\"1814\"  >1814<\/option><option value=\"1815\"  >1815<\/option><option value=\"1816\"  >1816<\/option><option value=\"1817\"  >1817<\/option><option value=\"1818\"  >1818<\/option><option value=\"1819\"  >1819<\/option><option value=\"1820\"  >1820<\/option><option value=\"1821\"  >1821<\/option><option value=\"1822\"  >1822<\/option><option value=\"1823\"  >1823<\/option><option value=\"1824\"  >1824<\/option><option value=\"1825\"  >1825<\/option><option value=\"1826\"  >1826<\/option><option value=\"1827\"  >1827<\/option><option value=\"1828\"  >1828<\/option><option value=\"1829\"  >1829<\/option><option value=\"1830\"  >1830<\/option><option value=\"1831\"  >1831<\/option><option value=\"1832\"  >1832<\/option><option value=\"1833\"  >1833<\/option><option value=\"1834\"  >1834<\/option><option value=\"1835\"  >1835<\/option><option value=\"1836\"  >1836<\/option><option value=\"1837\"  >1837<\/option><option value=\"1838\"  >1838<\/option><option value=\"1839\"  >1839<\/option><option value=\"1840\"  >1840<\/option><option value=\"1841\"  >1841<\/option><option value=\"1842\"  >1842<\/option><option value=\"1843\"  >1843<\/option><option value=\"1844\"  >1844<\/option><option value=\"1845\"  >1845<\/option><option value=\"1846\"  >1846<\/option><option value=\"1847\"  >1847<\/option><option value=\"1848\"  >1848<\/option><option value=\"1849\"  >1849<\/option><option value=\"1850\"  >1850<\/option><option value=\"1851\"  >1851<\/option><option value=\"1852\"  >1852<\/option><option value=\"1853\"  >1853<\/option><option value=\"1854\"  >1854<\/option><option value=\"1855\"  >1855<\/option><option value=\"1856\"  >1856<\/option><option value=\"1857\"  >1857<\/option><option value=\"1858\"  >1858<\/option><option value=\"1859\"  >1859<\/option><option value=\"1860\"  >1860<\/option><option value=\"1861\"  >1861<\/option><option value=\"1862\"  >1862<\/option><option value=\"1863\"  >1863<\/option><option value=\"1864\"  >1864<\/option><option value=\"1865\"  >1865<\/option><option value=\"1866\"  >1866<\/option><option value=\"1867\"  >1867<\/option><option value=\"1868\"  >1868<\/option><option value=\"1869\"  >1869<\/option><option value=\"1870\"  >1870<\/option><option value=\"1871\"  >1871<\/option><option value=\"1872\"  >1872<\/option><option value=\"1873\"  >1873<\/option><option value=\"1874\"  >1874<\/option><option value=\"1875\"  >1875<\/option><option value=\"1876\"  >1876<\/option><option value=\"1877\"  >1877<\/option><option value=\"1878\"  >1878<\/option><option value=\"1879\"  >1879<\/option><option value=\"1880\"  >1880<\/option><option value=\"1881\"  >1881<\/option><option value=\"1882\"  >1882<\/option><option value=\"1883\"  >1883<\/option><option value=\"1884\"  >1884<\/option><option value=\"1885\"  >1885<\/option><option value=\"1886\"  >1886<\/option><option value=\"1887\"  >1887<\/option><option value=\"1888\"  >1888<\/option><option value=\"1889\"  >1889<\/option><option value=\"1890\"  >1890<\/option><option value=\"1891\"  >1891<\/option><option value=\"1892\"  >1892<\/option><option value=\"1893\"  >1893<\/option><option value=\"1894\"  >1894<\/option><option value=\"1895\"  >1895<\/option><option value=\"1896\"  >1896<\/option><option value=\"1897\"  >1897<\/option><option value=\"1898\"  >1898<\/option><option value=\"1899\"  >1899<\/option><option value=\"1900\"  >1900<\/option><option value=\"1901\"  >1901<\/option><option value=\"1902\"  >1902<\/option><option value=\"1903\"  >1903<\/option><option value=\"1904\"  >1904<\/option><option value=\"1905\"  >1905<\/option><option value=\"1906\"  >1906<\/option><option value=\"1907\"  >1907<\/option><option value=\"1908\"  >1908<\/option><option value=\"1909\"  >1909<\/option><option value=\"1910\"  >1910<\/option><option value=\"1911\"  >1911<\/option><option value=\"1912\"  >1912<\/option><option value=\"1913\"  >1913<\/option><option value=\"1914\"  >1914<\/option><option value=\"1915\"  >1915<\/option><option value=\"1916\"  >1916<\/option><option value=\"1917\"  >1917<\/option><option value=\"1918\"  >1918<\/option><option value=\"1919\"  >1919<\/option><option value=\"1920\"  >1920<\/option><option value=\"1921\"  >1921<\/option><option value=\"1922\"  >1922<\/option><option value=\"1923\"  >1923<\/option><option value=\"1924\"  >1924<\/option><option value=\"1925\"  >1925<\/option><option value=\"1926\"  >1926<\/option><option value=\"1927\"  >1927<\/option><option value=\"1928\"  >1928<\/option><option value=\"1929\"  >1929<\/option><option value=\"1930\"  >1930<\/option><option value=\"1931\"  >1931<\/option><option value=\"1932\"  >1932<\/option><option value=\"1933\"  >1933<\/option><option value=\"1934\"  >1934<\/option><option value=\"1935\"  >1935<\/option><option value=\"1936\"  >1936<\/option><option value=\"1937\"  >1937<\/option><option value=\"1938\"  >1938<\/option><option value=\"1939\"  >1939<\/option><option value=\"1940\"  >1940<\/option><option value=\"1941\"  >1941<\/option><option value=\"1942\"  >1942<\/option><option value=\"1943\"  >1943<\/option><option value=\"1944\"  >1944<\/option><option value=\"1945\"  >1945<\/option><option value=\"1946\"  >1946<\/option><option value=\"1947\"  >1947<\/option><option value=\"1948\"  >1948<\/option><option value=\"1949\"  >1949<\/option><option value=\"1950\"  >1950<\/option><option value=\"1951\"  >1951<\/option><option value=\"1952\"  >1952<\/option><option value=\"1953\"  >1953<\/option><option value=\"1954\"  >1954<\/option><option value=\"1955\"  >1955<\/option><option value=\"1956\"  >1956<\/option><option value=\"1957\"  >1957<\/option><option value=\"1958\"  >1958<\/option><option value=\"1959\"  >1959<\/option><option value=\"1960\"  >1960<\/option><option value=\"1961\"  >1961<\/option><option value=\"1962\"  >1962<\/option><option value=\"1963\"  >1963<\/option><option value=\"1964\"  >1964<\/option><option value=\"1965\"  >1965<\/option><option value=\"1966\"  >1966<\/option><option value=\"1967\"  >1967<\/option><option value=\"1968\"  >1968<\/option><option value=\"1969\"  >1969<\/option><option value=\"1970\"  >1970<\/option><option value=\"1971\"  >1971<\/option><option value=\"1972\"  >1972<\/option><option value=\"1973\"  >1973<\/option><option value=\"1974\"  >1974<\/option><option value=\"1975\"  >1975<\/option><option value=\"1976\"  >1976<\/option><option value=\"1977\"  >1977<\/option><option value=\"1978\"  >1978<\/option><option value=\"1979\"  >1979<\/option><option value=\"1980\"  >1980<\/option><option value=\"1981\"  >1981<\/option><option value=\"1982\"  >1982<\/option><option value=\"1983\"  >1983<\/option><option value=\"1984\"  >1984<\/option><option value=\"1985\"  >1985<\/option><option value=\"1986\"  >1986<\/option><option value=\"1987\"  >1987<\/option><option value=\"1988\"  >1988<\/option><option value=\"1989\"  >1989<\/option><option value=\"1990\"  >1990<\/option><option value=\"1991\"  >1991<\/option><option value=\"1992\"  >1992<\/option><option value=\"1993\"  >1993<\/option><option value=\"1994\"  >1994<\/option><option value=\"1995\"  >1995<\/option><option value=\"1996\"  >1996<\/option><option value=\"1997\"  >1997<\/option><option value=\"1998\"  >1998<\/option><option value=\"1999\"  >1999<\/option><option value=\"2000\"  >2000<\/option><\/select><\/div><input type=\"hidden\" id=\"wpforms-3902-field_17\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][17]\" value=\"&#036;0.66\"><\/div><div id=\"wpforms-3902-field_18-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-single\" data-field-id=\"18\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_18\">Stationnement<\/label><input type=\"text\" id=\"wpforms-3902-field_18\" class=\"wpforms-field-medium wpforms-payment-user-input wpforms-payment-price\" data-rule-currency=\"[&quot;$&quot;,false]\" data-rule-required-minimum-price=\"0.00\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-3902-field_18-error\"><\/div><div id=\"wpforms-3902-field_19-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-single\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_19\">Taxi<\/label><input type=\"text\" id=\"wpforms-3902-field_19\" class=\"wpforms-field-medium wpforms-payment-user-input wpforms-payment-price\" data-rule-currency=\"[&quot;$&quot;,false]\" data-rule-required-minimum-price=\"0.00\" name=\"wpforms[fields][19]\" value=\"&#036;0.00\" aria-errormessage=\"wpforms-3902-field_19-error\"><\/div><div id=\"wpforms-3902-field_29-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"29\"><div id=\"wpforms-3902-field_29\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_29-error\"><h3>H\u00e9bergement<\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_20-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-single\" data-field-id=\"20\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_20\">Autres<\/label><input type=\"text\" id=\"wpforms-3902-field_20\" class=\"wpforms-field-medium wpforms-payment-user-input wpforms-payment-price\" data-rule-currency=\"[&quot;$&quot;,false]\" data-rule-required-minimum-price=\"0.00\" name=\"wpforms[fields][20]\" value=\"&#036;0.00\" aria-errormessage=\"wpforms-3902-field_20-error\"><\/div><div id=\"wpforms-3902-field_25-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">H\u00e9bergement (cochez toutes les cases qui s\u2019appliquent) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3902-field_25\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3902-field_25_1\" name=\"wpforms[fields][25][]\" value=\"H\u00f4tel\" aria-errormessage=\"wpforms-3902-field_25_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_25_1\">H\u00f4tel<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3902-field_25_2\" name=\"wpforms[fields][25][]\" value=\"H\u00e9bergement priv\u00e9\" aria-errormessage=\"wpforms-3902-field_25_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_25_2\">H\u00e9bergement priv\u00e9<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-3902-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-3902-field_1\" >l&#039;activit\u00e9 Faux d\u00e9part<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-3902-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-3902-field_26-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"payment-single\" data-field-id=\"26\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_26\">Co\u00fbt de l&#039;h\u00f4tel<\/label><input type=\"text\" id=\"wpforms-3902-field_26\" class=\"wpforms-field-medium wpforms-payment-user-input wpforms-payment-price\" data-rule-currency=\"[&quot;$&quot;,false]\" data-rule-required-minimum-price=\"0.00\" name=\"wpforms[fields][26]\" value=\"&#036;0.00\" aria-errormessage=\"wpforms-3902-field_26-error\"><\/div><div id=\"wpforms-3902-field_27-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-conditional-field wpforms-conditional-show wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"27\" style=\"display:none;\"><label class=\"wpforms-field-label\">H\u00e9bergement priv\u00e9<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">Price: <span class=\"wpforms-price\">&#036;50.00<\/span><\/div><select id=\"wpforms-3902-field_27-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][27]\"><option value=\"0\"  selected='selected' >0<\/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><\/select><\/div><input type=\"hidden\" id=\"wpforms-3902-field_27\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][27]\" value=\"&#036;50.00\"><\/div><div id=\"wpforms-3902-field_30-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"30\"><div id=\"wpforms-3902-field_30\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_30-error\"><h3>Repas<\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_31-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"31\"><fieldset><legend class=\"wpforms-field-label\">Date de d\u00e9part de la maison <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3902-field_31\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][31][date]\" aria-errormessage=\"wpforms-3902-field_31-error\" required><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-3902-field_31\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-3902-field_31-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][31][time]\" aria-errormessage=\"wpforms-3902-field_31-time-error\" required><label for=\"wpforms-3902-field_31-time\" class=\"wpforms-field-sublabel after\">Heure<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3902-field_32-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\">Date de retour \u00e0 la maison <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3902-field_32\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][32][date]\" aria-errormessage=\"wpforms-3902-field_32-error\" required><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-3902-field_32\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-3902-field_32-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][32][time]\" aria-errormessage=\"wpforms-3902-field_32-time-error\" required><label for=\"wpforms-3902-field_32-time\" class=\"wpforms-field-sublabel after\">Heure<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3902-field_34-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"34\"><label class=\"wpforms-field-label\">D\u00e9jeuner<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">Prix : <span class=\"wpforms-price\">&#036;29.95<\/span><\/div><select id=\"wpforms-3902-field_34-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][34]\"><option value=\"0\"  selected='selected' >0<\/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><\/select><\/div><input type=\"hidden\" id=\"wpforms-3902-field_34\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][34]\" value=\"&#036;29.95\"><\/div><div id=\"wpforms-3902-field_35-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"35\"><label class=\"wpforms-field-label\">D\u00eener<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">Prix : <span class=\"wpforms-price\">&#036;30.55<\/span><\/div><select id=\"wpforms-3902-field_35-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][35]\"><option value=\"0\"  selected='selected' >0<\/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><\/select><\/div><input type=\"hidden\" id=\"wpforms-3902-field_35\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][35]\" value=\"&#036;30.55\"><\/div><div id=\"wpforms-3902-field_36-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"36\"><label class=\"wpforms-field-label\"> Souper<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">Prix : <span class=\"wpforms-price\">&#036;62.70<\/span><\/div><select id=\"wpforms-3902-field_36-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][36]\"><option value=\"0\"  selected='selected' >0<\/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><\/select><\/div><input type=\"hidden\" id=\"wpforms-3902-field_36\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][36]\" value=\"&#036;62.70\"><\/div><div id=\"wpforms-3902-field_37-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-payment-quantities-enabled\" data-field-type=\"payment-single\" data-field-id=\"37\"><label class=\"wpforms-field-label\">Faux frais<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">Prix : <span class=\"wpforms-price\">&#036;25.00<\/span><\/div><select id=\"wpforms-3902-field_37-quantity\" class=\"wpforms-payment-quantity\" name=\"wpforms[quantities][37]\"><option value=\"0\"  selected='selected' >0<\/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><\/select><\/div><input type=\"hidden\" id=\"wpforms-3902-field_37\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][37]\" value=\"&#036;25.00\"><\/div><div id=\"wpforms-3902-field_75-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"75\"><div id=\"wpforms-3902-field_75\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_75-error\"><h3>Total des d\u00e9penses<\/h3>\n<p>\u00a0<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_76-container\" class=\"wpforms-field wpforms-field-number wpforms-calculations-field\" data-field-type=\"number\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_76\">Total des d\u00e9penses<\/label><input type=\"number\" id=\"wpforms-3902-field_76\" class=\"wpforms-field-medium\" name=\"wpforms[fields][76]\" step=\"any\" readonly=\"readonly\" aria-errormessage=\"wpforms-3902-field_76-error\" ><\/div><div id=\"wpforms-3902-field_40-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"40\"><div id=\"wpforms-3902-field_40\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_40-error\"><h3>Salaires (y compris le compl\u00e9ment salarial)<\/h3>\n<p>Pour les membres du Conseil du Tr\u00e9sor et du CST qui r\u00e9clament des salaires, veuillez joindre votre document de cong\u00e9 approuv\u00e9 avant de soumettre ce formulaire.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_41\">Classification et niveau<\/label><input type=\"text\" id=\"wpforms-3902-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-3902-field_41-error\" ><\/div><div id=\"wpforms-3902-field_49-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_49\">Jours de semaine r\u00e9clam\u00e9s<\/label><input type=\"number\" id=\"wpforms-3902-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" step=\"any\" aria-errormessage=\"wpforms-3902-field_49-error\" ><\/div><div id=\"wpforms-3902-field_50-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_50\">Salaire des jours de semaine<\/label><input type=\"number\" id=\"wpforms-3902-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" value=\"$\" step=\"any\" aria-errormessage=\"wpforms-3902-field_50-error\" ><\/div><div id=\"wpforms-3902-field_72-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"72\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_72\">Jours de fin de semaine r\u00e9clam\u00e9s<\/label><input type=\"number\" id=\"wpforms-3902-field_72\" class=\"wpforms-field-medium\" name=\"wpforms[fields][72]\" step=\"any\" aria-errormessage=\"wpforms-3902-field_72-error\" ><\/div><div id=\"wpforms-3902-field_73-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_73\">Salaire de fin de semaine<\/label><input type=\"number\" id=\"wpforms-3902-field_73\" class=\"wpforms-field-medium\" name=\"wpforms[fields][73]\" value=\"$\" step=\"any\" aria-errormessage=\"wpforms-3902-field_73-error\" ><\/div><div id=\"wpforms-3902-field_77-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"77\"><div id=\"wpforms-3902-field_77\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_77-error\"><h3>Total des salaires<\/h3>\n<p>\u00a0<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_48-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-calculations-field\" data-field-type=\"payment-single\" data-field-id=\"48\"><label class=\"wpforms-field-label\">Total des salaires<\/label><div class=\"wpforms-single-item-price-content\"><div class=\"wpforms-single-item-price wpforms-field-medium wpforms-payment-price\">$<\/div><\/div><input type=\"hidden\" id=\"wpforms-3902-field_48\" class=\"wpforms-field-medium wpforms-payment-price\" name=\"wpforms[fields][48]\"><\/div><div id=\"wpforms-3902-field_52-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"52\"><fieldset><legend class=\"wpforms-field-label\">Avez-vous re\u00e7u une avance?<\/legend><ul id=\"wpforms-3902-field_52\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3902-field_52_1\" name=\"wpforms[fields][52]\" value=\"Oui\" aria-errormessage=\"wpforms-3902-field_52_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_52_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3902-field_52_2\" name=\"wpforms[fields][52]\" value=\"Non\" aria-errormessage=\"wpforms-3902-field_52_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3902-field_52_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3902-field_60-container\" class=\"wpforms-field wpforms-field-payment-single wpforms-calculations-field\" data-field-type=\"payment-single\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_60\">Montant de la d\u00e9duction anticip\u00e9e (-)<\/label><input type=\"text\" id=\"wpforms-3902-field_60\" class=\"wpforms-field-medium wpforms-payment-user-input wpforms-payment-price\" data-rule-currency=\"[&quot;$&quot;,false]\" data-rule-required-minimum-price=\"0.00\" name=\"wpforms[fields][60]\" readonly=\"readonly\" aria-errormessage=\"wpforms-3902-field_60-error\"><\/div><div id=\"wpforms-3902-field_22-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"22\"><div id=\"wpforms-3902-field_22\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_22-error\"><h1><span style=\"color:#000000\"><span style=\"color:#99cc00\">Montant net de la demande<\/span><\/span><\/h1>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_68-container\" class=\"wpforms-field wpforms-field-number wpforms-calculations-field\" data-field-type=\"number\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_68\">(Avant les retenues obligatoires)<\/label><input type=\"number\" id=\"wpforms-3902-field_68\" class=\"wpforms-field-medium\" name=\"wpforms[fields][68]\" step=\"any\" readonly=\"readonly\" aria-errormessage=\"wpforms-3902-field_68-error\" aria-describedby=\"wpforms-3902-field_68-description\" ><div id=\"wpforms-3902-field_68-description\" class=\"wpforms-field-description\">Veuillez noter que le syst\u00e8me ne permet pas de d\u00e9duire directement l\u2019avance. Par cons\u00e9quent, celle-ci est ajout\u00e9e au total, puis d\u00e9duite deux fois \u00e0 la ligne \u00ab Total moins d\u00e9duction de l\u2019avance \u00bb<\/div><\/div><div id=\"wpforms-3902-field_63-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"63\"><div id=\"wpforms-3902-field_63\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_63-error\"><h1>Pi\u00e8ces jointes<\/h1>\n<h3>Ch\u00e8que annul\u00e9<\/h3>\n<p>Si vous demandez le d\u00e9p\u00f4t direct de votre demande d\u2019indemnisation, vous devrez fournir un ch\u00e8que annul\u00e9. Si vous avez d\u00e9j\u00e0 fourni cette information, vous n\u2019avez pas besoin de la soumettre \u00e0 nouveau.<\/p>\n<p>Si vous h\u00e9sitez \u00e0 fournir votre NAS ou vos renseignements bancaires en ligne, veuillez communiquer avec Daniel Quesnel-Roussel au 1-866-594-4505, poste 27, ou \u00e0 l\u2019adresse claims@unde.org<\/p>\n<h3>Re\u00e7us<\/h3>\n<p>Tous les re\u00e7us (taxi, h\u00f4tel, stationnement, etc.) doivent \u00eatre joints; \u00e0 d\u00e9faut, le traitement de votre demande sera retard\u00e9. Cela ne s\u2019applique pas aux repas, car des indemnit\u00e9s journali\u00e8res sont pr\u00e9vues \u00e0 cet effet.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_23-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_23\">Joindre des fichiers<\/label><div\n\t\tclass=\"wpforms-uploader 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fichiers.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-3902-field_23\"\n\t\tname=\"wpforms_3902_23\" \t\tvalue=\"\">\n<div id=\"wpforms-3902-field_23-description\" class=\"wpforms-field-description\">Pour acc\u00e9l\u00e9rer le traitement de votre demande :\n Joignez tous les re\u00e7us.\n Pour les membres du Conseil du Tr\u00e9sor et du CSE qui demandent le remboursement de leur salaire, veuillez joindre votre document de cong\u00e9 approuv\u00e9 avant de soumettre ce formulaire.\n Joignez le FORMULAIRE DE D\u00c9PENSES FAMILIALES (le cas \u00e9ch\u00e9ant).\n Si vous avez demand\u00e9 le D\u00c9P\u00d4T DIRECT, veuillez joindre une copie d\u2019un ch\u00e8que annul\u00e9.\nLes fichiers PDF, .jpg, .png et .docx sont accept\u00e9s, la taille maximale \u00e9tant de 10 Mo.<\/div><\/div><div id=\"wpforms-3902-field_71-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-3902-field_71\">Commentaires<\/label><textarea id=\"wpforms-3902-field_71\" class=\"wpforms-field-medium\" name=\"wpforms[fields][71]\" aria-errormessage=\"wpforms-3902-field_71-error\" ><\/textarea><\/div><div id=\"wpforms-3902-field_51-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"51\"><div id=\"wpforms-3902-field_51\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-3902-field_51-error\"><h3>Autorisation<\/h3>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-3902-field_24-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" 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