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<input type="hidden" name="queried_id" value="18862"/>
			
			<div class="elementor-form-fields-wrapper elementor-labels-">
								<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-md-50 elementor-sm-100 elementor-field-required">
												<label for="form-field-name" class="elementor-field-label elementor-screen-only">
								Prénom							</label>
														<input size="1" type="text" name="form_fields[name]" id="form-field-name" class="elementor-field elementor-size-sm  elementor-field-textual" placeholder="Prénom" required="required" aria-required="true">
											</div>
								<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c0493bd elementor-col-50 elementor-md-50 elementor-field-required">
												<label for="form-field-field_c0493bd" class="elementor-field-label elementor-screen-only">
								nom de famille							</label>
														<input size="1" type="text" name="form_fields[field_c0493bd]" id="form-field-field_c0493bd" class="elementor-field elementor-size-sm  elementor-field-textual" placeholder="nom de famille" required="required" aria-required="true">
											</div>
								<div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-md-50 elementor-field-required">
												<label for="form-field-email" class="elementor-field-label elementor-screen-only">
								E-mail							</label>
														<input size="1" type="email" name="form_fields[email]" id="form-field-email" class="elementor-field elementor-size-sm  elementor-field-textual" placeholder="E-mail" required="required" aria-required="true">
											</div>
								<div class="elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_719ed13 elementor-col-50 elementor-md-50 elementor-field-required">
												<label for="form-field-field_719ed13" class="elementor-field-label elementor-screen-only">
								Numéro de téléphone							</label>
								<input size="1" type="tel" name="form_fields[field_719ed13]" id="form-field-field_719ed13" class="elementor-field elementor-size-sm  elementor-field-textual" placeholder="Numéro de téléphone" required="required" aria-required="true" pattern="[0-9()#&+*-=.]+" title="Seuls les caractères de numéros de téléphone (#, -, *, etc.) sont acceptés.">

</div>
								<div class="elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_65d29d2 elementor-col-50 elementor-md-50 elementor-field-required">
												<label for="form-field-field_65d29d2" class="elementor-field-label elementor-screen-only">
								Date							</label>
						
		<input type="date" name="form_fields[field_65d29d2]" id="form-field-field_65d29d2" class="elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native" placeholder="Date" required="required" aria-required="true" pattern="[0-9]{4}-[0-9]{2}-[0-9]{2}">
						</div>
								<div class="elementor-field-type-time elementor-field-group elementor-column elementor-field-group-field_793d329 elementor-col-50 elementor-md-50 elementor-field-required">
												<label for="form-field-field_793d329" class="elementor-field-label elementor-screen-only">
								Heure							</label>
								<input type="time" name="form_fields[field_793d329]" id="form-field-field_793d329" class="elementor-field elementor-size-sm  elementor-field-textual elementor-time-field elementor-use-native" placeholder="Heure" required="required" aria-required="true">
						</div>
								<div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100 elementor-md-100">
												<label for="form-field-message" class="elementor-field-label elementor-screen-only">
								nouvelles							</label>
						<textarea class="elementor-field-textual elementor-field  elementor-size-sm" name="form_fields[message]" id="form-field-message" rows="2" placeholder="nouvelles"></textarea>				</div>
								<div class="elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_4767ccd elementor-col-100 elementor-md-100 elementor-field-required">
							<div class="elementor-field-subgroup">
			<span class="elementor-field-option">
				<input type="checkbox" name="form_fields[field_4767ccd]" id="form-field-field_4767ccd" class="elementor-field elementor-size-sm  elementor-acceptance-field" required="required" aria-required="true">
				<label for="form-field-field_4767ccd"><a href="https://www.hochwasserschutz.shop/fr/protection-des-donnees/" style="color: white;">J&rsquo;accepte la déclaration de confidentialité*.</a></label>			</span>
		</div>
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								<div class="elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_35b578e elementor-col-100 recaptcha_v3-inline">
					<div class="elementor-field" id="form-field-field_35b578e"><div class="elementor-g-recaptcha" data-sitekey="6LeMchMdAAAAAM6Dtb8H6PzTx6gYLUeaQjaEOe_a" data-type="v3" data-action="Form" data-badge="inline" data-size="invisible"></div></div>				</div>
								<div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons elementor-md-100">
					<button class="elementor-button elementor-size-sm" type="submit">
						<span class="elementor-button-content-wrapper">
																						<span class="elementor-button-text">Envoyer maintenant</span>
													</span>
					</button>
				</div>
			</div>
		</form>
				</div>
				</div>
				</div>
				</div>
				</div>
				</div>

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