{"id":4508,"date":"2026-01-27T18:08:16","date_gmt":"2026-01-27T17:08:16","guid":{"rendered":"https:\/\/www.sclerodermie.ch\/?page_id=4508"},"modified":"2026-01-27T18:18:07","modified_gmt":"2026-01-27T17:18:07","slug":"formulaire-dadhesion","status":"publish","type":"page","link":"https:\/\/www.sclerodermie.ch\/fr\/ass\/devenir-membre\/formulaire-dadhesion\/","title":{"rendered":"Formulaire d&rsquo;adh\u00e9sion"},"content":{"rendered":"\n<div class=\"wp-block-citadela-blocks-custom-container citadela-block-custom-container size-wide bg-type-none inside-space-none\"><div class=\"inner-holder\">\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div style=\"--bb--crumb-gap:.4em; font-style:normal;font-weight:600;\" class=\"hide-home-page wp-block-boldblocks-breadcrumb-block has-large-font-size\"><nav role=\"navigation\" aria-label=\"Breadcrumbs\" class=\"breadcrumb\"><ol class=\"breadcrumb-items\"><li class=\"breadcrumb-item breadcrumb-item--current breadcrumb-item--home\"><span class=\"breadcrumb-item-name\">Home<\/span><\/li><\/ol><\/nav><\/div>\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p class=\"has-text-align-center has-medium-font-size\"><a href=\"https:\/\/www.sclerodermie.ch\/wp-content\/uploads\/2024\/06\/Statuts_f.pdf\" data-type=\"attachment\" data-id=\"2641\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>T\u00e9l\u00e9charger les statuts de l&rsquo;ASS<\/strong><\/a><\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4502-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"4502\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/4508#wpcf7-f4502-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4502\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4502-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label><strong>Je, soussigne\u0301-e, souhaite devenir membre de l\u2019Association Suisse des Scle\u0301rodermiques (ASS)<\/strong><\/label><br \/>\n<label> <strong>Votre nom<\/strong> (obligatoire) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-lastname\" \/><\/span> <\/label><br \/>\n<label> <strong>Votre pr\u00e9nom<\/strong> (obligatoire) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-firstname\" \/><\/span> <\/label><br \/>\n<label> <strong>Votre adresse<\/strong> (obligatoire) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-adress\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-adress\" \/><\/span> <\/label><br \/>\n<label> <strong>Votre num\u00e9ro postal et ville<\/strong> (obligatoire) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span> <\/label><br \/>\n<label> <strong>Votre num\u00e9ro de t\u00e9l\u00e9phone<\/strong>:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span> <\/label><br \/>\n<label> <strong>Votre e-mail<\/strong> (obligatoire) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label><br \/>\n<label> <strong>Votre date de naissance<\/strong> (obligatoire) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-birthday\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"your-birthday\" \/><\/span> <\/label>\n<\/p>\n<p><label> <strong>Langue parl\u00e9e<\/strong> (obligatoire) : <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"spoken\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"spoken\" value=\"Fran\u00e7ais\" \/><span class=\"wpcf7-list-item-label\">Fran\u00e7ais<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"spoken\" value=\"Allemand\" \/><span class=\"wpcf7-list-item-label\">Allemand<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"spoken\" value=\"Italien\" \/><span class=\"wpcf7-list-item-label\">Italien<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> <strong>En tant que <\/strong> (obligatoire) : <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"membership\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"membership\" value=\"Scl\u00e9rodermique\" \/><span class=\"wpcf7-list-item-label\">Scl\u00e9rodermique<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"membership\" value=\"Proche\" \/><span class=\"wpcf7-list-item-label\">Proche<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"membership\" value=\"Parent\" \/><span class=\"wpcf7-list-item-label\">Parent<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"membership\" value=\"Donateur\" \/><span class=\"wpcf7-list-item-label\">Donateur<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"membership\" value=\"Autres\" \/><span class=\"wpcf7-list-item-label\">Autres<\/span><\/label><\/span><\/span><\/span><br \/>\n<label> <strong>Si scl\u00e9rodermique, pr\u00e9ciser le diagnostique<\/strong> (facultatif) :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-diagnostic\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-diagnostic\" \/><\/span> <\/label><br \/>\n<label> <strong>Si \"Autres\", pr\u00e9ciser<\/strong> :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other\" \/><\/span> <\/label><br \/>\n<label> <strong>Je certifie que les renseignements ci-dessus sont juste et j'ai pris connaissance des statuts de l'ASS<\/strong> : <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"aknowledgement\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"aknowledgement\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"aknowledgement\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><strong>Ces renseignements sont confidentiels et ne servent qu\u2019\u00e0 l\u2019utilisation interne de sclerodermie.ch<\/strong>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/><br \/>\n\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"401\" height=\"712\" src=\"https:\/\/www.sclerodermie.ch\/wp-content\/uploads\/2026\/01\/SclerodermaDays2017-edited.jpg\" alt=\"\" class=\"wp-image-4515\" style=\"aspect-ratio:9\/16;object-fit:cover\" srcset=\"https:\/\/www.sclerodermie.ch\/wp-content\/uploads\/2026\/01\/SclerodermaDays2017-edited.jpg 401w, https:\/\/www.sclerodermie.ch\/wp-content\/uploads\/2026\/01\/SclerodermaDays2017-edited-169x300.jpg 169w\" sizes=\"auto, (max-width: 401px) 100vw, 401px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:60px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-citadela-blocks-custom-container citadela-block-custom-container size-wide bg-type-none inside-space-none\"><div class=\"inner-holder\">\n<hr class=\"wp-block-separator has-css-opacity is-style-dots\"\/>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-citadela-blocks-custom-container citadela-block-custom-container size-wide bg-type-color inside-space-zero has-bg\" style=\"background-color:rgba(238, 113, 37, 1)\"><div class=\"inner-holder\">\n<div class=\"wp-block-columns alignwide are-vertically-aligned-center has-3-columns has-white-color has-text-color has-link-color wp-elements-6bb8fe760e257e423d82783bd40d9594 is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-citadela-blocks-service citadela-block-service main-holder layout-box header-type-icon standard\"><div class=\"service-header\"><div class=\"service-icon\"><a href=\"https:\/\/www.sclerodermie.ch\/contact\/\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-at\" style=\"color:#ffffff\"><\/i><\/a><\/div><\/div><div class=\"service-content\"><div class=\"service-content-wrap\"><a href=\"https:\/\/www.sclerodermie.ch\/contact\/\" target=\"_blank\" rel=\"noopener noreferrer\"><h3 class=\"service-title\" style=\"color:#ffffff\">NOUS ECRIRE<\/h3><\/a><p class=\"service-description\" style=\"color:#ffffff\">info@sclerodermie.ch<br\/>sclerodermie.ch<br\/>3000 Berne <\/p><\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-citadela-blocks-service citadela-block-service main-holder layout-box header-type-icon standard\"><div class=\"service-header\"><div class=\"service-icon\"><i class=\"fas fa-phone\" style=\"color:#ffffff\"><\/i><\/div><\/div><div class=\"service-content\"><div class=\"service-content-wrap\"><h3 class=\"service-title\" style=\"color:#ffffff\">NOUS APPELER<\/h3><p class=\"service-description\" style=\"color:#ffffff\"><strong>077 469 75 58 \u2013 Fran\u00e7ais<br\/>077 502 18 68 \u2013 Deutsch<br\/>077 501 67 59 \u2013 Italiano <\/strong><\/p><\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-citadela-blocks-service citadela-block-service main-holder layout-box header-type-icon standard\"><div class=\"service-header\"><div class=\"service-icon\"><i class=\"fas fa-piggy-bank\" style=\"color:#ffffff\"><\/i><\/div><\/div><div class=\"service-content\"><div class=\"service-content-wrap\"><h3 class=\"service-title\" style=\"color:#ffffff\">NOUS SOUTENIR<\/h3><p class=\"service-description\" style=\"color:#ffffff\">Compte postal : 12-864923-6 CHF<br\/>Code BIC : POFICHBEXXX<br\/>IBAN : CH47 0900 0000 1286 4923 6<\/p><\/div><\/div><\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":4521,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_citadela_hide_page_title":"1","_citadela_remove_header_space":"1","_citadela_custom_class":"","_citadela_half_map_provider":"","_citadela_half_map_theme":"","_citadela_half_map_themeOSM":"","_citadela_half_map_customTheme":"","_citadela_half_map_dataType":"","_citadela_half_map_dynamicTrack":false,"_citadela_half_map_trackColor":"","_citadela_half_map_trackEndpointsColor":"","_citadela_half_map_filterCategory":"","_citadela_half_map_filterLocation":"","_citadela_half_map_filterFeatured":false,"_citadela_half_map_noDataBehavior":"empty-map","_citadela_half_map_noDataText":"","_citadela_half_map_clusterGridSize":80,"_citadela_header":false,"_citadela_header_over_content":false,"_citadela_header_text_color":"","_citadela_header_logo":[],"_citadela_header_bg_image":[],"_citadela_header_bg_position":[],"_citadela_header_bg_size":"","_citadela_header_bg_repeat":"","_citadela_header_bg_fixed":false,"_citadela_header_bg_color":"","_citadela_header_bg_image_overlay":"","_citadela_header_transparent_bg":false,"_citadela_content_width":"","_citadela_half_layout_position":"","footnotes":""},"class_list":["post-4508","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/pages\/4508","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/comments?post=4508"}],"version-history":[{"count":10,"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/pages\/4508\/revisions"}],"predecessor-version":[{"id":4587,"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/pages\/4508\/revisions\/4587"}],"up":[{"embeddable":true,"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/pages\/4521"}],"wp:attachment":[{"href":"https:\/\/www.sclerodermie.ch\/fr\/wp-json\/wp\/v2\/media?parent=4508"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}