{"id":1290,"date":"2023-11-05T14:23:43","date_gmt":"2023-11-05T13:23:43","guid":{"rendered":"https:\/\/www.survi.fr\/registration-for-survi-network-members\/"},"modified":"2024-10-08T11:33:38","modified_gmt":"2024-10-08T09:33:38","slug":"registration-for-survi-network-members","status":"publish","type":"page","link":"https:\/\/www.survi.fr\/en\/registration-for-survi-network-members\/","title":{"rendered":"Registration for SURVI network members"},"content":{"rendered":"\t\t<script id=\"ur-recaptcha-cloudflare_0\">\n\t\t\tconst ur_cloudflare_recaptcha_code = {\"site_key\":\"0x4AAAAAAAEZ98dtAiD-q0xl\",\"is_captcha_enable\":true,\"version\":\"cloudflare\",\"is_invisible\":false,\"theme_mode\":\"auto\"}\t\t<\/script>\n\t\t\t<div class='user-registration ur-frontend-form   ' id='user-registration-form-297'>\n\t\t\t\t\t\t\t\t<form method='post' class='register' data-form-id=\"297\"\n\t\t\t\tdata-enable-strength-password=\"1\" data-minimum-password-strength=\"2\"\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t data-captcha-enabled=\"1\">\n\n\t\t\t\t<div class=\"ur-form-row\" data-row-id=\"0\">\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"select_1698417938\" class=\"ur-field-item field-select \" data-ref-id=\"select_1698417938\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"select_1698417938_field\" data-priority=\"\" ><label for=\"select_1698417938\" class=\"ur-label\">Title<\/label><select data-rules=\"\" data-id=\"select_1698417938\" name=\"select_1698417938\" id=\"select_1698417938\" class=\"select ur-frontend-field  \" data-label=\"Title\" data-allow_clear=\"true\" data-placeholder=\"\">\n\t\t\t\t\t\t\t<option value=\"Dr\" >Dr.<\/option><option value=\"Pr\" >Prof.<\/option><option value=\"Mr\" >Mr.<\/option><option value=\"Mme\" >Mrs.<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"ur-form-row\" data-row-id=\"1\">\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"first_name\" class=\"ur-field-item field-first_name \" data-ref-id=\"first_name\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"first_name_field\" data-priority=\"\" ><label for=\"first_name\" class=\"ur-label\">First name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"first_name\" type=\"text\" class=\"input-text  without_icon input-text ur-frontend-field  \" name=\"first_name\" id=\"first_name\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"First name\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"select_1698418584\" class=\"ur-field-item field-select \" data-ref-id=\"select_1698418584\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"select_1698418584_field\" data-priority=\"\" ><label for=\"select_1698418584\" class=\"ur-label\">Specialty <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><select data-rules=\"\" data-id=\"select_1698418584\" name=\"select_1698418584\" id=\"select_1698418584\" class=\"select ur-frontend-field  \" required=\"required\" data-label=\"Specialty\" data-default=\"Allergologie\" data-allow_clear=\"true\" data-placeholder=\"\">\n\t\t\t\t\t\t\t<option value=\"Allergologie\"  selected='selected'>Allergology<\/option><option value=\"Anesth\u00e9siologie\" >Anesthesiology<\/option><option value=\"Andrologie\" >Andrology<\/option><option value=\"Cardiologie\" >Cardiology<\/option><option value=\"Chirurgie\" >Surgery<\/option><option value=\"Dermatologie\" >Dermatology<\/option><option value=\"Endocrinologie\" >Endocrinology<\/option><option value=\"Gastro-ent\u00e9rologie\" >Gastroenterology<\/option><option value=\"G\u00e9riatrie\" >Geriatrics<\/option><option value=\"Gyn\u00e9cologie\" >Gynaecology<\/option><option value=\"H\u00e9matologie\" >Hematology<\/option><option value=\"H\u00e9patologie\" >Hepatology<\/option><option value=\"Infectiologie\" >Infectiology<\/option><option value=\"M\u00e9decine aigu\u00eb\" >Acute medicine<\/option><option value=\"M\u00e9decine du travail\" >Occupational medicine<\/option><option value=\"M\u00e9decine g\u00e9n\u00e9rale\" >Family medicine<\/option><option value=\"M\u00e9decine interne\" >Internal medicine<\/option><option value=\"M\u00e9decine nucl\u00e9aire\" >Nuclear medicine<\/option><option value=\"M\u00e9decine palliative\" >Palliative care<\/option><option value=\"M\u00e9decine physique\" >Physical medicine<\/option><option value=\"M\u00e9decine pr\u00e9ventive\" >Preventive healthcare<\/option><option value=\"N\u00e9onatologie\" >Neonatology<\/option><option value=\"N\u00e9phrologie\" >Nephrology<\/option><option value=\"Neurologie\" >Neurology<\/option><option value=\"Odontologie\" >Dentistry<\/option><option value=\"Oncologie\" >Oncology<\/option><option value=\"Obst\u00e9trique\" >Obstetrics<\/option><option value=\"Ophtalmologie\" >Ophthalmology<\/option><option value=\"Orthop\u00e9die\" >Orthopedic surgery<\/option><option value=\"Oto-rhino-laryngologie\" >Otorhinolaryngology<\/option><option value=\"P\u00e9diatrie\" >Pediatrics<\/option><option value=\"Pneumologie\" >Pulmonology<\/option><option value=\"Psychiatrie\" >Psychiatry<\/option><option value=\"Radiologie\" >Radiology<\/option><option value=\"Radioth\u00e9rapie\" >Radiotherapy<\/option><option value=\"Recherche\" >Research<\/option><option value=\"Rhumatologie\" >Rheumatology<\/option><option value=\"Urologie\" >Urology<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"input_box_1698418093\" class=\"ur-field-item field-text \" data-ref-id=\"input_box_1698418093\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"input_box_1698418093_field\" data-priority=\"\" ><label for=\"input_box_1698418093\" class=\"ur-label\">City <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"input_box_1698418093\" type=\"text\" class=\"input-text  without_icon input-text ur-frontend-field  \" name=\"input_box_1698418093\" id=\"input_box_1698418093\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"City\" maxlength=\"50\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"last_name\" class=\"ur-field-item field-last_name \" data-ref-id=\"last_name\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"last_name_field\" data-priority=\"\" ><label for=\"last_name\" class=\"ur-label\">Last name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"last_name\" type=\"text\" class=\"input-text  without_icon input-text ur-frontend-field  \" name=\"last_name\" id=\"last_name\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Last name\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"select_1698417963\" class=\"ur-field-item field-select \" data-ref-id=\"select_1698417963\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"select_1698417963_field\" data-priority=\"\" ><label for=\"select_1698417963\" class=\"ur-label\">Mode of practice <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><select data-rules=\"\" data-id=\"select_1698417963\" name=\"select_1698417963\" id=\"select_1698417963\" class=\"select ur-frontend-field  \" required=\"required\" data-label=\"Mode of practice\" data-default=\"Hospitalier\" data-allow_clear=\"true\" data-placeholder=\"\">\n\t\t\t\t\t\t\t<option value=\"Lib\u00e9rale\" >Private practice<\/option><option value=\"Hospitalier\"  selected='selected'>Hospital employment<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"country_1698418256\" class=\"ur-field-item field-country \" data-ref-id=\"country_1698418256\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"country_1698418256_field\" data-priority=\"\" ><label for=\"country_1698418256\" class=\"ur-label\">Country <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><select data-rules=\"\" data-id=\"country_1698418256\" name=\"country_1698418256\" id=\"country_1698418256\" class=\"select ur-frontend-field  \" required=\"required\" data-label=\"Country\" data-default=\"FR\" data-allow_clear=\"true\" data-placeholder=\"\">\n\t\t\t\t\t\t\t<option value=\"AF\" >Afghanistan<\/option><option value=\"AX\" >&#197;land Islands<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"PW\" >Belau<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"VG\" >British Virgin Islands<\/option><option value=\"BN\" >Brunei<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cape Verde<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo (Brazzaville)<\/option><option value=\"CD\" >Congo (Kinshasa)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura&ccedil;ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\"  selected='selected'>France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"CI\" >Ivory Coast<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Laos<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao S.A.R., China<\/option><option value=\"MK\" >Macedonia<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia<\/option><option value=\"MD\" >Moldova<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"KP\" >North Korea<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PS\" >Palestinian Territory<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RE\" >Reunion<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russia<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"BL\" >Saint Barth&eacute;lemy<\/option><option value=\"SH\" >Saint Helena<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"SX\" >Saint Martin (Dutch part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia\/Sandwich Islands<\/option><option value=\"KR\" >South Korea<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SZ\" >Swaziland<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syria<\/option><option value=\"TW\" >Taiwan<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TR\" >Turkey<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom (UK)<\/option><option value=\"US\" >United States (US)<\/option><option value=\"UM\" >United States (US) Minor Outlying Islands<\/option><option value=\"VI\" >United States (US) Virgin Islands<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican<\/option><option value=\"VE\" >Venezuela<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"WS\" >Samoa<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"ur-form-row\" data-row-id=\"4\">\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"select_1699194078\" class=\"ur-field-item field-select \" data-ref-id=\"select_1699194078\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"select_1699194078_field\" data-priority=\"\" ><label for=\"select_1699194078\" class=\"ur-label\">SURVI referral center <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><select data-rules=\"\" data-id=\"select_1699194078\" name=\"select_1699194078\" id=\"select_1699194078\" class=\"select ur-frontend-field  \" required=\"required\" data-label=\"SURVI referral center\" data-allow_clear=\"true\" data-placeholder=\"\">\n\t\t\t\t\t\t\t<option value=\"H\u00f4pital Beaujon\" >Beaujon Hospital<\/option><option value=\"H\u00f4pital Bichat\" >Bichat Hospital<\/option><option value=\"Lyon-CHANCE\" >Lyon-CHANCE<\/option><option value=\"Marseille-SOS ISCHEMIE\" >Marseille-SOS ISCHEMIE<\/option>\n\t\t\t\t\t\t<\/select><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"user_email\" class=\"ur-field-item field-user_email \" data-ref-id=\"user_email\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"user_email_field\" data-priority=\"\" ><label for=\"user_email\" class=\"ur-label\">Email address <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"user_email\" type=\"email\" class=\"input-text  without_icon input-email ur-frontend-field  \" name=\"user_email\" id=\"user_email\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Email address\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"ur-form-row\" data-row-id=\"2\">\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"user_pass\" class=\"ur-field-item field-user_pass \" data-ref-id=\"user_pass\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required hide_show_password\" id=\"user_pass_field\" data-priority=\"\"><label for=\"user_pass\" class=\"ur-label\">Password <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <span class=\"password-input-group input-form-field-icons\"><input data-rules=\"\" data-id=\"user_pass\" type=\"password\" class=\"input-text without_icon input-password ur-frontend-field  \" name=\"user_pass\" id=\"user_pass\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Password\" \/><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-2\"\n\t\t\t\t\t\t\t\tstyle=\"width:48%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"user_confirm_password\" class=\"ur-field-item field-user_confirm_password \" data-ref-id=\"user_confirm_password\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required hide_show_password\" id=\"user_confirm_password_field\" data-priority=\"\"><label for=\"user_confirm_password\" class=\"ur-label\">Confirm password <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <span class=\"password-input-group input-form-field-icons\"><input data-rules=\"\" data-id=\"user_confirm_password\" type=\"password\" class=\"input-text without_icon input-password ur-frontend-field  \" name=\"user_confirm_password\" id=\"user_confirm_password\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Confirm password\" \/><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"ur-form-row\" data-row-id=\"3\">\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"check_box_1698418288\" class=\"ur-field-item field-checkbox \" data-ref-id=\"check_box_1698418288\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"check_box_1698418288_field\" data-priority=\"\" ><label class=\"ur-label\" required=\"required\" data-label=\"This registration form is reserved for healthcare professionals\">This registration form is reserved for healthcare professionals <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><ul ><li class=\"ur-checkbox-list\"><input data-rules=\"\" data-id=\"check_box_1698418288[]\" required=\"required\" data-label=\"This registration form is reserved for healthcare professionals\" data-value=\"Je certifie \u00eatre un professionnel de sant\u00e9\" type=\"checkbox\" class=\"input-checkbox ur-frontend-field  \" name=\"check_box_1698418288[]\" id=\"check_box_1698418288_Je certifie \u00eatre un professionnel de sant\u00e9\" value=\"Je certifie \u00eatre un professionnel de sant\u00e9\" \/><label class=\"ur-checkbox-label\" for=\"check_box_1698418288_Je certifie \u00eatre un professionnel de sant\u00e9\">I certify that I am a healthcare professional<\/label> <\/li><\/ul><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"ur-recaptcha-node\"> <div id=\"node_recaptcha_register\" class=\"cf-turnstile\"><\/div><\/div>\t\t\t\t\t\t<div class=\"ur-button-container \" >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<button type=\"submit\" class=\"btn button ur-submit-button \"  conditional_rules=\"&quot;&quot;\">\n\t\t\t\t\t\t\t\t<span><\/span>\n\t\t\t\t\t\t\t\tRegistration\t\t\t\t\t\t\t<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t<div style=\"clear:both\"><\/div>\n\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"ur-registration-language\" value=\"en\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"ur-user-form-id\" value=\"297\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"ur-redirect-url\" value=\"\"\/>\n\t\t\t\t<input type=\"hidden\" id=\"ur_frontend_form_nonce\" name=\"ur_frontend_form_nonce\" value=\"2f3e81207b\" \/>\n\t\t\t\t\n\t\t\t<\/form>\n\t\t\t\n\t\t<div style=\"clear:both\"><\/div>\n\t<\/div>\n\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1290","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/pages\/1290","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/comments?post=1290"}],"version-history":[{"count":0,"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/pages\/1290\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.survi.fr\/en\/wp-json\/wp\/v2\/media?parent=1290"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}