Prescription

<!-- Begin MailChimp Signup Form --><!-- [et_pb_line_break_holder] --><link href="//cdn-images.mailchimp.com/embedcode/classic-10_7.css" rel="stylesheet" type="text/css"><!-- [et_pb_line_break_holder] --><style type="text/css"><!-- [et_pb_line_break_holder] --> #mc_embed_signup{background:rgba(185,185,185,0); clear:left; font:18px Lato; }<!-- [et_pb_line_break_holder] --> /* Add your own MailChimp form style overrides in your site stylesheet or in this style block.<!-- [et_pb_line_break_holder] --> We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */<!-- [et_pb_line_break_holder] --></style><!-- [et_pb_line_break_holder] --><div id="mc_embed_signup"><!-- [et_pb_line_break_holder] --><form action="https://sylviepierrel.us14.list-manage.com/subscribe/post?u=4ad97a73ba22b0fdf06c1c1ab&id=2dd3919438" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate><!-- [et_pb_line_break_holder] --> <div id="mc_embed_signup_scroll"><!-- [et_pb_line_break_holder] --> <h2>Recevez dans votre boite la brochure détaillée </h2><!-- [et_pb_line_break_holder] --><div class="indicates-required"><span class="asterisk">*</span> indicates required</div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL" placeholder="Email"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="FNAME" class="" id="mce-FNAME" placeholder="Prénom"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="LNAME" class="" id="mce-LNAME" placeholder="NOM"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group input-group"><!-- [et_pb_line_break_holder] --> <strong>Formation </strong><!-- [et_pb_line_break_holder] --> <ul><li><input type="checkbox" value="1" name="group[5035][1]" id="mce-group[5035]-5035-0"><label for="mce-group[5035]-5035-0"> Votre matériau c'est vous</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="2" name="group[5035][2]" id="mce-group[5035]-5035-1"><label for="mce-group[5035]-5035-1"> Mon matériau c'est vous</label></li><!-- [et_pb_line_break_holder] --></ul><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --> <div id="mce-responses" class="clear"><!-- [et_pb_line_break_holder] --> <div class="response" id="mce-error-response" style="display:none"></div><!-- [et_pb_line_break_holder] --> <div class="response" id="mce-success-response" style="display:none"></div><!-- [et_pb_line_break_holder] --> </div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups--><!-- [et_pb_line_break_holder] --> <div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_4ad97a73ba22b0fdf06c1c1ab_2dd3919438" tabindex="-1" value=""></div><!-- [et_pb_line_break_holder] --> <div class="clear"><input type="submit" value="Je recois ma brochure" name="subscribe" id="mc-embedded-subscribe" class="button"></div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--End mc_embed_signup-->