{"id":7553,"date":"2021-10-21T13:33:30","date_gmt":"2021-10-21T13:33:30","guid":{"rendered":"https:\/\/www.electrodes-generiques.com\/affiliate-home\/affiliate-register\/"},"modified":"2021-10-21T13:33:30","modified_gmt":"2021-10-21T13:33:30","slug":"affiliate-register","status":"publish","type":"page","link":"https:\/\/www.electrodes-generiques.com\/en\/affiliate-home\/affiliate-register\/","title":{"rendered":"S\u2019inscrire"},"content":{"rendered":"<div id=\"wpam_form_error_panel\" class=\"wpam_form_errors\">\n\t\t<ul>\n\n\t\t<\/ul>\n\t<\/div>\n<form action=\"\" method=\"post\" id=\"mainForm\" class=\"pure-form pure-form-stacked\" data-trp-original-action=\"\">\n    <input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"3b9714f31e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/7553\/\" \/>\t\t* Champs obligatoires<br \/><br \/>\n\t\t<fieldset>\n\t\t\t\t\t\t\t\t<label for=\"_firstName\">Pr\u00e9nom&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_firstName\" name=\"_firstName\" value=\"\" required \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_lastName\">Nom de famille&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_lastName\" name=\"_lastName\" value=\"\" required \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_phoneNumber\">Num\u00e9ro de t\u00e9l\u00e9phone&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_phoneNumber\" name=\"_phoneNumber\" value=\"\" required \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_email\">Adresse de messagerie&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t                                                            <input type=\"text\" id=\"_email\" name=\"_email\" value=\"\" required \/>\n                                                            \t\t\t\t\t\t\t\t<label for=\"_addressLine1\">Adresse 1&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_addressLine1\" name=\"_addressLine1\" value=\"\" required \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_addressLine2\">Adresse 2<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_addressLine2\" name=\"_addressLine2\" value=\"\"  \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_addressCity\">Ville&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_addressCity\" name=\"_addressCity\" value=\"\" required \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_addressState\">\u00c9tat&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<select id=\"_addressState\" name=\"_addressState\" required>\n\t\t\t\t\t\t\t\t<option value=\"\">S\u00e9lectionnez une option<\/option><option value=\"OU\">Outside US<\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option>\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_addressZipCode\">Code Postal&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_addressZipCode\" name=\"_addressZipCode\" value=\"\" required \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_addressCountry\">Pays&nbsp;*<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<select id=\"_addressCountry\" name=\"_addressCountry\" required>\n\t\t\t\t\t\t\t\t<option value=\"\">S\u00e9lectionnez une option<\/option><option value=\"AF\">AFGHANISTAN<\/option><option value=\"AX\">ALAND 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=\"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=\"BA\">BOSNIA AND HERZEGOVINA<\/option><option value=\"BW\">BOTSWANA<\/option><option value=\"BV\">BOUVET ISLAND<\/option><option value=\"BR\">BRAZIL<\/option><option value=\"BN\">BRUNEI DARUSSALAM<\/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=\"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 (MALVINAS)<\/option><option value=\"FO\">FAROE ISLANDS<\/option><option value=\"FJ\">FIJI<\/option><option value=\"FI\">FINLAND<\/option><option value=\"FR\">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=\"GN\">GUINEA<\/option><option value=\"GW\">GUINEA-BISSAU<\/option><option value=\"GY\">GUYANA<\/option><option value=\"HT\">HAITI<\/option><option value=\"VA\">HOLY SEE (VATICAN CITY STATE)<\/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 ISLAMIC REPUBLIC OF<\/option><option value=\"IQ\">IRAQ<\/option><option value=\"IE\">IRELAND<\/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=\"JO\">JORDAN<\/option><option value=\"KZ\">KAZAKHSTAN<\/option><option value=\"KE\">KENYA<\/option><option value=\"KI\">KIRIBATI<\/option><option value=\"KP\">KOREA<\/option><option value=\"KR\">KOREA REPUBLIC OF<\/option><option value=\"KW\">KUWAIT<\/option><option value=\"KG\">KYRGYZSTAN<\/option><option value=\"LA\">LAO<\/option><option value=\"LV\">LATVIA<\/option><option value=\"LB\">LEBANON<\/option><option value=\"LS\">LESOTHO<\/option><option value=\"LR\">LIBERIA<\/option><option value=\"LY\">LIBYAN ARAB JAMAHIRIYA<\/option><option value=\"LI\">LIECHTENSTEIN<\/option><option value=\"LT\">LITHUANIA<\/option><option value=\"LU\">LUXEMBOURG<\/option><option value=\"MO\">MACAO<\/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, REPUBLIC OF<\/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\">Namibie<\/option><option value=\"NR\">NAURU<\/option><option value=\"NP\">N\u00e9pal<\/option><option value=\"NL\">Pays Bas<\/option><option value=\"AN\">Antilles holandaises<\/option><option value=\"NC\">Nouvelle Cal\u00e9donie<\/option><option value=\"NZ\">Nouvelle Z\u00e9lande<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nig\u00e9ria<\/option><option value=\"NU\">NIUE<\/option><option value=\"NF\">NORFOLK ISLAND<\/option><option value=\"MP\">NORTHERN MARIANA ISLANDS<\/option><option value=\"NO\">NORWAY<\/option><option value=\"OM\">OMAN<\/option><option value=\"PK\">PAKISTAN<\/option><option value=\"PW\">PALAU<\/option><option value=\"PS\">PALESTINIAN TERRITORY<\/option><option value=\"PA\">PANAMA<\/option><option value=\"PG\">Papouasie Nouvelle Guin\u00e9e<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">P\u00e9rou<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">PITCAIRN<\/option><option value=\"PL\">Pologne<\/option><option value=\"PT\">Portugal<\/option><option value=\"PR\">Porto Rico<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">R\u00e9union<\/option><option value=\"RO\">ROMANIA<\/option><option value=\"RU\">RUSSIAN FEDERATION<\/option><option value=\"RW\">RWANDA<\/option><option value=\"SH\">SAINT HELENA<\/option><option value=\"KN\">SAINT KITTS AND NEVIS<\/option><option value=\"LC\">SAINT LUCIA<\/option><option value=\"PM\">SAINT PIERRE AND MIQUELON<\/option><option value=\"WS\">SAMOA<\/option><option value=\"SM\">SAN MARINO<\/option><option value=\"ST\">SAO TOME AND PRINCIPE<\/option><option value=\"SA\">Arabie Saoudite<\/option><option value=\"SN\">S\u00e9n\u00e9gal<\/option><option value=\"RS\">Serbie<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra L\u00e9one<\/option><option value=\"SG\">Singapour<\/option><option value=\"SK\">Slovaquie<\/option><option value=\"SI\">Slov\u00e9nie<\/option><option value=\"SB\">\u00celes Salomon<\/option><option value=\"SO\">Somalie<\/option><option value=\"ZA\">SOUTH AFRICA<\/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\">Su\u00e8de<\/option><option value=\"CH\">Suisse<\/option><option value=\"SY\">SYRIAN ARAB REPUBLIC<\/option><option value=\"TW\">TAIWAN<\/option><option value=\"TJ\">TAJIKISTAN<\/option><option value=\"TZ\">TANZANIA UNITED REPUBLIC OF<\/option><option value=\"TH\">Tha\u00eflande<\/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\">Turkm\u00e9nistan<\/option><option value=\"TC\">TURKS AND CAICOS ISLANDS<\/option><option value=\"TV\">TUVALU<\/option><option value=\"UG\">Ouganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">\u00c9mirats Arabes Unis<\/option><option value=\"GB\">Royaume Uni<\/option><option value=\"US\">\u00c9tats Unis<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">UZBEKISTAN<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VE\">V\u00e9n\u00e9zuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"VG\">\u00celes vierges britaniques<\/option><option value=\"VI\">\u00celes vierges am\u00e9ricaines<\/option><option value=\"WF\">Wallis et futuna<\/option><option value=\"EH\">Sahara de l\u2019ouest<\/option><option value=\"YE\">Y\u00e9men<\/option><option value=\"ZM\">Zambie<\/option><option value=\"ZW\">Zimbabw\u00e9<\/option>\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_companyName\">Nom de l\u2019entreprise<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_companyName\" name=\"_companyName\" value=\"\"  \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_websiteUrl\">URL du site web<\/label>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\" id=\"_websiteUrl\" name=\"_websiteUrl\" value=\"\"  \/>\n\t\t\t\t\t\t\t\t\t\t\n                        <label for=\"chkAgreeTerms\" id=\"agreeTermsLabel\" class=\"pure-checkbox\"><input type=\"checkbox\" id=\"chkAgreeTerms\" name=\"chkAgreeTerms\"  \/>&nbsp;J\u2019ai lu et j\u2019accepte les <a target=\"_blank\" href=\"https:\/\/www.electrodes-generiques.com\/en\/terms-and-conditions\/\">Termes et conditions<\/a><\/label>\n                        <div id=\"termsAgreeWarning\" style=\"color: red; display: none\">Vous devez accepter les conditions.<\/div>\n\t\t\t\n               \n                 \n                <!--<div class=\"wpam-registration-form\">-->\n                <input type=\"hidden\" name=\"wpam_reg_submit\" value=\"1\" \/>\n                <input type=\"submit\" name=\"submit\" value=\"Envoyer la demande\" class=\"wpam-registration-form-submit pure-button pure-button-active\" \/>\n                <!--<\/div>-->  \n                <\/fieldset>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n\n<div id=\"tncDialog\" style=\"display: none\">\n\t<div id=\"termsBox\" style=\"padding: 20px; width: auto; height: 380px; overflow: scroll; background-color: white; color: black; border: 1px solid black; white-space: pre-wrap;\">[AffiliatesRegister]<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":7552,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/pages\/7553"}],"collection":[{"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/comments?post=7553"}],"version-history":[{"count":0,"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/pages\/7553\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/pages\/7552"}],"wp:attachment":[{"href":"https:\/\/www.electrodes-generiques.com\/en\/wp-json\/wp\/v2\/media?parent=7553"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}