{"id":126,"date":"2024-10-16T20:24:26","date_gmt":"2024-10-16T20:24:26","guid":{"rendered":"https:\/\/prrf.org\/prrf-adult-publicity-release\/"},"modified":"2024-10-24T01:31:48","modified_gmt":"2024-10-24T01:31:48","slug":"prrf-adult-publicity-release","status":"publish","type":"page","link":"https:\/\/prrf.org\/fr\/prrf-adult-publicity-release\/","title":{"rendered":"PRRF Adult Publicity Release"},"content":{"rendered":"\n\t\t<div id=\"fws_69e604c461656\"  data-column-margin=\"default\" data-midnight=\"dark\"  class=\"wpb_row vc_row-fluid vc_row\"  style=\"padding-top: 0px; padding-bottom: 0px; \"><div class=\"row-bg-wrap\" data-bg-animation=\"none\" data-bg-animation-delay=\"\" data-bg-overlay=\"false\"><div class=\"inner-wrap row-bg-layer\" ><div class=\"row-bg viewport-desktop\"  style=\"\"><\/div><\/div><\/div><div class=\"row_col_wrap_12 col span_12 dark left\">\n\t<div  class=\"vc_col-sm-12 wpb_column column_container vc_column_container col no-extra-padding inherit_tablet inherit_phone \"  data-padding-pos=\"all\" data-has-bg-color=\"false\" data-bg-color=\"\" data-bg-opacity=\"1\" data-animation=\"\" data-delay=\"0\" >\n\t\t<div class=\"vc_column-inner\" >\n\t\t\t<div class=\"wpb_wrapper\">\n\t\t\t\t\n<div class=\"wpb_text_column wpb_content_element \" >\n\t<div class=\"wpb_wrapper\">\n\t\t<div class=\"sqs-html-content\">\n<h2 style=\"text-align: center; white-space: pre-wrap;\">PRRF Adult Publicity Release<\/h2>\n<\/div>\n<div class=\"form-wrapper\">\n<div class=\"form-inner-wrapper\" hidden=\"\">\n<form action=\"https:\/\/website-admin-sja3.squarespace.com\" autocomplete=\"on\" method=\"POST\" novalidate=\"\" data-form-id=\"63f16f64a89e1f316405587a\" data-success-redirect=\"\" data-dynamic-strings=\"\">\n<div class=\"hidden form-submission-html\" data-submission-html=\"\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t<\/div>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n<\/div><\/div>\n\t\t<div id=\"fws_69e604c46193b\"  data-column-margin=\"default\" data-midnight=\"dark\"  class=\"wpb_row vc_row-fluid vc_row\"  style=\"padding-top: 0px; padding-bottom: 0px; \"><div class=\"row-bg-wrap\" data-bg-animation=\"none\" data-bg-animation-delay=\"\" data-bg-overlay=\"false\"><div class=\"inner-wrap row-bg-layer\" ><div class=\"row-bg viewport-desktop\"  style=\"\"><\/div><\/div><\/div><div class=\"row_col_wrap_12 col span_12 dark left\">\n\t<div  class=\"vc_col-sm-2 wpb_column column_container vc_column_container col no-extra-padding inherit_tablet inherit_phone \"  data-padding-pos=\"all\" data-has-bg-color=\"false\" data-bg-color=\"\" data-bg-opacity=\"1\" data-animation=\"\" data-delay=\"0\" >\n\t\t<div class=\"vc_column-inner\" >\n\t\t\t<div class=\"wpb_wrapper\">\n\t\t\t\t\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t<div  class=\"vc_col-sm-8 wpb_column column_container vc_column_container col no-extra-padding inherit_tablet inherit_phone \"  data-padding-pos=\"all\" data-has-bg-color=\"false\" data-bg-color=\"\" data-bg-opacity=\"1\" data-animation=\"\" data-delay=\"0\" >\n\t\t<div class=\"vc_column-inner\" >\n\t\t\t<div class=\"wpb_wrapper\">\n\t\t\t\t<style id=\"wpforms-css-vars-6227\">\n\t\t\t\t#wpforms-6227 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-6227\"><form id=\"wpforms-form-6227\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"6227\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/126\" data-token=\"3a47db9e72724ffa9c5c9acb639c25f4\" data-token-time=\"1776682180\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-6227-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name of Individual <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6227-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-6227-field_0-error\" required><label for=\"wpforms-6227-field_0\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6227-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-6227-field_0-last-error\" required><label for=\"wpforms-6227-field_0-last\" class=\"wpforms-field-sublabel after\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-6227-field_11-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"11\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-6227-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-6227-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-6227-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-6227-field_1-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-6227-field_9-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-6227-field_9\">Phone<\/label><input type=\"tel\" id=\"wpforms-6227-field_9\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][9]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-6227-field_9-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-6227-field_10-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-6227-field_10\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][10][address1]\" aria-errormessage=\"wpforms-6227-field_10-error\" required><label for=\"wpforms-6227-field_10\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-6227-field_10-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][10][address2]\" aria-errormessage=\"wpforms-6227-field_10-address2-error\" ><label for=\"wpforms-6227-field_10-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-6227-field_10-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][10][city]\" aria-errormessage=\"wpforms-6227-field_10-city-error\" required><label for=\"wpforms-6227-field_10-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6227-field_10-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][10][state]\" aria-errormessage=\"wpforms-6227-field_10-state-error\" required><label for=\"wpforms-6227-field_10-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-6227-field_10-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][10][postal]\" aria-errormessage=\"wpforms-6227-field_10-postal-error\" required><label for=\"wpforms-6227-field_10-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-6227-field_10-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][10][country]\" aria-errormessage=\"wpforms-6227-field_10-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- S\u00e9lectionner\u00a0: country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/option><option value=\"DE\" >Allemagne<\/option><option value=\"AD\" >Andorre<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctique<\/option><option value=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\" >France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordanie<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KG\" >Kirghizistan<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malaisie<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malte<\/option><option value=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"TR\" >Turquie<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard et McDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-6227-field_10-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-6227-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">I give my permission for my image or interview to be used in the following manner: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-6227-field_7\" class=\"wpforms-field-required\"><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_7_5\" name=\"wpforms[fields][7]\" value=\"Media interviews (television, print, radio)\" aria-errormessage=\"wpforms-6227-field_7_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_7_5\">Media interviews (television, print, radio)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_7_7\" name=\"wpforms[fields][7]\" value=\"Podcast interviews\" aria-errormessage=\"wpforms-6227-field_7_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_7_7\">Podcast interviews<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_7_9\" name=\"wpforms[fields][7]\" value=\"PRRF program brochures describing programs\" aria-errormessage=\"wpforms-6227-field_7_9-error\" required ><label class=\"wpforms-field-label-inline\" 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id=\"wpforms-6227-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-6227-field_2\" >used my: I<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-6227-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-6227-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-6227-field_12\">Name specific event or manner that the image or interview can be used<\/label><input type=\"text\" id=\"wpforms-6227-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-6227-field_12-error\" ><\/div><div id=\"wpforms-6227-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">I give my permission for the use of my: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-6227-field_8\" class=\"wpforms-field-required\"><li class=\"choice-21 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_8_21\" name=\"wpforms[fields][8]\" value=\"First name only\" aria-errormessage=\"wpforms-6227-field_8_21-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_8_21\">First name only<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_8_23\" name=\"wpforms[fields][8]\" value=\"First and last name\" aria-errormessage=\"wpforms-6227-field_8_23-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_8_23\">First and last name<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_8_25\" name=\"wpforms[fields][8]\" value=\"Do not use my real name\" aria-errormessage=\"wpforms-6227-field_8_25-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_8_25\">Do not use my real name<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"radio\" id=\"wpforms-6227-field_8_27\" name=\"wpforms[fields][8]\" value=\"Medical diagnosis (as related to retinal diseases only)\" aria-errormessage=\"wpforms-6227-field_8_27-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_8_27\">Medical diagnosis (as related to retinal diseases only)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-6227-field_6-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Conditions <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-6227-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6227-field_6_1\" name=\"wpforms[fields][6][]\" value=\"I agree to the following terms\" aria-errormessage=\"wpforms-6227-field_6_1-error\" aria-describedby=\"wpforms-6227-field_6-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6227-field_6_1\">I agree to the following terms<\/label><\/li><\/ul><div id=\"wpforms-6227-field_6-description\" class=\"wpforms-field-description wpforms-disclaimer-description\">I understand and agree that any narratives, depictions, pictures, film, photographs, audio-visual or sound recordings or testimonials of me made by the Pediatric Retinal Research Foundation (PRRF) or its respective employees and agents may be used by PRRF, and those acting with permission, for illustration, broadcast, or testimonial shared with the general public in connection with the work of PRRF. I assign to PRRF all of my rights to these materials. I understand that these materials made by PRRF, its employees and agents are owned by PRRF and that they may copyright them. I further consent to allow PRRF, their respective employees and agents, and those acting with PRRF\u2019s permission, to use my protected health information, as defined under 45 C.F.R. 164.501, for the purpose of illustration, broadcast, or testimonial in connection with any work of PRRF, and to release this information to the general public. I understand that these materials may be published on PRRF\u2019s website, and this may disclose my personal and protected health information online. However, PRRF\u2019s online disclosure of my name and residence will be limited to my child\u2019s first name and the geographical location where he or she receives services. PRRF does not need to submit these materials to me for approval. I understand that these materials may be modified and that PRRF may decide not to use them. I acknowledge that the rights described above are granted to PRRF on an unlimited basis without any compensation or payment being made for any current or future use. I understand that my consent is voluntary, and that I may revoke my consent to allow PRRF to release my protected health information if that information has not already been disclosed. To revoke my consent, I must notify PRRF in writing. Such written notification must be sent to PRRF, Attn: Foundation Board President, 8424 E 12 Mile Rd, Ste B2, Warren, MI 48093. I understand that a revocation is not effective to the extent that PRRF has relied on the use or disclosure of the protected health information. I understand and agree that once PRRF, its respective employees and agents, and those acting with permission, disclose my protected health information, this information may no longer be protected by the Health Insurance Portability and Accountability act of 1996. This release and authorization expire five (5) years from the date of my signature below. I have read this release and authorization before signing below, and I fully understand its contents.<\/div><\/fieldset><\/div><div id=\"wpforms-6227-field_3-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-6227-field_3\">Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-6227-field_3\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][3][date]\" aria-errormessage=\"wpforms-6227-field_3-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-6227-field_2-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-6227-field_2-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-6227-field_2-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6227\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/pages\/126\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-6227\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/prrf.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t<div  class=\"vc_col-sm-2 wpb_column column_container vc_column_container col no-extra-padding inherit_tablet inherit_phone \"  data-padding-pos=\"all\" data-has-bg-color=\"false\" data-bg-color=\"\" data-bg-opacity=\"1\" data-animation=\"\" data-delay=\"0\" >\n\t\t<div class=\"vc_column-inner\" >\n\t\t\t<div class=\"wpb_wrapper\">\n\t\t\t\t\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"PRRF Adult Publicity Release Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Name of Individual...","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","om_disable_all_campaigns":false,"footnotes":""},"class_list":["post-126","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/pages\/126","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/comments?post=126"}],"version-history":[{"count":3,"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/pages\/126\/revisions"}],"predecessor-version":[{"id":6571,"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/pages\/126\/revisions\/6571"}],"wp:attachment":[{"href":"https:\/\/prrf.org\/fr\/wp-json\/wp\/v2\/media?parent=126"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}