{"id":241739,"date":"2025-02-14T00:01:59","date_gmt":"2025-02-14T00:01:59","guid":{"rendered":"https:\/\/msacanada.ca\/donate\/"},"modified":"2025-05-16T20:06:45","modified_gmt":"2025-05-16T20:06:45","slug":"faire-un-don","status":"publish","type":"page","link":"https:\/\/msacanada.ca\/fr\/faire-un-don\/","title":{"rendered":"Faire un don"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_row_inner content_placement=\u00a0\u00bbmiddle\u00a0\u00bb][vc_column_inner width=\u00a0\u00bb1\/3&Prime;][vc_column_text css=\u00a0\u00bb\u00a0\u00bb]<img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-241177\" src=\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02.png\" alt=\"\" width=\"800\" height=\"800\" srcset=\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02.png 800w, https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02-300x300.png 300w, https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02-150x150.png 150w, https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02-768x768.png 768w, https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02-600x600.png 600w, https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Brain-02-200x200.png 200w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\u00a0\u00bb2\/3&Prime;][vc_column_text css=\u00a0\u00bb.vc_custom_1747258335306{margin-bottom: 15px !important;}\u00a0\u00bb]<\/p>\n<div align=\"center\">\n<h2>FAIRE UN DON \u00c0 <span style=\"color: #7b54a0;\">L&rsquo;AMS<\/span><\/h2>\n<h4>Aidez-nous \u00e0 aider ceux qui souffrent de l&rsquo;atrophie multisyst\u00e9matis\u00e9e!<\/h4>\n<p><strong>Pour envoyer un ch\u00e8que, t\u00e9l\u00e9chargez notre formulaire de don et envoyez-le \u00e0 :<\/strong><\/p>\n<p>Defeat Multiple System Atrophy (MSA) Canada \/<br \/>\nVaincre L\u2019atrophie Multisyst\u00e9matis\u00e9e (AMS) Canada<br \/>\n3041 Dougall Avenue, Suite 208<br \/>\nWindsor, Ontario N9E 1S3<\/div>\n<p>[\/vc_column_text]<style type=\"text\/css\" data-type=\"the7_shortcodes-inline-css\">#default-btn-9f3764409cc36260b3698b89ebdb18a0 {\n  border-radius: 3px;\n  font-size: 16px;\n  line-height: 18px;\n}\n.btn-shadow#default-btn-9f3764409cc36260b3698b89ebdb18a0 {\n  box-shadow: 0 1px 6px rgba(0,0,0,0.12);\n  transition: box-shadow 0.2s ease-out, opacity 0.45s;\n}\n.btn-shadow#default-btn-9f3764409cc36260b3698b89ebdb18a0:hover {\n  box-shadow: 0 5px 11px 0 rgba(0,0,0,0.18), 0 4px 15px 0 rgba(0,0,0,0.15);\n}\n.btn-3d#default-btn-9f3764409cc36260b3698b89ebdb18a0 {\n  box-shadow: 0px 2px 0px 0px #903143;\n}\n.btn-3d#default-btn-9f3764409cc36260b3698b89ebdb18a0:hover {\n  box-shadow: 0px 2px 0px 0px #722332;\n}\n.btn-flat#default-btn-9f3764409cc36260b3698b89ebdb18a0 {\n  box-shadow: none;\n}\n.btn-flat#default-btn-9f3764409cc36260b3698b89ebdb18a0:hover {\n  box-shadow: none;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0.ico-right-side > i {\n  margin-right: 0px;\n  margin-left: 8px;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0 > i {\n  margin-right: 8px;\n  font-size: 16px;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0:not(:hover) {\n  border-width: 1px;\n  border-color: #D72749 !important;\n  color: #FFFFFF;\n  background: #D72749 !important;\n  padding: 15px 20px 15px 20px;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0:not(:hover) * {\n  color: #FFFFFF;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0:hover {\n  border-width: 1px;\n  border-color: #B61C3A !important;\n  color: #FFFFFF;\n  background: #B61C3A !important;\n  padding: 15px 20px 15px 20px;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0:hover * {\n  color: #FFFFFF;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0.ico-right-side > i {\n  margin-right: 0px;\n  margin-left: 8px;\n}\n#default-btn-9f3764409cc36260b3698b89ebdb18a0 > i {\n  margin-right: 8px;\n}\n<\/style><div class=\"btn-align-center\"><a href=\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/02\/CANADA-Mail-In-Donation-Form-2019.pdf\" class=\"default-btn-shortcode dt-btn link-hover-off ico-right-side btn-flat \" target=\"_blank\" id=\"default-btn-9f3764409cc36260b3698b89ebdb18a0\" rel=\"noopener\"><span>T\u00c9L\u00c9CHARGER LE FORMULAIRE DE DON (en anglais seulement)<\/span><i class=\"dt-icon-the7-download\"><\/i><\/a><\/div>[vc_empty_space][vc_column_text css=\u00a0\u00bb.vc_custom_1747258364558{margin-bottom: 15px !important;}\u00a0\u00bb]<\/p>\n<div align=\"center\">\n<p>Num\u00e9ro d&rsquo;entreprise\/inscription : 758784284RR0001<\/p><\/div>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_empty_space][vc_column_text css=\u00a0\u00bb.vc_custom_1747258384934{margin-bottom: 15px !important;}\u00a0\u00bb]<\/p>\n<div align=\"center\">\n<h3>Pour faire un don par carte de cr\u00e9dit, veuillez remplir le formulaire ci-dessous.<\/h3>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=\u00a0\u00bb.vc_custom_1739633587632{margin-top: 20px !important;padding-right: 30px !important;padding-bottom: 30px !important;padding-left: 30px !important;background-color: #F8F8F8 !important;border-radius: 15px !important;}\u00a0\u00bb][vc_column]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_3' style='display:none'>\r\n\t\t<script>\r\n\t\t\tif ( typeof gform !== 'undefined' ) {\r\n\t\t\t\tgform.extensions = gform.extensions || {};\r\n\t\t\t\tgform.extensions.styles = gform.extensions.styles || {};\r\n\t\t\t\tgform.extensions.styles.gravityformsstripe = gform.extensions.styles.gravityformsstripe || {};\r\n\t\t\t\tgform.extensions.styles.gravityformsstripe[3] = gform.extensions.styles.gravityformsstripe[3] || {};\r\n\t\t\t\tgform.extensions.styles.gravityformsstripe[3][0] = {\"labels\":\"floating\",\"theme\":\"stripe\",\"variables\":{\"borderRadius\":\"--gf-ctrl-radius\",\"colorBackground\":\"--gf-ctrl-bg-color\",\"colorBackgroundText\":\"--gf-ctrl-color\",\"colorIcon\":\"--gf-ctrl-color\",\"colorIconCardCvc\":\"--gf-ctrl-color\",\"colorIconCardCvcError\":\"--gf-color-danger\",\"colorIconCardError\":\"--gf-color-danger\",\"colorIconTab\":\"--gf-ctrl-btn-icon-color-secondary\",\"colorIconTabHover\":\"--gf-ctrl-btn-icon-color-hover-secondary\",\"colorIconTabSelected\":\"--gf-ctrl-btn-color-secondary\",\"colorIconTabMore\":\"--gf-ctrl-btn-icon-color-secondary\",\"colorIconTabMoreHover\":\"--gf-ctrl-btn-icon-color-hover-secondary\",\"colorIconMenu\":\"--gf-ctrl-color\",\"colorPrimary\":\"--gf-color-primary\",\"colorPrimaryText\":\"--gf-color-primary-contrast\",\"colorDanger\":\"--gf-color-danger\",\"colorDangerText\":\"--gf-color-danger-contrast\",\"colorSuccess\":\"--gf-color-success\",\"colorSuccessText\":\"--gf-color-success-contrast\",\"colorText\":\"--gf-ctrl-color\",\"colorTextPlaceholder\":\"--gf-ctrl-placeholder-color\",\"colorTextSecondary\":\"--gf-ctrl-color\",\"fontFamily\":\"--gf-font-family-base\",\"fontSizeBase\":\"16px\",\"fontSmooth\":\"--gf-ctrl-font-smoothing\",\"spacingGridRow\":\"--gf-field-gap-y\",\"spacingGridColumn\":\"--gf-field-gap-x\"},\"rules\":{\".Input\":{\"borderColor\":\"--gf-ctrl-border-color\",\"borderWidth\":\"--gf-ctrl-border-width\",\"borderStyle\":\"--gf-ctrl-border-style\",\"color\":\"--gf-ctrl-color\",\"fontWeight\":\"--gf-ctrl-font-weight\",\"fontSize\":\"--gf-ctrl-font-size\",\"letterSpacing\":\"--gf-ctrl-letter-spacing\"},\".Input:hover\":{\"backgroundColor\":\"--gf-ctrl-bg-color-hover\",\"borderColor\":\"--gf-ctrl-border-color-hover\",\"color\":\"--gf-ctrl-color-hover\"},\".Input:hover:focus\":{\"backgroundColor\":\"--gf-ctrl-bg-color-focus\",\"borderColor\":\"--gf-ctrl-border-color-focus\",\"boxShadow\":\"--gf-ctrl-shadow-focus\",\"color\":\"--gf-ctrl-color-focus\"},\".Input:focus\":{\"backgroundColor\":\"--gf-ctrl-bg-color-focus\",\"borderColor\":\"--gf-ctrl-border-color-focus\",\"boxShadow\":\"--gf-ctrl-shadow-focus\",\"color\":\"--gf-ctrl-color-focus\"},\".Input:disabled\":{\"backgroundColor\":\"--gf-ctrl-bg-color-disabled\",\"borderColor\":\"--gf-ctrl-border-color-disabled\",\"color\":\"--gf-ctrl-color-disabled\"},\".Input:disabled:hover\":{\"backgroundColor\":\"--gf-ctrl-bg-color-disabled\",\"borderColor\":\"--gf-ctrl-border-color-disabled\",\"color\":\"--gf-ctrl-color-disabled\"},\".Input--invalid\":{\"backgroundColor\":\"--gf-ctrl-bg-color-error\",\"borderColor\":\"--gf-ctrl-border-color-error\",\"boxShadow\":\"0\",\"color\":\"--gf-ctrl-color-error\"},\".Input--invalid:hover\":{\"borderColor\":\"--gf-ctrl-border-color-error\"},\".Input::placeholder\":{\"fontFamily\":\"--gf-ctrl-placeholder-font-family\",\"fontSize\":\"--gf-ctrl-placeholder-font-size\",\"fontWeight\":\"--gf-ctrl-placeholder-font-weight\",\"letterSpacing\":\"--gf-ctrl-placeholder-letter-spacing\"},\".CodeInput\":{\"borderColor\":\"--gf-ctrl-border-color\",\"borderWidth\":\"--gf-ctrl-border-width\",\"borderStyle\":\"--gf-ctrl-border-style\",\"color\":\"--gf-ctrl-color\",\"fontWeight\":\"--gf-ctrl-font-weight\",\"fontSize\":\"--gf-ctrl-font-size\",\"letterSpacing\":\"--gf-ctrl-letter-spacing\"},\".CodeInput:focus\":{\"backgroundColor\":\"--gf-ctrl-bg-color-focus\",\"borderColor\":\"--gf-ctrl-border-color-focus\",\"boxShadow\":\"--gf-ctrl-shadow-focus\",\"color\":\"--gf-ctrl-color-focus\"},\".CheckboxInput\":{\"borderColor\":\"--gf-ctrl-border-color\",\"borderWidth\":\"--gf-ctrl-border-width\",\"borderStyle\":\"--gf-ctrl-border-style\",\"borderRadius\":\"--gf-ctrl-checkbox-check-radius\"},\".CheckboxInput:hover\":{\"backgroundColor\":\"--gf-ctrl-bg-color-hover\",\"borderColor\":\"--gf-ctrl-border-color-hover\"},\".CheckboxInput--checked:hover\":{\"backgroundColor\":\"--gf-ctrl-bg-color\",\"borderColor\":\"--gf-ctrl-border-color\"},\".Error\":{\"color\":\"--gf-ctrl-desc-color-error\",\"fontFamily\":\"--gf-ctrl-desc-font-family-error\",\"fontSize\":\"--gf-ctrl-desc-font-size-error\",\"fontWeight\":\"--gf-ctrl-desc-font-weight-error\",\"letterSpacing\":\"--gf-ctrl-desc-letter-spacing-error\",\"lineHeight\":\"--gf-ctrl-desc-line-height-error\",\"marginTop\":\"--gf-desc-space\"},\".Label--resting\":{\"color\":\"--gf-ctrl-placeholder-color\",\"fontFamily\":\"--gf-ctrl-placeholder-font-family\",\"fontSize\":\"--gf-ctrl-placeholder-font-size\",\"fontWeight\":\"--gf-ctrl-placeholder-font-weight\",\"letterSpacing\":\"--gf-ctrl-placeholder-letter-spacing\",\"opacity\":\"--gf-ctrl-placeholder-opacity\"},\".Label--floating\":{\"color\":\"--gf-ctrl-color\",\"fontFamily\":\"--gf-ctrl-placeholder-font-family\",\"fontWeight\":\"--gf-ctrl-label-font-weight-primary\",\"letterSpacing\":\"--gf-ctrl-placeholder-letter-spacing\"},\".Tab\":{\"backgroundColor\":\"--gf-ctrl-button-bg-color-secondary\",\"borderColor\":\"--gf-ctrl-button-border-color-secondary\",\"borderWidth\":\"--gf-ctrl-button-border-width-secondary\",\"borderStyle\":\"--gf-ctrl-button-border-style-secondary\",\"color\":\"--gf-ctrl-button-color-secondary\"},\".Tab:hover\":{\"backgroundColor\":\"--gf-ctrl-btn-bg-color-hover-secondary\",\"borderColor\":\"--gf-ctrl-btn-border-color-hover-secondary\",\"color\":\"--gf-ctrl-btn-color-hover-secondary\"},\".Tab:focus\":{\"backgroundColor\":\"--gf-ctrl-btn-bg-color-focus-secondary\",\"borderColor\":\"--gf-ctrl-btn-border-color-focus-secondary\",\"boxShadow\":\"--gf-ctrl-shadow-focus\",\"color\":\"--gf-ctrl-btn-color-focus-secondary\"},\".Tab:disabled\":{\"backgroundColor\":\"--gf-ctrl-btn-bg-color-disabled-secondary\",\"borderColor\":\"--gf-ctrl-btn-border-color-disabled-secondary\",\"color\":\"--gf-ctrl-btn-color-disabled-secondary\"},\".Tab--selected\":{\"borderColor\":\"--gf-ctrl-btn-border-color-focus-secondary\",\"color\":\"--gf-ctrl-btn-color-secondary\"},\".Tab--selected:hover\":{\"borderColor\":\"--gf-ctrl-btn-border-color-focus-secondary\",\"color\":\"--gf-ctrl-btn-color-secondary\"},\".Tab--selected:focus\":{\"borderColor\":\"--gf-ctrl-btn-border-color-focus-secondary\",\"boxShadow\":\"--gf-ctrl-shadow-focus\",\"color\":\"--gf-ctrl-btn-color-secondary\"},\".RedirectText\":{\"color\":\"--gf-color-primary\",\"fontFamily\":\"--gf-ctrl-desc-font-family\",\"fontSize\":\"--gf-ctrl-desc-font-size\",\"fontWeight\":\"--gf-ctrl-desc-font-weight\",\"letterSpacing\":\"--gf-ctrl-desc-letter-spacing\",\"lineHeight\":\"--gf-ctrl-desc-line-height\"},\".PickerItem--new\":{\"color\":\"--gf-ctrl-color\"},\".TermsText\":{\"color\":\"--gf-ctrl-desc-color\"},\".TermsLink\":{\"color\":\"--gf-ctrl-desc-color\"},\".Block\":{\"borderRadius\":\"--gf-ctrl-radius-max-lg\"}}};\r\n\t\t\t}\r\n\t\t<\/script>\r\n\r\n\t\t<style>#gform_wrapper_3[data-form-index=\"0\"].gform-theme,[data-parent-form=\"3_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/fr\/wp-json\/wp\/v2\/pages\/241739' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_3\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Montant du don<\/h2><\/li><li id=\"field_3_2\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_list_inline gfield_price gfield_price_3_2 gfield_product_3_2 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Choisissez le montant de votre don ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_2'>\n\t\t\t<li class='gchoice gchoice_3_2_0'>\n\t\t\t\t<input name='input_2' type='radio' value='$35|35'  id='choice_3_2_0'    \/>\n\t\t\t\t<label for='choice_3_2_0' id='label_3_2_0' class='gform-field-label gform-field-label--type-inline'>$35<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_1'>\n\t\t\t\t<input name='input_2' type='radio' value='$50|50'  id='choice_3_2_1'    \/>\n\t\t\t\t<label for='choice_3_2_1' id='label_3_2_1' class='gform-field-label gform-field-label--type-inline'>$50<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_2'>\n\t\t\t\t<input name='input_2' type='radio' value='$75|75'  id='choice_3_2_2'    \/>\n\t\t\t\t<label for='choice_3_2_2' id='label_3_2_2' class='gform-field-label gform-field-label--type-inline'>$75<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_3'>\n\t\t\t\t<input name='input_2' type='radio' value='$100|100'  id='choice_3_2_3'    \/>\n\t\t\t\t<label for='choice_3_2_3' id='label_3_2_3' class='gform-field-label gform-field-label--type-inline'>$100<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_4'>\n\t\t\t\t<input name='input_2' type='radio' value='$250|250'  id='choice_3_2_4'    \/>\n\t\t\t\t<label for='choice_3_2_4' id='label_3_2_4' class='gform-field-label gform-field-label--type-inline'>$250<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_5'>\n\t\t\t\t<input name='input_2' type='radio' value='$500|500'  id='choice_3_2_5'    \/>\n\t\t\t\t<label for='choice_3_2_5' id='label_3_2_5' class='gform-field-label gform-field-label--type-inline'>$500<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_6'>\n\t\t\t\t<input name='input_2' type='radio' value='$1000|1000'  id='choice_3_2_6'    \/>\n\t\t\t\t<label for='choice_3_2_6' id='label_3_2_6' class='gform-field-label gform-field-label--type-inline'>$1000<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_7'>\n\t\t\t\t<input name='input_2' type='radio' value='$5000|5000'  id='choice_3_2_7'    \/>\n\t\t\t\t<label for='choice_3_2_7' id='label_3_2_7' class='gform-field-label gform-field-label--type-inline'>$5000<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_2_8'>\n\t\t\t\t<input name='input_2' type='radio' value='Autre|0'  id='choice_3_2_8'    \/>\n\t\t\t\t<label for='choice_3_2_8' id='label_3_2_8' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_5\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_5 gfield_product_3_5 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_5'>Montant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_5' id='input_3_5' type='text' value='' class='medium ginput_amount'  placeholder='$' aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Fr\u00e9quence du don<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_3_7'>Les dons r\u00e9currents sont la meilleure fa\u00e7on de soutenir nos efforts pour vaincre l\u2019AMS !<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_7'>\n\t\t\t<li class='gchoice gchoice_3_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Une fois'  id='choice_3_7_0'    \/>\n\t\t\t\t<label for='choice_3_7_0' id='label_3_7_0' class='gform-field-label gform-field-label--type-inline'>Une fois<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='Mensuel'  id='choice_3_7_1'    \/>\n\t\t\t\t<label for='choice_3_7_1' id='label_3_7_1' class='gform-field-label gform-field-label--type-inline'>Mensuel<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_7_2'>\n\t\t\t\t<input name='input_7' type='radio' value='Trimestriel'  id='choice_3_7_2'    \/>\n\t\t\t\t<label for='choice_3_7_2' id='label_3_7_2' class='gform-field-label gform-field-label--type-inline'>Trimestriel<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_7_3'>\n\t\t\t\t<input name='input_7' type='radio' value='Annuel'  id='choice_3_7_3'    \/>\n\t\t\t\t<label for='choice_3_7_3' id='label_3_7_3' class='gform-field-label gform-field-label--type-inline'>Annuel<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Coordonn\u00e9es<\/h2><\/li><li id=\"field_3_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_35'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_3_35' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_34'>Don en m\u00e9moire \/ en l\u2019honneur de<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_3_34' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_10\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_10'>Num\u00e9ro de t\u00e9l\u00e9phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_3_10' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_11\" class=\"gfield gfield--type-email gfield--input-type-email gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_11'>Courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_3_11' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_3_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_36'>Famille li\u00e9e \u00e0 la personne comm\u00e9mor\u00e9e<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_3_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_12\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Informations de facturation<\/h2><\/li><li id=\"field_3_13\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_13' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_13_1_container' >\n                                        <input type='text' name='input_13.1' id='input_3_13_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_13_1' id='input_3_13_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_13_2_container' >\n                                        <input type='text' name='input_13.2' id='input_3_13_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_13_2' id='input_3_13_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_13_3_container' >\n                                    <input type='text' name='input_13.3' id='input_3_13_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_13_3' id='input_3_13_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_13_4_container' >\n                                        <input type='text' name='input_13.4' id='input_3_13_4' value=''      aria-required='true'    \/>\n                                        <label for='input_3_13_4' id='input_3_13_4_label' class='gform-field-label gform-field-label--type-sub '>\u00c9tat \/ Province \/ R\u00e9gion<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_13_5_container' >\n                                    <input type='text' name='input_13.5' id='input_3_13_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_13_5' id='input_3_13_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Code postal<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_3_13_6_container' >\n                                        <select name='input_13.6' id='input_3_13_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba ' >Bonaire, Saint-Eustache et Saba <\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option><\/select>\n                                        <label for='input_3_13_6' id='input_3_13_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Informations de paiement<\/h2><\/li><li id=\"field_3_37\" class=\"gfield gfield--type-stripe_creditcard gfield--input-type-stripe_creditcard gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--type-stripe_creditcard-payment-element\"  ><label class='gfield_label gfield_label_before_complex gform-field-label' for='input_3_37_1'>Carte de cr\u00e9dit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_creditcard ginput_stripe_creditcard gform-grid-row' id='input_3_37'><div class='ginput_full gform-grid-col' id='input_3_37_1_container' data-payment-element='true'><div id='input_3_37_1' class='StripeElement--payment-element'><\/div><\/div><!-- .ginput_full --><\/div><!-- .ginput_container -->\r\n\t\t\t<style type=\"text\/css\">\r\n\t\t\t\t:root {\r\n  \t\t\t\t\t--link-login-string: \"Link login\"\r\n\t\t\t\t}\r\n\t\t\t<\/style><\/li><li id=\"field_3_6\" class=\"gfield gfield--type-total gfield--input-type-total gfield_price gfield_price_3_ gfield_total gfield_total_3_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_3_6'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_3'>$ 0.00 CAD<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_6' id='input_3_6' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_3_16\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Si vous avez un objectif particulier pour votre don, veuillez nous en informer.<\/h2><\/li><li id=\"field_3_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Vous souhaitez d\u00e9dier votre don \u00e0 quelqu\u2019un ?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_18'>\n\t\t\t<li class='gchoice gchoice_3_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Oui'  id='choice_3_18_0'    \/>\n\t\t\t\t<label for='choice_3_18_0' id='label_3_18_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='Non' checked='checked' id='choice_3_18_1'    \/>\n\t\t\t\t<label for='choice_3_18_1' id='label_3_18_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Choisir<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_23'>\n\t\t\t<li class='gchoice gchoice_3_23_0'>\n\t\t\t\t<input name='input_23' type='radio' value='En l&#039;honneur de' checked='checked' id='choice_3_23_0'    \/>\n\t\t\t\t<label for='choice_3_23_0' id='label_3_23_0' class='gform-field-label gform-field-label--type-inline'>En l'honneur de<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_23_1'>\n\t\t\t\t<input name='input_23' type='radio' value='\u00c0 la m\u00e9moire de'  id='choice_3_23_1'    \/>\n\t\t\t\t<label for='choice_3_23_1' id='label_3_23_1' class='gform-field-label gform-field-label--type-inline'>\u00c0 la m\u00e9moire de<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_23_2'>\n\t\t\t\t<input name='input_23' type='radio' value='En hommage \u00e0'  id='choice_3_23_2'    \/>\n\t\t\t\t<label for='choice_3_23_2' id='label_3_23_2' class='gform-field-label gform-field-label--type-inline'>En hommage \u00e0<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_24\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Nom<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_3_24'>\n                            \n                            <span id='input_3_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.3' id='input_3_24_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_24_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            <span id='input_3_24_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.4' id='input_3_24_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_24_4' class='gform-field-label gform-field-label--type-sub '>2\u00e8me pr\u00e9nom<\/label>\n                                                <\/span>\n                            <span id='input_3_24_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.6' id='input_3_24_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_24_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_3_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_25'><li class='gchoice gchoice_3_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='Veuillez envoyer un remerciement \u00e0 la personne ou \u00e0 la famille \u00e0 qui ce don est d\u00e9di\u00e9'  id='choice_3_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_25_1' id='label_3_25_1' class='gform-field-label gform-field-label--type-inline'>Veuillez envoyer un remerciement \u00e0 la personne ou \u00e0 la famille \u00e0 qui ce don est d\u00e9di\u00e9<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Comment souhaitez-vous envoyer un accus\u00e9 de r\u00e9ception ?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_26'>\n\t\t\t<li class='gchoice gchoice_3_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Envoyer un accus\u00e9 de r\u00e9ception par courriel'  id='choice_3_26_0'    \/>\n\t\t\t\t<label for='choice_3_26_0' id='label_3_26_0' class='gform-field-label gform-field-label--type-inline'>Envoyer un accus\u00e9 de r\u00e9ception par courriel<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_3_26'>En envoyant une confirmation \u00e0 la famille que vous avez fait un don en l\u2019honneur de leur proche, vous nous faites \u00e9conomiser du temps ainsi que les frais d\u2019impression et de postage. Nous pouvons vous aider \u00e0 envoyer cette confirmation en vous envoyant un accus\u00e9 de r\u00e9ception par courriel accompagn\u00e9 de votre re\u00e7u de don, que vous pourrez imprimer et transmettre \u00e0 la famille de la personne honor\u00e9e. Si vous souhaitez malgr\u00e9 tout que nous envoyions une lettre d\u2019accus\u00e9 de r\u00e9ception par la poste, veuillez nous \u00e9crire \u00e0 : director@msacanada.ca  \n<\/div><\/li><li id=\"field_3_27\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_27'>\n                            \n                            <span id='input_3_27_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.3' id='input_3_27_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_27_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_27_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.6' id='input_3_27_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_27_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_3_28\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_28'>Courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_28' id='input_3_28' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_3_28\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_3_28'>Un accus\u00e9 de r\u00e9ception sera envoy\u00e9 \u00e0 cette adresse courriel.<\/div><\/li><li id=\"field_3_31\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_31'>Message de d\u00e9dicace<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_3_31' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_33\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_33'>Souhaitez-vous que votre don soit destin\u00e9 \u00e0 un fonds patrimonial sp\u00e9cifique ?<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_3_33' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Pas de fonds de legs sp\u00e9cifique' selected='selected'>Pas de fonds de legs sp\u00e9cifique<\/option><option value='Maureen Frances Herlihey' >Maureen Frances Herlihey<\/option><option value='Steven Foster' >Steven Foster<\/option><option value='Janine Lalonde Paquette' >Janine Lalonde Paquette<\/option><option value='Thomas Shiels Hyman' >Thomas Shiels Hyman<\/option><option value='Anne Marie Brady' >Anne Marie Brady<\/option><option value='Garneau Family\/La Famille Garneau' >Garneau Family\/La Famille Garneau<\/option><option value='Adelene McGillivary' >Adelene McGillivary<\/option><option value='David Edey' >David Edey<\/option><option value='Beverly Rundle Woolcock' >Beverly Rundle Woolcock<\/option><option value='Kelly Murphy' >Kelly Murphy<\/option><\/select><\/div><\/li><li id=\"field_3_19\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'>Comment souhaitez-vous que votre don soit utilis\u00e9 ?<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_3_19' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Utiliser selon les besoins (recommand\u00e9)' selected='selected'>Utiliser selon les besoins (recommand\u00e9)<\/option><option value='Soutien aux patients et aux soignants' >Soutien aux patients et aux soignants<\/option><option value='Recherche AMS' >Recherche AMS<\/option><option value='\u00c9ducation m\u00e9dicale' >\u00c9ducation m\u00e9dicale<\/option><option value='Sensibilisation du public' >Sensibilisation du public<\/option><option value='Centre de soutien du groupe' >Centre de soutien du groupe<\/option><\/select><\/div><\/li><li id=\"field_3_20\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_20'>Quel est votre lien avec l\u2019atrophie multisyst\u00e9mique ?<\/label><div class='gfield_description' id='gfield_description_3_20'>choisissez la r\u00e9ponse qui vous convient le mieux<\/div><div class='ginput_container ginput_container_select'><select name='input_20' id='input_3_20' class='medium gfield_select'  aria-describedby=\"gfield_description_3_20\"   aria-invalid=\"false\" ><option value='Patient.e' selected='selected'>Patient.e<\/option><option value='Conjoint.e' >Conjoint.e<\/option><option value='Membre de la famille' >Membre de la famille<\/option><option value='Ami du patient' >Ami du patient<\/option><option value='Coll\u00e8gue du patient' >Coll\u00e8gue du patient<\/option><option value='Professionnel de sant\u00e9' >Professionnel de sant\u00e9<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/li><li id=\"field_3_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Options de don<\/h2><\/li><li id=\"field_3_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Votre don est trait\u00e9 de mani\u00e8re s\u00e9curis\u00e9e. Toutefois, des frais de transaction de 3 % sont ajout\u00e9s par notre banque. Veuillez envisager d\u2019ajouter 3 % suppl\u00e9mentaires afin que 100 % du montant de votre don nous soit vers\u00e9.   <\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_22'>\n\t\t\t<li class='gchoice gchoice_3_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='Donner 100 % \u2013 Ajouter 3 % pour que 100 % du don aille \u00e0 VAINCRE l\u2019AMS !'  id='choice_3_22_0'    \/>\n\t\t\t\t<label for='choice_3_22_0' id='label_3_22_0' class='gform-field-label gform-field-label--type-inline'>Donner 100 % \u2013 Ajouter 3 % pour que 100 % du don aille \u00e0 VAINCRE l\u2019AMS !<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='Utiliser 3 % de mon don pour couvrir les frais bancaires.' checked='checked' id='choice_3_22_1'    \/>\n\t\t\t\t<label for='choice_3_22_1' id='label_3_22_1' class='gform-field-label gform-field-label--type-inline'>Utiliser 3 % de mon don pour couvrir les frais bancaires.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_32'><li class='gchoice gchoice_3_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Inscrivez-vous \u00e0 notre infolettre'  id='choice_3_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_1' id='label_3_32_1' class='gform-field-label gform-field-label--type-inline'>Inscrivez-vous \u00e0 notre infolettre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='FAITES VOTRE DON'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/msacanada.ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_3').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_3').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_3').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_3').val();gformInitSpinner( 3, 'https:\/\/msacanada.ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [3, current_page]);window['gf_submitting_3'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_3').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [3]);window['gf_submitting_3'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_3').text());}else{jQuery('#gform_3').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"3\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_3\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_3\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_3\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 3, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_row_inner content_placement=\u00a0\u00bbmiddle\u00a0\u00bb][vc_column_inner width=\u00a0\u00bb1\/3&Prime;][vc_column_text css=\u00a0\u00bb\u00a0\u00bb][\/vc_column_text][\/vc_column_inner][vc_column_inner width=\u00a0\u00bb2\/3&Prime;][vc_column_text css=\u00a0\u00bb.vc_custom_1747258335306{margin-bottom: 15px !important;}\u00a0\u00bb] FAIRE UN DON \u00c0 L&rsquo;AMS Aidez-nous \u00e0 aider ceux qui souffrent de l&rsquo;atrophie multisyst\u00e9matis\u00e9e! Pour envoyer un ch\u00e8que, t\u00e9l\u00e9chargez notre formulaire de don et envoyez-le \u00e0 : Defeat Multiple System Atrophy (MSA) Canada \/ Vaincre L\u2019atrophie Multisyst\u00e9matis\u00e9e (AMS) Canada 3041 Dougall Avenue, Suite 208 Windsor, Ontario N9E&hellip;<\/p>\n","protected":false},"author":2,"featured_media":241712,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-241739","page","type-page","status-publish","has-post-thumbnail","hentry","description-off"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Faire un don pour soutenir les patients atteints de l&#039;AMS<\/title>\n<meta name=\"description\" content=\"Faites une diff\u00e9rence aujourd&#039;hui. Votre don soutient les Canadiens atteints de l&#039;AMS par les soins, la d\u00e9fense des droits et la recherche.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/msacanada.ca\/fr\/faire-un-don\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Faire un don pour soutenir les patients atteints de l&#039;AMS\" \/>\n<meta property=\"og:description\" content=\"Faites une diff\u00e9rence aujourd&#039;hui. Votre don soutient les Canadiens atteints de l&#039;AMS par les soins, la d\u00e9fense des droits et la recherche.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/msacanada.ca\/fr\/faire-un-don\/\" \/>\n<meta property=\"og:site_name\" content=\"MSA Canada\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/defeatmsacanada\/\" \/>\n<meta property=\"article:modified_time\" content=\"2025-05-16T20:06:45+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1920\" \/>\n\t<meta property=\"og:image:height\" content=\"1008\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/\",\"url\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/\",\"name\":\"Faire un don pour soutenir les patients atteints de l'AMS\",\"isPartOf\":{\"@id\":\"https:\/\/msacanada.ca\/fr\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg\",\"datePublished\":\"2025-02-14T00:01:59+00:00\",\"dateModified\":\"2025-05-16T20:06:45+00:00\",\"description\":\"Faites une diff\u00e9rence aujourd'hui. Votre don soutient les Canadiens atteints de l'AMS par les soins, la d\u00e9fense des droits et la recherche.\",\"breadcrumb\":{\"@id\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/msacanada.ca\/fr\/faire-un-don\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/#primaryimage\",\"url\":\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg\",\"contentUrl\":\"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg\",\"width\":1920,\"height\":1008},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/msacanada.ca\/fr\/faire-un-don\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/msacanada.ca\/fr\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Faire un don\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/msacanada.ca\/fr\/#website\",\"url\":\"https:\/\/msacanada.ca\/fr\/\",\"name\":\"MSA Canada\",\"description\":\"Defeat MSA\/Vaincre AMS Canada\",\"publisher\":{\"@id\":\"https:\/\/msacanada.ca\/fr\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/msacanada.ca\/fr\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/msacanada.ca\/fr\/#organization\",\"name\":\"MSA Canada\",\"url\":\"https:\/\/msacanada.ca\/fr\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/msacanada.ca\/fr\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/msacanada.ca\/wp-content\/uploads\/2024\/11\/MSA-Canada-Logo-ret.png\",\"contentUrl\":\"https:\/\/msacanada.ca\/wp-content\/uploads\/2024\/11\/MSA-Canada-Logo-ret.png\",\"width\":400,\"height\":400,\"caption\":\"MSA Canada\"},\"image\":{\"@id\":\"https:\/\/msacanada.ca\/fr\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.facebook.com\/defeatmsacanada\/\",\"https:\/\/www.instagram.com\/msaamscanada\/\",\"https:\/\/www.youtube.com\/channel\/UCT9R2fSQUFmhiJ_xP3hICxg\",\"https:\/\/www.linkedin.com\/company\/defeatmsacanada\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Faire un don pour soutenir les patients atteints de l'AMS","description":"Faites une diff\u00e9rence aujourd'hui. Votre don soutient les Canadiens atteints de l'AMS par les soins, la d\u00e9fense des droits et la recherche.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/msacanada.ca\/fr\/faire-un-don\/","og_locale":"fr_FR","og_type":"article","og_title":"Faire un don pour soutenir les patients atteints de l'AMS","og_description":"Faites une diff\u00e9rence aujourd'hui. Votre don soutient les Canadiens atteints de l'AMS par les soins, la d\u00e9fense des droits et la recherche.","og_url":"https:\/\/msacanada.ca\/fr\/faire-un-don\/","og_site_name":"MSA Canada","article_publisher":"https:\/\/www.facebook.com\/defeatmsacanada\/","article_modified_time":"2025-05-16T20:06:45+00:00","og_image":[{"width":1920,"height":1008,"url":"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_misc":{"Dur\u00e9e de lecture estim\u00e9e":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/msacanada.ca\/fr\/faire-un-don\/","url":"https:\/\/msacanada.ca\/fr\/faire-un-don\/","name":"Faire un don pour soutenir les patients atteints de l'AMS","isPartOf":{"@id":"https:\/\/msacanada.ca\/fr\/#website"},"primaryImageOfPage":{"@id":"https:\/\/msacanada.ca\/fr\/faire-un-don\/#primaryimage"},"image":{"@id":"https:\/\/msacanada.ca\/fr\/faire-un-don\/#primaryimage"},"thumbnailUrl":"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg","datePublished":"2025-02-14T00:01:59+00:00","dateModified":"2025-05-16T20:06:45+00:00","description":"Faites une diff\u00e9rence aujourd'hui. Votre don soutient les Canadiens atteints de l'AMS par les soins, la d\u00e9fense des droits et la recherche.","breadcrumb":{"@id":"https:\/\/msacanada.ca\/fr\/faire-un-don\/#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/msacanada.ca\/fr\/faire-un-don\/"]}]},{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/msacanada.ca\/fr\/faire-un-don\/#primaryimage","url":"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg","contentUrl":"https:\/\/msacanada.ca\/wp-content\/uploads\/2025\/04\/MSA-Featured.jpg","width":1920,"height":1008},{"@type":"BreadcrumbList","@id":"https:\/\/msacanada.ca\/fr\/faire-un-don\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/msacanada.ca\/fr\/"},{"@type":"ListItem","position":2,"name":"Faire un don"}]},{"@type":"WebSite","@id":"https:\/\/msacanada.ca\/fr\/#website","url":"https:\/\/msacanada.ca\/fr\/","name":"MSA Canada","description":"Defeat MSA\/Vaincre AMS Canada","publisher":{"@id":"https:\/\/msacanada.ca\/fr\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/msacanada.ca\/fr\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/msacanada.ca\/fr\/#organization","name":"MSA Canada","url":"https:\/\/msacanada.ca\/fr\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/msacanada.ca\/fr\/#\/schema\/logo\/image\/","url":"https:\/\/msacanada.ca\/wp-content\/uploads\/2024\/11\/MSA-Canada-Logo-ret.png","contentUrl":"https:\/\/msacanada.ca\/wp-content\/uploads\/2024\/11\/MSA-Canada-Logo-ret.png","width":400,"height":400,"caption":"MSA Canada"},"image":{"@id":"https:\/\/msacanada.ca\/fr\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/defeatmsacanada\/","https:\/\/www.instagram.com\/msaamscanada\/","https:\/\/www.youtube.com\/channel\/UCT9R2fSQUFmhiJ_xP3hICxg","https:\/\/www.linkedin.com\/company\/defeatmsacanada"]}]}},"_links":{"self":[{"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/pages\/241739","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/comments?post=241739"}],"version-history":[{"count":3,"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/pages\/241739\/revisions"}],"predecessor-version":[{"id":242391,"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/pages\/241739\/revisions\/242391"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/media\/241712"}],"wp:attachment":[{"href":"https:\/\/msacanada.ca\/fr\/wp-json\/wp\/v2\/media?parent=241739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}