<form class="forminscription"> <div class="et_pb_module et_pb_accordion et_pb_accordion_0"> <div class="et_pb_module et_pb_toggle et_pb_accordion_item_0 et_pb_toggle_open"> <h5 class="et_pb_toggle_title">Etape 1</h5> <div class="et_pb_toggle_content clearfix" style="display: block;"> <p> <span class="intitule">Nom</span> <input type="text" required="" name="last_name" /> </br> <span class="intitule">Prénom</span> <input type="text" required="" name="first_name" /> </br> <span class="intitule">Date de naissance</span> <select class="intitule_tiers" name="birth_date" type="text" required=""> <option value="1">1</option> <option value="2">2</option> <option value="3">3</option> <option value="4">4</option> <option value="5">5</option> <option value="6">6</option> <option value="7">7</option> <option value="8">8</option> <option value="9">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> <option value="13">13</option> <option value="14">14</option> <option value="15">15</option> <option value="16">16</option> <option value="17">17</option> <option value="18">18</option> <option value="19">19</option> <option value="20">20</option> <option value="21">21</option> <option value="22">22</option> <option value="23">23</option> <option value="24">24</option> <option value="25">25</option> <option value="26">26</option> <option value="27">27</option> <option value="28">28</option> <option value="29">29</option> <option value="30">30</option> <option value="31">31</option> </select> <select class="intitule_tiers" name="birth_month" type="text" required=""> <option value="1">Janvier</option> <option value="2">Fevrier</option> <option value="3">Mars</option> <option value="4">Avril</option> <option value="5">Mai</option> <option value="6">Juin</option> <option value="7">Juillet</option> <option value="8">Aout</option> <option value="9">Septembre</option> <option value="10">Octobre</option> <option value="11">Novembre</option> <option value="12">Décembre</option> </select> <select class="intitule_tiers" name="birth_year" type="text" required=""> <option value="1">2005</option> <option value="2">2004</option> <option value="3">2003</option> <option value="4">2002</option> <option value="5">2001</option> <option value="6">2000</option> <option value="7">1999</option> <option value="8">1998</option> <option value="9">1997</option> <option value="10">1996</option> <option value="11">1995</option> <option value="12">1994</option> <option value="13">1993</option> <option value="14">1992</option> <option value="15">1991</option> <option value="16">1990</option> <option value="17">1989</option> <option value="18">1988</option> <option value="19">1987</option> <option value="20">1986</option> </select> </br> <span class="intitule">Adresse</span> <input name="adresse" required="" type="text" /> </br> <span class="intitule">Telephone portable</span> <input type="tel" pattern="^((\+\d{1,3}(-| )?\(?\d\)?(-| )?\d{1,5})|(\(?\d{2,6}\)?))(-| )?(\d{3,4})(-| )?(\d{4})(( x| ext)\d{1,5}){0,1}$" required="" name="numtel"> </p> </div> <!-- .et_pb_toggle_content --> </div> <!-- .et_pb_toggle --> <div class="et_pb_module et_pb_toggle et_pb_accordion_item_1 et_pb_toggle_close"> <h5 class="et_pb_toggle_title">Etape 2</h5> <div class="et_pb_toggle_content clearfix" style="display: none;"> <p> <span class="intitule">Ecole (si étudiant)</span> <input name="school" required="" type="text" /> </br> <span class="intitule">Campus ou Ville (si besoin)</span> <input name="school_campus" required="" type="text" /> </br> <span class="intitule">Niveau d'études (en cours)</span> <select name="study_level" type="text" required=""> <option value="1">Seconde</option> <option value="2">Première</option> <option value="3">Terminale</option> <option value="4">BAC+1</option> <option value="5">BAC+2</option> <option value="6">BAC+3</option> <option value="7">BAC+4</option> <option value="8">BAC+5</option> <option value="10">> BAC+5</option> <option value="11">3ème</option> <option value="12">4ème</option> </select> </p> </div> <!-- .et_pb_toggle_content --> </div> <!-- .et_pb_toggle --> <div class="et_pb_module et_pb_toggle et_pb_accordion_item_2 et_pb_toggle_close"> <h5 class="et_pb_toggle_title">Etape 3</h5> <div class="et_pb_toggle_content clearfix" style="display: none;"> <p> <span class="intitule">Adresse email</span> <input type="email" required="" name="email" /> </br> <span class="intitule">Confirmer votre email</span> <input type="email" required="" name="confirm_email" /> </br> <span class="intitule">Mot de passe</span> <input type="password" required="" name="password" /> </br> <span class="intitule">Confirmer Mot de passe</span> <input type="password" required="" name="password" /> </p> </div> <!-- .et_pb_toggle_content --> </div> <!-- .et_pb_toggle --> </div> <span class="intitule">Code Promo</span> <input type="text" name="code_promo" /> <br><br><span class="privacy-policy"> <input type="checkbox" required="" name="checkbox" />J'accepte <a href="https://www.limon.cards/cgv/" onclick="window.open(this.href); return false;">les Conditions</a>.</span> <br/><br /> <div class="login"> <input type="submit" name="S'inscrire" /> </div> </form>