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            <div class="field--type-string field--name-field-numero-tahiti field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-numero-tahiti-wrapper" data-drupal-states="{&quot;visible&quot;:{&quot;input[name=\u0022field_statut\u0022]&quot;:{&quot;value&quot;:&quot;professionnel&quot;}}}" id="edit-field-numero-tahiti-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-numero-tahiti-0-value js-form-item-field-numero-tahiti-0-value form-group">
      <label for="edit-field-numero-tahiti-0-value" class="control-label">Numéro Tahiti</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-numero-tahiti-0-value" type="text" id="edit-field-numero-tahiti-0-value" name="field_numero_tahiti[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
  </div>

  </div>

        </div>
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    <div class="row">
        <div class="col-md-12">
            <div class="field--type-string field--name-field-enseigne field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-enseigne-wrapper" data-drupal-states="{&quot;visible&quot;:{&quot;input[name=\u0022field_statut\u0022]&quot;:{&quot;value&quot;:&quot;professionnel&quot;}}}" id="edit-field-enseigne-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-enseigne-0-value js-form-item-field-enseigne-0-value form-group">
      <label for="edit-field-enseigne-0-value" class="control-label">Enseigne</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-enseigne-0-value" type="text" id="edit-field-enseigne-0-value" name="field_enseigne[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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    <div class="row">
        <div class="col-md-12">
            <div class="field--type-string field--name-field-site-internet field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-site-internet-wrapper" data-drupal-states="{&quot;visible&quot;:{&quot;input[name=\u0022field_statut\u0022]&quot;:{&quot;value&quot;:&quot;professionnel&quot;}}}" id="edit-field-site-internet-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-site-internet-0-value js-form-item-field-site-internet-0-value form-group">
      <label for="edit-field-site-internet-0-value" class="control-label">Site internet</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-site-internet-0-value" type="text" id="edit-field-site-internet-0-value" name="field_site_internet[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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            <div data-drupal-selector="edit-account" class="form-group js-form-wrapper form-wrapper" id="edit-account"><div class="form-item js-form-item form-type-email js-form-type-email form-item-mail js-form-item-mail form-group">
      <label for="edit-mail" class="control-label js-form-required form-required">Adresse de courriel</label>
  
  
  <input data-drupal-selector="edit-mail" aria-describedby="edit-mail--description" class="form-email required form-control" type="email" id="edit-mail" name="mail" value="" size="60" maxlength="254" required="required" aria-required="true" />

  
      <div id="edit-mail--description" class="description help-block">
      Une adresse de courriel valide. Tous les courriels de la part du système seront envoyés à cette adresse. L'adresse de courriel n'est pas publique et ne sera utilisée que si vous souhaitez recevoir un nouveau mot de passe, certaines actualités ou des notifications par courriel.
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<div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-name js-form-item-name form-group">
      <label for="edit-name" class="control-label js-form-required form-required">Nom d'utilisateur</label>
  
  
  <input class="username form-text required form-control" autocorrect="off" autocapitalize="off" spellcheck="false" data-drupal-selector="edit-name" aria-describedby="edit-name--description" type="text" id="edit-name" name="name" value="" size="60" maxlength="60" required="required" aria-required="true" title="Plusieurs caractères spéciaux sont autorisés : l&#039;espace, le point (.), le tiret (-), l&#039;apostrophe (&#039;), le tiret bas (_) et le signe @." data-toggle="tooltip" />

  
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  <input class="password-field js-password-field form-text required form-control" data-drupal-selector="edit-pass-pass1" title="Saisissez un mot de passe pour le nouveau compte dans les deux champs." data-toggle="tooltip" type="password" id="edit-pass-pass1" name="pass[pass1]" size="25" maxlength="128" required="required" aria-required="true" />

  
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<div class="form-item js-form-item form-type-password js-form-type-password form-item-pass-pass2 js-form-item-pass-pass2 form-group">
      <label for="edit-pass-pass2" class="control-label js-form-required form-required">Confirmer le mot de passe</label>
  
  
  <input class="password-confirm js-password-confirm form-text required form-control" data-drupal-selector="edit-pass-pass2" type="password" id="edit-pass-pass2" name="pass[pass2]" size="25" maxlength="128" required="required" aria-required="true" />

  
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            <div class="field--type-string field--name-field-nom field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-nom-wrapper" id="edit-field-nom-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-nom-0-value js-form-item-field-nom-0-value form-group">
      <label for="edit-field-nom-0-value" class="control-label js-form-required form-required">Nom</label>
  
  
  <input class="js-text-full text-full form-text required form-control" data-drupal-selector="edit-field-nom-0-value" type="text" id="edit-field-nom-0-value" name="field_nom[0][value]" value="" size="60" maxlength="255" placeholder="" required="required" aria-required="true" />

  
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            <div class="field--type-string field--name-field-prenom field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-prenom-wrapper" id="edit-field-prenom-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-prenom-0-value js-form-item-field-prenom-0-value form-group">
      <label for="edit-field-prenom-0-value" class="control-label js-form-required form-required">Prénom</label>
  
  
  <input class="js-text-full text-full form-text required form-control" data-drupal-selector="edit-field-prenom-0-value" type="text" id="edit-field-prenom-0-value" name="field_prenom[0][value]" value="" size="60" maxlength="255" placeholder="" required="required" aria-required="true" />

  
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      <label for="edit-field-comite-entreprise-0-value" class="control-label">Comité entreprise</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-comite-entreprise-0-value" type="text" id="edit-field-comite-entreprise-0-value" name="field_comite_entreprise[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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      <label for="edit-field-adresse-0-value" class="control-label">Adresse</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-adresse-0-value" type="text" id="edit-field-adresse-0-value" name="field_adresse[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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            <div class="field--type-string field--name-field-boite-postale field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-boite-postale-wrapper" id="edit-field-boite-postale-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-boite-postale-0-value js-form-item-field-boite-postale-0-value form-group">
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  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-boite-postale-0-value" type="text" id="edit-field-boite-postale-0-value" name="field_boite_postale[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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            <div class="field--type-string field--name-field-commune field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-commune-wrapper" id="edit-field-commune-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-commune-0-value js-form-item-field-commune-0-value form-group">
      <label for="edit-field-commune-0-value" class="control-label">Commune</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-commune-0-value" type="text" id="edit-field-commune-0-value" name="field_commune[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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        <div class="col-md-12">
            <div class="field--type-string field--name-field-code-postal field--widget-string-textfield form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-code-postal-wrapper" id="edit-field-code-postal-wrapper">      <div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-field-code-postal-0-value js-form-item-field-code-postal-0-value form-group">
      <label for="edit-field-code-postal-0-value" class="control-label">Code postal</label>
  
  
  <input class="js-text-full text-full form-text form-control" data-drupal-selector="edit-field-code-postal-0-value" type="text" id="edit-field-code-postal-0-value" name="field_code_postal[0][value]" value="" size="60" maxlength="255" placeholder="" />

  
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        <div class="col-md-6">
            <div class="field--type-telephone field--name-field-telephone field--widget-telephone-default form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-telephone-wrapper" id="edit-field-telephone-wrapper">      <div class="form-inline form-item js-form-item form-type-tel js-form-type-tel form-item-field-telephone-0-value js-form-item-field-telephone-0-value form-group">
      <label for="edit-field-telephone-0-value" class="control-label">Téléphone</label>
  
  
  <input data-drupal-selector="edit-field-telephone-0-value" class="form-tel form-control" type="tel" id="edit-field-telephone-0-value" name="field_telephone[0][value]" value="" size="30" maxlength="128" placeholder="" />

  
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        </div>
        <div class="col-md-6">
            <div class="field--type-telephone field--name-field-mobile field--widget-telephone-default form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-field-mobile-wrapper" id="edit-field-mobile-wrapper">      <div class="form-inline form-item js-form-item form-type-tel js-form-type-tel form-item-field-mobile-0-value js-form-item-field-mobile-0-value form-group">
      <label for="edit-field-mobile-0-value" class="control-label">Mobile</label>
  
  
  <input data-drupal-selector="edit-field-mobile-0-value" class="form-tel form-control" type="tel" id="edit-field-mobile-0-value" name="field_mobile[0][value]" value="" size="30" maxlength="128" placeholder="" />

  
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