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<DIV ALIGN='center'>
<FORM ACTION='inscrIns.php#haut', METHOD='POST'>
<TABLE border='0'>
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<INPUT TYPE='HIDDEN' NAME='nbOpt' VALUE=''><br />
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<INPUT TYPE='HIDDEN' NAME='optionLibre' VALUE=''><br />
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<TR><TD class='list-title2'><FONT color='#000000'>Nom *</FONT></TD><TD class='list-title2'><INPUT TYPE='text' SIZE=25 maxlength=25 VALUE='' NAME='nom'></TD></TR>
<TR><TD class='list-title'><FONT color='#000000'>Prénom *</FONT></TD><TD class='list-title'><INPUT TYPE='text' SIZE=25 maxlength=25 VALUE='' NAME='prenom'></TD></TR>
<TR><TD class='list-title2'><FONT color='#000000'>Titre *</FONT></TD><TD class='list-title2'><SELECT NAME='titr'> <OPTION> ---- </OPTION>
<OPTION>Monsieur</OPTION>
<OPTION>Madame</OPTION>
</SELECT></TD></TR>
<TR><TD class='list-title'><FONT color='#000000'>Rue *</TD><TD class='list-title'><INPUT TYPE='text' SIZE=35 maxlength=35 VALUE='' NAME='rue1'></TD></TR>
<TR><TD class='list-title2'><FONT color='#000000'>Numéro Postal *</FONT></TD><TD class='list-title2'><INPUT TYPE='text' SIZE=8 maxlength=8 VALUE='' NAME='zip'></TD></TR>
<TR><TD class='list-title'><FONT color='#000000'>Ville *</FONT></TD><TD class='list-title'><INPUT TYPE='text' SIZE=25 maxlength=25 VALUE='' NAME='ville'></TD></TR>
<TR><TD class='list-title2'><FONT color='#000000'>Pays *</FONT></TD><TD class='list-title2'><SELECT NAME='pays' size='1'> <OPTION Value=''> ---- </OPTION>
<OPTION value='CHE'>Switzerland                              </OPTION>
<OPTION value='FRA'>France                                   </OPTION>
<OPTION value='DEU'>Germany                                  </OPTION>
<OPTION value='ITA'>Italy                                    </OPTION>
<OPTION value='AUT'>Austria                                  </OPTION>
<OPTION value='GBR'>Great Britain                            </OPTION>
<OPTION value='ESP'>Spain                                    </OPTION>
<OPTION value='BEL'>Belgium                                  </OPTION>
<Option Value='' disabled>-----------------------------------</option>
<OPTION value='AFG'>Afghanistan                                               </OPTION>
<OPTION value='ALB'>Albania                                                   </OPTION>
<OPTION value='DZA'>Algeria                                                   </OPTION>
<OPTION value='ASM'>American Samoa                                            </OPTION>
<OPTION value='AND'>Andorra                                                   </OPTION>
<OPTION value='AGO'>Angola                                                    </OPTION>
<OPTION value='AIA'>Anguilla                                                  </OPTION>
<OPTION value='ATA'>Antarctica                                                </OPTION>
<OPTION value='ATG'>Antigua and Barbuda                                       </OPTION>
<OPTION value='ARG'>Argentina                                                 </OPTION>
<OPTION value='ARM'>Armenia                                                   </OPTION>
<OPTION value='ABW'>Aruba                                                     </OPTION>
<OPTION value='AUS'>Australia                                                 </OPTION>
<OPTION value='AUT'>Austria                                                   </OPTION>
<OPTION value='AZE'>Azerbaijan                                                </OPTION>
<OPTION value='BHS'>Bahamas (the)                                             </OPTION>
<OPTION value='BHR'>Bahrain                                                   </OPTION>
<OPTION value='BGD'>Bangladesh                                                </OPTION>
<OPTION value='BRB'>Barbados                                                  </OPTION>
<OPTION value='BLR'>Belarus                                                   </OPTION>
<OPTION value='BEL'>Belgium                                                   </OPTION>
<OPTION value='BLZ'>Belize                                                    </OPTION>
<OPTION value='BEN'>Benin                                                     </OPTION>
<OPTION value='BMU'>Bermuda                                                   </OPTION>
<OPTION value='BTN'>Bhutan                                                    </OPTION>
<OPTION value='BOL'>Bolivia (Plurinational State of)                          </OPTION>
<OPTION value='BES'>Bonaire, Sint Eustatius and Saba                          </OPTION>
<OPTION value='BIH'>Bosnia and Herzegovina                                    </OPTION>
<OPTION value='BWA'>Botswana                                                  </OPTION>
<OPTION value='BVT'>Bouvet Island                                             </OPTION>
<OPTION value='BRA'>Brazil                                                    </OPTION>
<OPTION value='IOT'>British Indian Ocean Territory (the)                      </OPTION>
<OPTION value='BRN'>Brunei Darussalam                                         </OPTION>
<OPTION value='BGR'>Bulgaria                                                  </OPTION>
<OPTION value='BFA'>Burkina Faso                                              </OPTION>
<OPTION value='BDI'>Burundi                                                   </OPTION>
<OPTION value='CPV'>Cabo Verde                                                </OPTION>
<OPTION value='KHM'>Cambodia                                                  </OPTION>
<OPTION value='CMR'>Cameroon                                                  </OPTION>
<OPTION value='CAN'>Canada                                                    </OPTION>
<OPTION value='CYM'>Cayman Islands (the)                                      </OPTION>
<OPTION value='CAF'>Central African Republic (the)                            </OPTION>
<OPTION value='TCD'>Chad                                                      </OPTION>
<OPTION value='CHL'>Chile                                                     </OPTION>
<OPTION value='CHN'>China                                                     </OPTION>
<OPTION value='CXR'>Christmas Island                                          </OPTION>
<OPTION value='CCK'>Cocos (Keeling) Islands (the)                             </OPTION>
<OPTION value='COL'>Colombia                                                  </OPTION>
<OPTION value='COM'>Comoros (the)                                             </OPTION>
<OPTION value='COD'>Congo (the Democratic Republic of the)                    </OPTION>
<OPTION value='COG'>Congo (the)                                               </OPTION>
<OPTION value='COK'>Cook Islands (the)                                        </OPTION>
<OPTION value='CRI'>Costa Rica                                                </OPTION>
<OPTION value='HRV'>Croatia                                                   </OPTION>
<OPTION value='CUB'>Cuba                                                      </OPTION>
<OPTION value='CUW'>Curaçao                                                   </OPTION>
<OPTION value='CYP'>Cyprus                                                    </OPTION>
<OPTION value='CZE'>Czechia                                                   </OPTION>
<OPTION value='CIV'>Côte d'Ivoire                                             </OPTION>
<OPTION value='DNK'>Denmark                                                   </OPTION>
<OPTION value='DJI'>Djibouti                                                  </OPTION>
<OPTION value='DMA'>Dominica                                                  </OPTION>
<OPTION value='DOM'>Dominican Republic (the)                                  </OPTION>
<OPTION value='ECU'>Ecuador                                                   </OPTION>
<OPTION value='EGY'>Egypt                                                     </OPTION>
<OPTION value='SLV'>El Salvador                                               </OPTION>
<OPTION value='GNQ'>Equatorial Guinea                                         </OPTION>
<OPTION value='ERI'>Eritrea                                                   </OPTION>
<OPTION value='EST'>Estonia                                                   </OPTION>
<OPTION value='SWZ'>Eswatini                                                  </OPTION>
<OPTION value='ETH'>Ethiopia                                                  </OPTION>
<OPTION value='FLK'>Falkland Islands (the) [Malvinas]                         </OPTION>
<OPTION value='FRO'>Faroe Islands (the)                                       </OPTION>
<OPTION value='FJI'>Fiji                                                      </OPTION>
<OPTION value='FIN'>Finland                                                   </OPTION>
<OPTION value='FRA'>France                                                    </OPTION>
<OPTION value='GUF'>French Guiana                                             </OPTION>
<OPTION value='PYF'>French Polynesia                                          </OPTION>
<OPTION value='ATF'>French Southern Territories (the)                         </OPTION>
<OPTION value='GAB'>Gabon                                                     </OPTION>
<OPTION value='GMB'>Gambia (the)                                              </OPTION>
<OPTION value='GEO'>Georgia                                                   </OPTION>
<OPTION value='DEU'>Germany                                                   </OPTION>
<OPTION value='GHA'>Ghana                                                     </OPTION>
<OPTION value='GIB'>Gibraltar                                                 </OPTION>
<OPTION value='GRC'>Greece                                                    </OPTION>
<OPTION value='GRL'>Greenland                                                 </OPTION>
<OPTION value='GRD'>Grenada                                                   </OPTION>
<OPTION value='GLP'>Guadeloupe                                                </OPTION>
<OPTION value='GUM'>Guam                                                      </OPTION>
<OPTION value='GTM'>Guatemala                                                 </OPTION>
<OPTION value='GGY'>Guernsey                                                  </OPTION>
<OPTION value='GIN'>Guinea                                                    </OPTION>
<OPTION value='GNB'>Guinea-Bissau                                             </OPTION>
<OPTION value='GUY'>Guyana                                                    </OPTION>
<OPTION value='HTI'>Haiti                                                     </OPTION>
<OPTION value='HMD'>Heard Island and McDonald Islands                         </OPTION>
<OPTION value='VAT'>Holy See (the)                                            </OPTION>
<OPTION value='HND'>Honduras                                                  </OPTION>
<OPTION value='HKG'>Hong Kong                                                 </OPTION>
<OPTION value='HUN'>Hungary                                                   </OPTION>
<OPTION value='ISL'>Iceland                                                   </OPTION>
<OPTION value='IND'>India                                                     </OPTION>
<OPTION value='IDN'>Indonesia                                                 </OPTION>
<OPTION value='IRN'>Iran (Islamic Republic of)                                </OPTION>
<OPTION value='IRQ'>Iraq                                                      </OPTION>
<OPTION value='IRL'>Ireland                                                   </OPTION>
<OPTION value='IMN'>Isle of Man                                               </OPTION>
<OPTION value='ISR'>Israel                                                    </OPTION>
<OPTION value='ITA'>Italy                                                     </OPTION>
<OPTION value='JAM'>Jamaica                                                   </OPTION>
<OPTION value='JPN'>Japan                                                     </OPTION>
<OPTION value='JEY'>Jersey                                                    </OPTION>
<OPTION value='JOR'>Jordan                                                    </OPTION>
<OPTION value='KAZ'>Kazakhstan                                                </OPTION>
<OPTION value='KEN'>Kenya                                                     </OPTION>
<OPTION value='KIR'>Kiribati                                                  </OPTION>
<OPTION value='PRK'>Korea (the Democratic People's Republic of)               </OPTION>
<OPTION value='KOR'>Korea (the Republic of)                                   </OPTION>
<OPTION value='KWT'>Kuwait                                                    </OPTION>
<OPTION value='KGZ'>Kyrgyzstan                                                </OPTION>
<OPTION value='LAO'>Lao People's Democratic Republic (the)                    </OPTION>
<OPTION value='LVA'>Latvia                                                    </OPTION>
<OPTION value='LBN'>Lebanon                                                   </OPTION>
<OPTION value='LSO'>Lesotho                                                   </OPTION>
<OPTION value='LBR'>Liberia                                                   </OPTION>
<OPTION value='LBY'>Libya                                                     </OPTION>
<OPTION value='LIE'>Liechtenstein                                             </OPTION>
<OPTION value='LTU'>Lithuania                                                 </OPTION>
<OPTION value='LUX'>Luxembourg                                                </OPTION>
<OPTION value='MAC'>Macao                                                     </OPTION>
<OPTION value='MDG'>Madagascar                                                </OPTION>
<OPTION value='MWI'>Malawi                                                    </OPTION>
<OPTION value='MYS'>Malaysia                                                  </OPTION>
<OPTION value='MDV'>Maldives                                                  </OPTION>
<OPTION value='MLI'>Mali                                                      </OPTION>
<OPTION value='MLT'>Malta                                                     </OPTION>
<OPTION value='MHL'>Marshall Islands (the)                                    </OPTION>
<OPTION value='MTQ'>Martinique                                                </OPTION>
<OPTION value='MRT'>Mauritania                                                </OPTION>
<OPTION value='MUS'>Mauritius                                                 </OPTION>
<OPTION value='MYT'>Mayotte                                                   </OPTION>
<OPTION value='MEX'>Mexico                                                    </OPTION>
<OPTION value='FSM'>Micronesia (Federated States of)                          </OPTION>
<OPTION value='MDA'>Moldova (the Republic of)                                 </OPTION>
<OPTION value='MCO'>Monaco                                                    </OPTION>
<OPTION value='MNG'>Mongolia                                                  </OPTION>
<OPTION value='MNE'>Montenegro                                                </OPTION>
<OPTION value='MSR'>Montserrat                                                </OPTION>
<OPTION value='MAR'>Morocco                                                   </OPTION>
<OPTION value='MOZ'>Mozambique                                                </OPTION>
<OPTION value='MMR'>Myanmar                                                   </OPTION>
<OPTION value='NAM'>Namibia                                                   </OPTION>
<OPTION value='NRU'>Nauru                                                     </OPTION>
<OPTION value='NPL'>Nepal                                                     </OPTION>
<OPTION value='NLD'>Netherlands (the)                                         </OPTION>
<OPTION value='NCL'>New Caledonia                                             </OPTION>
<OPTION value='NZL'>New Zealand                                               </OPTION>
<OPTION value='NIC'>Nicaragua                                                 </OPTION>
<OPTION value='NER'>Niger (the)                                               </OPTION>
<OPTION value='NGA'>Nigeria                                                   </OPTION>
<OPTION value='NIU'>Niue                                                      </OPTION>
<OPTION value='NFK'>Norfolk Island                                            </OPTION>
<OPTION value='MNP'>Northern Mariana Islands (the)                            </OPTION>
<OPTION value='NOR'>Norway                                                    </OPTION>
<OPTION value='OMN'>Oman                                                      </OPTION>
<OPTION value='PAK'>Pakistan                                                  </OPTION>
<OPTION value='PLW'>Palau                                                     </OPTION>
<OPTION value='PSE'>Palestine, State of                                       </OPTION>
<OPTION value='PAN'>Panama                                                    </OPTION>
<OPTION value='PNG'>Papua New Guinea                                          </OPTION>
<OPTION value='PRY'>Paraguay                                                  </OPTION>
<OPTION value='PER'>Peru                                                      </OPTION>
<OPTION value='PHL'>Philippines (the)                                         </OPTION>
<OPTION value='PCN'>Pitcairn                                                  </OPTION>
<OPTION value='POL'>Poland                                                    </OPTION>
<OPTION value='PRT'>Portugal                                                  </OPTION>
<OPTION value='PRI'>Puerto Rico                                               </OPTION>
<OPTION value='QAT'>Qatar                                                     </OPTION>
<OPTION value='MKD'>Republic of North Macedonia                               </OPTION>
<OPTION value='ROU'>Romania                                                   </OPTION>
<OPTION value='RUS'>Russian Federation (the)                                  </OPTION>
<OPTION value='RWA'>Rwanda                                                    </OPTION>
<OPTION value='REU'>Réunion                                                   </OPTION>
<OPTION value='BLM'>Saint Barthélemy                                          </OPTION>
<OPTION value='SHN'>Saint Helena, Ascension and Tristan da Cunha              </OPTION>
<OPTION value='KNA'>Saint Kitts and Nevis                                     </OPTION>
<OPTION value='LCA'>Saint Lucia                                               </OPTION>
<OPTION value='MAF'>Saint Martin (French part)                                </OPTION>
<OPTION value='SPM'>Saint Pierre and Miquelon                                 </OPTION>
<OPTION value='VCT'>Saint Vincent and the Grenadines                          </OPTION>
<OPTION value='WSM'>Samoa                                                     </OPTION>
<OPTION value='SMR'>San Marino                                                </OPTION>
<OPTION value='STP'>Sao Tome and Principe                                     </OPTION>
<OPTION value='SAU'>Saudi Arabia                                              </OPTION>
<OPTION value='SEN'>Senegal                                                   </OPTION>
<OPTION value='SRB'>Serbia                                                    </OPTION>
<OPTION value='SYC'>Seychelles                                                </OPTION>
<OPTION value='SLE'>Sierra Leone                                              </OPTION>
<OPTION value='SGP'>Singapore                                                 </OPTION>
<OPTION value='SXM'>Sint Maarten (Dutch part)                                 </OPTION>
<OPTION value='SVK'>Slovakia                                                  </OPTION>
<OPTION value='SVN'>Slovenia                                                  </OPTION>
<OPTION value='SLB'>Solomon Islands                                           </OPTION>
<OPTION value='SOM'>Somalia                                                   </OPTION>
<OPTION value='ZAF'>South Africa                                              </OPTION>
<OPTION value='SGS'>South Georgia and the South Sandwich Islands              </OPTION>
<OPTION value='SSD'>South Sudan                                               </OPTION>
<OPTION value='ESP'>Spain                                                     </OPTION>
<OPTION value='LKA'>Sri Lanka                                                 </OPTION>
<OPTION value='SDN'>Sudan (the)                                               </OPTION>
<OPTION value='SUR'>Suriname                                                  </OPTION>
<OPTION value='SJM'>Svalbard and Jan Mayen                                    </OPTION>
<OPTION value='SWE'>Sweden                                                    </OPTION>
<OPTION value='CHE'>Switzerland                                               </OPTION>
<OPTION value='SYR'>Syrian Arab Republic                                      </OPTION>
<OPTION value='TWN'>Taiwan (Province of China)                                </OPTION>
<OPTION value='TJK'>Tajikistan                                                </OPTION>
<OPTION value='TZA'>Tanzania, United Republic of                              </OPTION>
<OPTION value='THA'>Thailand                                                  </OPTION>
<OPTION value='TLS'>Timor-Leste                                               </OPTION>
<OPTION value='TGO'>Togo                                                      </OPTION>
<OPTION value='TKL'>Tokelau                                                   </OPTION>
<OPTION value='TON'>Tonga                                                     </OPTION>
<OPTION value='TTO'>Trinidad and Tobago                                       </OPTION>
<OPTION value='TUN'>Tunisia                                                   </OPTION>
<OPTION value='TUR'>Turkey                                                    </OPTION>
<OPTION value='TKM'>Turkmenistan                                              </OPTION>
<OPTION value='TCA'>Turks and Caicos Islands (the)                            </OPTION>
<OPTION value='TUV'>Tuvalu                                                    </OPTION>
<OPTION value='UGA'>Uganda                                                    </OPTION>
<OPTION value='UKR'>Ukraine                                                   </OPTION>
<OPTION value='ARE'>United Arab Emirates (the)                                </OPTION>
<OPTION value='GBR'>United Kingdom of Great Britain and Northern Ireland (the)</OPTION>
<OPTION value='UMI'>United States Minor Outlying Islands (the)                </OPTION>
<OPTION value='USA'>United States of America (the)                            </OPTION>
<OPTION value='URY'>Uruguay                                                   </OPTION>
<OPTION value='UZB'>Uzbekistan                                                </OPTION>
<OPTION value='VUT'>Vanuatu                                                   </OPTION>
<OPTION value='VEN'>Venezuela (Bolivarian Republic of)                        </OPTION>
<OPTION value='VNM'>Viet Nam                                                  </OPTION>
<OPTION value='VGB'>Virgin Islands (British)                                  </OPTION>
<OPTION value='VIR'>Virgin Islands (U.S.)                                     </OPTION>
<OPTION value='WLF'>Wallis and Futuna                                         </OPTION>
<OPTION value='ESH'>Western Sahara                                            </OPTION>
<OPTION value='YEM'>Yemen                                                     </OPTION>
<OPTION value='ZMB'>Zambia                                                    </OPTION>
<OPTION value='ZWE'>Zimbabwe                                                  </OPTION>
<OPTION value='ALA'>Åland Islands                                             </OPTION>
</SELECT></TD></TR>
</SELECT></TD></TR>
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<TR><TD class='list-title'>Date de naissance *</TD>
<TD class='list-title'><FONT color='#000000'>Jour: </FONT><SELECT NAME='jour'> <OPTION Value=0> 0 </OPTION>
<OPTION>1</OPTION>
<OPTION>2</OPTION>
<OPTION>3</OPTION>
<OPTION>4</OPTION>
<OPTION>5</OPTION>
<OPTION>6</OPTION>
<OPTION>7</OPTION>
<OPTION>8</OPTION>
<OPTION>9</OPTION>
<OPTION>10</OPTION>
<OPTION>11</OPTION>
<OPTION>12</OPTION>
<OPTION>13</OPTION>
<OPTION>14</OPTION>
<OPTION>15</OPTION>
<OPTION>16</OPTION>
<OPTION>17</OPTION>
<OPTION>18</OPTION>
<OPTION>19</OPTION>
<OPTION>20</OPTION>
<OPTION>21</OPTION>
<OPTION>22</OPTION>
<OPTION>23</OPTION>
<OPTION>24</OPTION>
<OPTION>25</OPTION>
<OPTION>26</OPTION>
<OPTION>27</OPTION>
<OPTION>28</OPTION>
<OPTION>29</OPTION>
<OPTION>30</OPTION>
<OPTION>31</OPTION>
</SELECT>
<FONT color='#000000'>Mois: </FONT><SELECT NAME='mois'> <OPTION> 0 </OPTION>
<OPTION>1</OPTION>
<OPTION>2</OPTION>
<OPTION>3</OPTION>
<OPTION>4</OPTION>
<OPTION>5</OPTION>
<OPTION>6</OPTION>
<OPTION>7</OPTION>
<OPTION>8</OPTION>
<OPTION>9</OPTION>
<OPTION>10</OPTION>
<OPTION>11</OPTION>
<OPTION>12</OPTION>
</SELECT>
<FONT color='#000000'>Année: </FONT><INPUT TYPE='text' PLACEHOLDER='Ex: 1970' size=4 maxlength=4 VALUE='' NAME='annee'></TD></TR>
<TR><TD class='list-title2'><FONT color='#000000'>E-mail *</FONT></TD><TD class='list-title2'><INPUT TYPE='text' SIZE=35 maxlength=60 VALUE='' NAME='email'></TD></TR>
<TR><TD class='list-title'>Tél: Mobile</TD><TD class='list-title'><INPUT TYPE='text' PLACEHOLDER='Ex: 0795551122' SIZE=20 maxlength=20 VALUE='' NAME='mobile'></TD></TR>
<TR><TD class='list-title2'>Club / Team</TD><TD class='list-title2'><INPUT TYPE='text' SIZE=35 maxlength=35 VALUE='' NAME='equipe'></TD></TR>
<TR><TD class='list-title'>N° de licence</TD><TD class='list-title'><INPUT TYPE='text' SIZE=20 maxlength=20 VALUE='' NAME='licence'></TD></TR>
<TR><TD class='list-title2'><FONT color='#000000'>J'ai lu les <A HREF= '../img/CGV-st.pdf' TARGET='_blank'>CG</A> et je les accepte *</TD><TD class='list-title2'><INPUT TYPE='checkbox' SIZE=15 VALUE='1' NAME='cgv'></TD></TR>
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<TR><TD colspan='2'><INPUT TYPE='submit' class='btn' VALUE='Enregistrer'></TD></TR>
</TABLE></FORM></DIV>
<CENTER>* Champs obligatoires.</CENTER>
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