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<div id="sg-form" style="width: 300px; margin: auto; margin-top: 0vh; position: relative; left: 0vw;"> <style type="text/css"> #sg-form-44539 button { overflow: visible; } #sg-form-44539 button, #sg-form-44539 select { text-transform: none; } #sg-form-44539 button, #sg-form-44539 html input[type="button"], #sg-form-44539 input[type="reset"], #sg-form-44539 input[type="submit"] { -webkit-appearance: button; cursor: pointer; } #sg-form-44539 button[disabled], #sg-form-44539 html input[disabled] { cursor: default; } #sg-form-44539 button::-moz-focus-inner, #sg-form-44539 input::-moz-focus-inner { border: 0; padding: 0; } #sg-form-44539 input { line-height: normal; } #sg-form-44539 input[type="checkbox"], #sg-form-44539 input[type="radio"] { -webkit-box-sizing: border-box; -moz-box-sizing: border-box; box-sizing: border-box; padding: 0; } #sg-form-44539 input[type="number"]::-webkit-inner-spin-button, #sg-form-44539 input[type="number"]::-webkit-outer-spin-button { height: auto; } #sg-form-44539 input[type="search"] { -webkit-appearance: textfield; -webkit-box-sizing: content-box; -moz-box-sizing: content-box; box-sizing: content-box; } #sg-form-44539 input[type="search"]::-webkit-search-cancel-button, #sg-form-44539 input[type="search"]::-webkit-search-decoration { -webkit-appearance: none; } #sg-form-44539 fieldset { border: 1px solid #c0c0c0; margin: 0 2px; padding: 0.35em 0.625em 0.75em; } #sg-form-44539 legend { border: 0; padding: 0; } #sg-form-44539 textarea { overflow: auto; } #sg-form-44539 optgroup { font-weight: bold; } #sg-form-44539 table { border-collapse: collapse; border-spacing: 0; } #sg-form-44539 td, #sg-form-44539 th { padding: 0; } #sg-form-44539 * { -webkit-box-sizing: border-box; -moz-box-sizing: border-box; box-sizing: border-box; } #sg-form-44539 input, #sg-form-44539 button, #sg-form-44539 select, #sg-form-44539 textarea { font-family: inherit; font-size: inherit; line-height: inherit; } #sg-form-44539 a { color: #337ab7; text-decoration: none; } #sg-form-44539 a:hover, #sg-form-44539 a:focus { color: #23527c; text-decoration: underline; } #sg-form-44539 a:focus { outline: 5px auto -webkit-focus-ring-color; outline-offset: -2px; } #sg-form-44539 figure { margin: 0; } #sg-form-44539 img { vertical-align: middle; } #sg-form-44539 .img-responsive { display: block; max-width: 100%; height: auto; } #sg-form-44539 .img-rounded { border-radius: 6px; } #sg-form-44539 .img-thumbnail { padding: 4px; line-height: 1.42857143; background-color: #ffffff; border: 1px solid #dddddd; border-radius: 4px; -webkit-transition: all 0.2s ease-in-out; -o-transition: all 0.2s ease-in-out; transition: all 0.2s ease-in-out; display: inline-block; max-width: 100%; height: auto; } #sg-form-44539 .img-circle { border-radius: 50%; } #sg-form-44539 hr { margin-top: 20px; margin-bottom: 20px; border: 0; border-top: 1px solid #eeeeee; } [role="button"] { cursor: pointer; } .row { margin-left: -15px; margin-right: -15px; } .col-xs-1, .col-sm-1, .col-md-1, .col-lg-1, .col-xs-2, .col-sm-2, .col-md-2, .col-lg-2, .col-xs-3, .col-sm-3, .col-md-3, .col-lg-3, .col-xs-4, .col-sm-4, .col-md-4, .col-lg-4, .col-xs-5, .col-sm-5, .col-md-5, .col-lg-5, .col-xs-6, .col-sm-6, .col-md-6, .col-lg-6, .col-xs-7, .col-sm-7, .col-md-7, .col-lg-7, .col-xs-8, .col-sm-8, .col-md-8, .col-lg-8, .col-xs-9, .col-sm-9, .col-md-9, .col-lg-9, .col-xs-10, .col-sm-10, .col-md-10, .col-lg-10, .col-xs-11, .col-sm-11, .col-md-11, .col-lg-11, .col-xs-12, .col-sm-12, .col-md-12, .col-lg-12 { position: relative; min-height: 1px; padding-left: 15px; padding-right: 15px; } .col-xs-1, .col-xs-2, .col-xs-3, .col-xs-4, .col-xs-5, .col-xs-6, .col-xs-7, .col-xs-8, .col-xs-9, .col-xs-10, .col-xs-11, .col-xs-12 { float: left; } .col-xs-12 { width: 100%; } .col-xs-11 { width: 91.66666667%; } .col-xs-10 { width: 83.33333333%; } .col-xs-9 { width: 75%; } .col-xs-8 { width: 66.66666667%; } .col-xs-7 { width: 58.33333333%; } .col-xs-6 { width: 50%; } .col-xs-5 { width: 41.66666667%; } .col-xs-4 { width: 33.33333333%; } .col-xs-3 { width: 25%; } .col-xs-2 { width: 16.66666667%; } .col-xs-1 { width: 8.33333333%; } .col-xs-pull-12 { right: 100%; } .col-xs-pull-11 { right: 91.66666667%; } .col-xs-pull-10 { right: 83.33333333%; } .col-xs-pull-9 { right: 75%; } .col-xs-pull-8 { right: 66.66666667%; } .col-xs-pull-7 { right: 58.33333333%; } .col-xs-pull-6 { right: 50%; } .col-xs-pull-5 { right: 41.66666667%; } .col-xs-pull-4 { right: 33.33333333%; } .col-xs-pull-3 { right: 25%; } .col-xs-pull-2 { right: 16.66666667%; } .col-xs-pull-1 { right: 8.33333333%; } .col-xs-pull-0 { right: auto; } .col-xs-push-12 { left: 100%; } .col-xs-push-11 { left: 91.66666667%; } .col-xs-push-10 { left: 83.33333333%; } .col-xs-push-9 { left: 75%; } .col-xs-push-8 { left: 66.66666667%; } .col-xs-push-7 { left: 58.33333333%; } .col-xs-push-6 { left: 50%; } .col-xs-push-5 { left: 41.66666667%; } .col-xs-push-4 { left: 33.33333333%; } .col-xs-push-3 { left: 25%; } .col-xs-push-2 { left: 16.66666667%; } .col-xs-push-1 { left: 8.33333333%; } .col-xs-push-0 { left: auto; } .col-xs-offset-12 { margin-left: 100%; } .col-xs-offset-11 { margin-left: 91.66666667%; } .col-xs-offset-10 { margin-left: 83.33333333%; } .col-xs-offset-9 { margin-left: 75%; } .col-xs-offset-8 { margin-left: 66.66666667%; } .col-xs-offset-7 { margin-left: 58.33333333%; } .col-xs-offset-6 { margin-left: 50%; } .col-xs-offset-5 { margin-left: 41.66666667%; } .col-xs-offset-4 { margin-left: 33.33333333%; } .col-xs-offset-3 { margin-left: 25%; } .col-xs-offset-2 { margin-left: 16.66666667%; } .col-xs-offset-1 { margin-left: 8.33333333%; } .col-xs-offset-0 { margin-left: 0%; } @media (min-width: 768px) { .col-sm-1, .col-sm-2, .col-sm-3, .col-sm-4, .col-sm-5, .col-sm-6, .col-sm-7, .col-sm-8, .col-sm-9, .col-sm-10, .col-sm-11, .col-sm-12 { float: left; } .col-sm-12 { width: 100%; } .col-sm-11 { width: 91.66666667%; } .col-sm-10 { width: 83.33333333%; } .col-sm-9 { width: 75%; } .col-sm-8 { width: 66.66666667%; } .col-sm-7 { width: 58.33333333%; } .col-sm-6 { width: 50%; } .col-sm-5 { width: 41.66666667%; } .col-sm-4 { width: 33.33333333%; } .col-sm-3 { width: 25%; } .col-sm-2 { width: 16.66666667%; } .col-sm-1 { width: 8.33333333%; } .col-sm-pull-12 { right: 100%; } .col-sm-pull-11 { right: 91.66666667%; } .col-sm-pull-10 { right: 83.33333333%; } .col-sm-pull-9 { right: 75%; } .col-sm-pull-8 { right: 66.66666667%; } .col-sm-pull-7 { right: 58.33333333%; } .col-sm-pull-6 { right: 50%; } .col-sm-pull-5 { right: 41.66666667%; } .col-sm-pull-4 { right: 33.33333333%; } .col-sm-pull-3 { right: 25%; } .col-sm-pull-2 { right: 16.66666667%; } .col-sm-pull-1 { right: 8.33333333%; } .col-sm-pull-0 { right: auto; } .col-sm-push-12 { left: 100%; } .col-sm-push-11 { left: 91.66666667%; } .col-sm-push-10 { left: 83.33333333%; } .col-sm-push-9 { left: 75%; } .col-sm-push-8 { left: 66.66666667%; } .col-sm-push-7 { left: 58.33333333%; } .col-sm-push-6 { left: 50%; } .col-sm-push-5 { left: 41.66666667%; } .col-sm-push-4 { left: 33.33333333%; } .col-sm-push-3 { left: 25%; } .col-sm-push-2 { left: 16.66666667%; } .col-sm-push-1 { left: 8.33333333%; } .col-sm-push-0 { left: auto; } .col-sm-offset-12 { margin-left: 100%; } .col-sm-offset-11 { margin-left: 91.66666667%; } .col-sm-offset-10 { margin-left: 83.33333333%; } .col-sm-offset-9 { margin-left: 75%; } .col-sm-offset-8 { margin-left: 66.66666667%; } .col-sm-offset-7 { margin-left: 58.33333333%; } .col-sm-offset-6 { margin-left: 50%; } .col-sm-offset-5 { margin-left: 41.66666667%; } .col-sm-offset-4 { margin-left: 33.33333333%; } .col-sm-offset-3 { margin-left: 25%; } .col-sm-offset-2 { margin-left: 16.66666667%; } .col-sm-offset-1 { margin-left: 8.33333333%; } .col-sm-offset-0 { margin-left: 0%; } } @media (min-width: 992px) { .col-md-1, .col-md-2, .col-md-3, .col-md-4, .col-md-5, .col-md-6, .col-md-7, .col-md-8, .col-md-9, .col-md-10, .col-md-11, .col-md-12 { float: left; } .col-md-12 { width: 100%; } .col-md-11 { width: 91.66666667%; } .col-md-10 { width: 83.33333333%; } .col-md-9 { width: 75%; } .col-md-8 { width: 66.66666667%; } .col-md-7 { width: 58.33333333%; } .col-md-6 { width: 50%; } .col-md-5 { width: 41.66666667%; } .col-md-4 { width: 33.33333333%; } .col-md-3 { width: 25%; } .col-md-2 { width: 16.66666667%; } .col-md-1 { width: 8.33333333%; } .col-md-pull-12 { right: 100%; } .col-md-pull-11 { right: 91.66666667%; } .col-md-pull-10 { right: 83.33333333%; } .col-md-pull-9 { right: 75%; } .col-md-pull-8 { right: 66.66666667%; } .col-md-pull-7 { right: 58.33333333%; } .col-md-pull-6 { right: 50%; } .col-md-pull-5 { right: 41.66666667%; } .col-md-pull-4 { right: 33.33333333%; } .col-md-pull-3 { right: 25%; } .col-md-pull-2 { right: 16.66666667%; } .col-md-pull-1 { right: 8.33333333%; } .col-md-pull-0 { right: auto; } .col-md-push-12 { left: 100%; } .col-md-push-11 { left: 91.66666667%; } .col-md-push-10 { left: 83.33333333%; } .col-md-push-9 { left: 75%; } .col-md-push-8 { left: 66.66666667%; } .col-md-push-7 { left: 58.33333333%; } .col-md-push-6 { left: 50%; } .col-md-push-5 { left: 41.66666667%; } .col-md-push-4 { left: 33.33333333%; } .col-md-push-3 { left: 25%; } .col-md-push-2 { left: 16.66666667%; } .col-md-push-1 { left: 8.33333333%; } .col-md-push-0 { left: auto; } .col-md-offset-12 { margin-left: 100%; } .col-md-offset-11 { margin-left: 91.66666667%; } .col-md-offset-10 { margin-left: 83.33333333%; } .col-md-offset-9 { margin-left: 75%; } .col-md-offset-8 { margin-left: 66.66666667%; } .col-md-offset-7 { margin-left: 58.33333333%; } .col-md-offset-6 { margin-left: 50%; } .col-md-offset-5 { margin-left: 41.66666667%; } .col-md-offset-4 { margin-left: 33.33333333%; } .col-md-offset-3 { margin-left: 25%; } .col-md-offset-2 { margin-left: 16.66666667%; } .col-md-offset-1 { margin-left: 8.33333333%; } .col-md-offset-0 { margin-left: 0%; } } @media (min-width: 1200px) { .col-lg-1, .col-lg-2, .col-lg-3, .col-lg-4, .col-lg-5, .col-lg-6, .col-lg-7, .col-lg-8, .col-lg-9, .col-lg-10, .col-lg-11, .col-lg-12 { float: left; } .col-lg-12 { width: 100%; } .col-lg-11 { width: 91.66666667%; } .col-lg-10 { width: 83.33333333%; } .col-lg-9 { width: 75%; } .col-lg-8 { width: 66.66666667%; } .col-lg-7 { width: 58.33333333%; } .col-lg-6 { width: 50%; } .col-lg-5 { width: 41.66666667%; } .col-lg-4 { width: 33.33333333%; } .col-lg-3 { width: 25%; } .col-lg-2 { width: 16.66666667%; } .col-lg-1 { width: 8.33333333%; } .col-lg-pull-12 { right: 100%; } .col-lg-pull-11 { right: 91.66666667%; } .col-lg-pull-10 { right: 83.33333333%; } .col-lg-pull-9 { right: 75%; } .col-lg-pull-8 { right: 66.66666667%; } .col-lg-pull-7 { right: 58.33333333%; } .col-lg-pull-6 { right: 50%; } .col-lg-pull-5 { right: 41.66666667%; } .col-lg-pull-4 { right: 33.33333333%; } .col-lg-pull-3 { right: 25%; } .col-lg-pull-2 { right: 16.66666667%; } .col-lg-pull-1 { right: 8.33333333%; } .col-lg-pull-0 { right: auto; } .col-lg-push-12 { left: 100%; } .col-lg-push-11 { left: 91.66666667%; } .col-lg-push-10 { left: 83.33333333%; } .col-lg-push-9 { left: 75%; } .col-lg-push-8 { left: 66.66666667%; } .col-lg-push-7 { left: 58.33333333%; } .col-lg-push-6 { left: 50%; } .col-lg-push-5 { left: 41.66666667%; } .col-lg-push-4 { left: 33.33333333%; } .col-lg-push-3 { left: 25%; } .col-lg-push-2 { left: 16.66666667%; } .col-lg-push-1 { left: 8.33333333%; } .col-lg-push-0 { left: auto; } .col-lg-offset-12 { margin-left: 100%; } .col-lg-offset-11 { margin-left: 91.66666667%; } .col-lg-offset-10 { margin-left: 83.33333333%; } .col-lg-offset-9 { margin-left: 75%; } .col-lg-offset-8 { margin-left: 66.66666667%; } .col-lg-offset-7 { margin-left: 58.33333333%; } .col-lg-offset-6 { margin-left: 50%; } .col-lg-offset-5 { margin-left: 41.66666667%; } .col-lg-offset-4 { margin-left: 33.33333333%; } .col-lg-offset-3 { margin-left: 25%; } .col-lg-offset-2 { margin-left: 16.66666667%; } .col-lg-offset-1 { margin-left: 8.33333333%; } .col-lg-offset-0 { margin-left: 0%; } } fieldset { padding: 0; margin: 0; border: 0; min-width: 0; } legend { display: block; width: 100%; padding: 0; margin-bottom: 20px; font-size: 21px; line-height: inherit; color: #333333; border: 0; border-bottom: 1px solid #e5e5e5; } label { display: inline-block; max-width: 100%; margin-bottom: 5px; font-weight: bold; } input[type="search"] { -webkit-box-sizing: border-box; -moz-box-sizing: border-box; box-sizing: border-box; } input[type="radio"], input[type="checkbox"] { margin: 4px 0 0; margin-top: 1px 9; line-height: normal; } input[type="file"] { display: block; } input[type="range"] { display: block; width: 100%; } select[multiple], select[size] { height: auto; } input[type="file"]:focus, input[type="radio"]:focus, input[type="checkbox"]:focus { outline: 5px auto -webkit-focus-ring-color; outline-offset: -2px; } output { display: block; padding-top: 7px; font-size: 14px; line-height: 1.42857143; color: #555555; } #sg-form-44539 .form-control { display: block; width: 100%; height: 34px; padding: 6px 12px; font-size: 14px; line-height: 1.42857143; color: #555555; background-color: #ffffff; background-image: none; border: 1px solid #cccccc; border-radius: 4px; -webkit-box-shadow: inset 0 1px 1px rgba(0, 0, 0, 0.075); box-shadow: inset 0 1px 1px rgba(0, 0, 0, 0.075); -webkit-transition: border-color ease-in-out .15s, -webkit-box-shadow ease-in-out .15s; -o-transition: border-color ease-in-out .15s, box-shadow ease-in-out .15s; transition: border-color ease-in-out .15s, box-shadow ease-in-out .15s; } .form-control:focus { border-color: #66afe9; outline: 0; -webkit-box-shadow: inset 0 1px 1px rgba(0,0,0,.075), 0 0 8px rgba(102, 175, 233, 0.6); box-shadow: inset 0 1px 1px rgba(0,0,0,.075), 0 0 8px rgba(102, 175, 233, 0.6); } .form-control::-moz-placeholder { color: #999999; opacity: 1; } .form-control:-ms-input-placeholder { color: #999999; } .form-control::-webkit-input-placeholder { color: #999999; } .form-control::-ms-expand { border: 0; background-color: transparent; } .form-control[disabled], .form-control[readonly], fieldset[disabled] .form-control { background-color: #eeeeee; opacity: 1; } .form-control[disabled], fieldset[disabled] .form-control { cursor: not-allowed; } textarea.form-control { height: auto; } input[type="search"] { -webkit-appearance: none; } @media screen and (-webkit-min-device-pixel-ratio: 0) { input[type="date"].form-control, input[type="time"].form-control, input[type="datetime-local"].form-control, input[type="month"].form-control { line-height: 34px; } input[type="date"].input-sm, input[type="time"].input-sm, input[type="datetime-local"].input-sm, input[type="month"].input-sm, .input-group-sm input[type="date"], .input-group-sm input[type="time"], .input-group-sm input[type="datetime-local"], .input-group-sm input[type="month"] { line-height: 30px; } input[type="date"].input-lg, input[type="time"].input-lg, input[type="datetime-local"].input-lg, input[type="month"].input-lg, .input-group-lg input[type="date"], .input-group-lg input[type="time"], .input-group-lg input[type="datetime-local"], .input-group-lg input[type="month"] { line-height: 46px; } } .form-group { margin-bottom: 15px; } .radio, .checkbox { position: relative; display: block; margin-top: 10px; margin-bottom: 10px; } .radio label, .checkbox label { min-height: 20px; padding-left: 20px; margin-bottom: 0; font-weight: normal; cursor: pointer; } .radio input[type="radio"], .radio-inline input[type="radio"], .checkbox input[type="checkbox"], .checkbox-inline input[type="checkbox"] { position: absolute; margin-left: -20px; margin-top: 4px 9; } .radio + .radio, .checkbox + .checkbox { margin-top: -5px; } .radio-inline, .checkbox-inline { position: relative; display: inline-block; padding-left: 20px; margin-bottom: 0; vertical-align: middle; font-weight: normal; cursor: pointer; } .radio-inline + .radio-inline, .checkbox-inline + .checkbox-inline { margin-top: 0; margin-left: 10px; } input[type="radio"][disabled], input[type="checkbox"][disabled], input[type="radio"].disabled, input[type="checkbox"].disabled, fieldset[disabled] input[type="radio"], fieldset[disabled] input[type="checkbox"] { cursor: not-allowed; } .radio-inline.disabled, .checkbox-inline.disabled, fieldset[disabled] .radio-inline, fieldset[disabled] .checkbox-inline { cursor: not-allowed; } .radio.disabled label, .checkbox.disabled label, fieldset[disabled] .radio label, fieldset[disabled] .checkbox label { cursor: not-allowed; } #sg-form-44539 .has-warning .help-block, #sg-form-44539 .has-warning .control-label, #sg-form-44539 .has-warning .radio, #sg-form-44539 .has-warning .checkbox, #sg-form-44539 .has-warning .radio-inline, #sg-form-44539 .has-warning .checkbox-inline, #sg-form-44539 .has-warning.radio label, #sg-form-44539 .has-warning.checkbox label, #sg-form-44539 .has-warning.radio-inline label, #sg-form-44539 .has-warning.checkbox-inline label { color: #8a6d3b; } @media (min-width: 768px) { .form-inline .form-group { display: inline-block; margin-bottom: 0; vertical-align: middle; } .form-inline .form-control { display: inline-block; width: auto; vertical-align: middle; } .form-inline .form-control-static { display: inline-block; } .form-inline .input-group { display: inline-table; vertical-align: middle; } .form-inline .input-group .input-group-addon, .form-inline .input-group .input-group-btn, .form-inline .input-group .form-control { width: auto; } .form-inline .input-group > .form-control { width: 100%; } .form-inline .control-label { margin-bottom: 0; vertical-align: middle; } .form-inline .radio, .form-inline .checkbox { display: inline-block; margin-top: 0; margin-bottom: 0; vertical-align: middle; } .form-inline .radio label, .form-inline .checkbox label { padding-left: 0; } .form-inline .radio input[type="radio"], .form-inline .checkbox input[type="checkbox"] { position: relative; margin-left: 0; } .form-inline .has-feedback .form-control-feedback { top: 0; } } .form-horizontal .radio, .form-horizontal .checkbox, .form-horizontal .radio-inline, .form-horizontal .checkbox-inline { margin-top: 0; margin-bottom: 0; padding-top: 7px; } .form-horizontal .radio, .form-horizontal .checkbox { min-height: 27px; } .form-horizontal .form-group { margin-left: -15px; margin-right: -15px; } @media (min-width: 768px) { .form-horizontal .control-label { text-align: right; margin-bottom: 0; padding-top: 7px; } } #sg-form-44539 .btn { display: inline-block; margin-bottom: 0; font-weight: normal; text-align: center; vertical-align: middle; -ms-touch-action: manipulation; touch-action: manipulation; cursor: pointer; background-image: none; border: 1px solid transparent; white-space: nowrap; padding: 6px 12px; font-size: 14px; line-height: 1.42857143; border-radius: 4px; -webkit-user-select: none; -moz-user-select: none; -ms-user-select: none; user-select: none; } #sg-form-44539 .btn:focus, #sg-form-44539 .btn:active:focus, #sg-form-44539 .btn.active:focus, #sg-form-44539 .btn.focus, #sg-form-44539 .btn:active.focus, #sg-form-44539 .btn.active.focus { outline: 5px auto -webkit-focus-ring-color; outline-offset: -2px; } #sg-form-44539 .btn:hover, #sg-form-44539 .btn:focus, #sg-form-44539 .btn.focus { color: #333333; text-decoration: none; } #sg-form-44539 .btn:active, #sg-form-44539 .btn.active { outline: 0; background-image: none; -webkit-box-shadow: inset 0 3px 5px rgba(0, 0, 0, 0.125); box-shadow: inset 0 3px 5px rgba(0, 0, 0, 0.125); } #sg-form-44539 .btn.disabled, #sg-form-44539 .btn[disabled], #sg-form-44539 fieldset[disabled] .btn { cursor: not-allowed; opacity: 0.65; filter: alpha(opacity=65); -webkit-box-shadow: none; box-shadow: none; } #sg-form-44539 a.btn.disabled, #sg-form-44539 fieldset[disabled] a.btn { pointer-events: none; } .btn-default { color: #333333; background-color: #ffffff; border-color: #cccccc; } #sg-form-44539 .btn-default:focus, #sg-form-44539 .btn-default.focus { color: #333333; background-color: #e6e6e6; border-color: #8c8c8c; } #sg-form-44539 .btn-default:hover { color: #333333; background-color: #e6e6e6; border-color: #adadad; } #sg-form-44539 .btn-default:active, #sg-form-44539 .btn-default.active, #sg-form-44539 .open > .dropdown-toggle.btn-default { color: #333333; background-color: #e6e6e6; border-color: #adadad; } #sg-form-44539 .btn-default:active:hover, #sg-form-44539 .btn-default.active:hover, #sg-form-44539 .open > .dropdown-toggle.btn-default:hover, #sg-form-44539 .btn-default:active:focus, #sg-form-44539 .btn-default.active:focus, #sg-form-44539 .open > .dropdown-toggle.btn-default:focus, #sg-form-44539 .btn-default:active.focus, #sg-form-44539 .btn-default.active.focus, #sg-form-44539 .open > .dropdown-toggle.btn-default.focus { color: #333333; background-color: #d4d4d4; border-color: #8c8c8c; } #sg-form-44539 .btn-default:active, #sg-form-44539 .btn-default.active, #sg-form-44539 .open > .dropdown-toggle.btn-default { background-image: none; } #sg-form-44539 .btn-block { display: block; width: 100%; } #sg-form-44539 form { margin: 10px; padding: 10px; } </style> <div id="sg-form-44539"> <div id="sg-form-header"> <h1> <p>Profitez de ...</p> <i></i> <i></i> <i></i> <i></i> </h1> </div> <form method="post" action="//sg-autorepondeur.com/public/subscribe.php" id="sg-form-body" target="_top"> <div class="form-group"><label>Email</label><input type="email" class="form-control" name="email" placeholder="Email" required="true"></div><div class="form-group"><label>Civilit&eacute;</label><select name="civility" class="form-control"><option value="Monsieur">Monsieur</option><option value="Madame">Madame</option></select></div><div class="form-group"><label>Pr&eacute;nom</label><input type="text" class="form-control" name="forename" placeholder="Pr&eacute;nom"></div><div class="form-group"><label>Nom</label><input type="text" class="form-control" name="surname" placeholder="Nom"></div><div class="form-group"><label>T&eacute;l&eacute;phone</label><input type="text" class="form-control" name="phone" placeholder="T&eacute;l&eacute;phone"></div><div class="form-group"><p>En soumettant ce formulaire, j'accepte que mes informations soient utilis&eacute;es uniquement dans le cadre de ma demande et de la relation commerciale &eacute;thique et personnalis&eacute;e qui peut en d&eacute;couler.</p></div><img src="https://sg-autorepondeur.com/tauxouverture/form.gif?membreid=19081&amp;listeid=134355&amp;id=44539" alt="" width="1" height="1" style="display: none"><input type="hidden" name="user" value="19081"><input type="hidden" name="list" value="134355"><input type="hidden" name="form" value="44539"> <button type="submit" class="btn btn-block">Je m'inscris !</button> </form> <div id="sg-form-footer" style="text-align: center"> <p>Pour conna&icirc;tre et exercer mes droits, notamment pour annuler mon consentement, je consulte la politique de vie priv&eacute;e en cliquant ici</p> </div> </div> </div>