{source}

<style >
label{
  font-weight: bold;
  font-size:15px;
  display: block;
  float: left;
  width: 100%;
  cursor: default;
}
.p_label{
  margin-bottom:0px;
  margin-top:0px;
}
.r_span{
  color:red;
  margin-left: 0px !important;
  float: none;
}
@media screen and (max-width:750px){
  .r_span{
    display: none;
  }
}
@media screen and (min-width:960px){
  form{
    margin-left: 10%;
  }
}
.grecaptcha-badge {display: none;}
.envoi{
  padding: 10px;background-color: rgba(176, 39, 123, 0.76);border: rgba(176, 39, 123, 0.76);color: white;font-weight: bold;margin-top: 10px;
}
</style>
<form method="post" target="_parent" action="/actualite-formation/immersion" id="envoiMail" name="mail">
  <p class="p_label">
    <span><label>Nom et prénom: </label>
      <input type="text" name="nom" style="width: 85%;
      border: 1px solid grey;
      border-radius: 5px;
      background-color: white;" placeholder="Champ obligatiore" required onblur="verif(this)"/>
    </span>
  </p>
  <p class="p_label">
    <span><label>Votre email: </label>
      <input type="email" name="email" style="width: 85%;
      border: 1px solid grey;
      border-radius: 5px;
      background-color: white;" required placeholder="Champ obligatiore" onblur="verif(this)"/>
    </span>
  </p>
  <p class="p_label">
    <span><label>Numéro de téléphone: </label>
      <input type="number" name="numero" style="width: 85%;
      border: 1px solid grey;
      border-radius: 5px;
      background-color: white;" required placeholder="Champ obligatiore" onblur="verif(this)"/>
    </span>
  </p>
  <p class="p_label">
    <span><label>Votre société: </label>
      <input type="text" name="entreprise" style="width: 85%;
      border: 1px solid grey;
      border-radius: 5px;
      background-color: white;" required placeholder="Champ obligatiore" onblur="verif(this)"/>
    </span>
  </p>
  <span style="font-size: 14px;"><strong>Conditions d'utilisation:</strong></span>
  <p style="font-size: 14px;">En transmettant ce formulaire, vous acceptez de nous communiquer les données<br/>
    qu'il contient protégées par notre charte de confidentialité et la loi sur la protection des données.</p>
    <span style="font-size:12px;"><input type="checkbox" id="condition_valide" name="condition" value="condition_ok" onclick="verif_box(this)" required><span style="font-size:15px;">J'accepte les conditions d'utilisation (obligatoire)</span></input></span>
    <br>
    <span style="font-size:12px;"><input type="checkbox" name="offre" value="offre_ok"><span style="font-size:15px;">J'accepte de recevoir les informations provenant du groupe Adhara France</span></input></span>
    <input type="hidden" name="envoi" value="oui"/>
    <input type="hidden" name="vider" value="oui"/>
    <div class="g-recaptcha" data-sitekey="6Lcq-icUAAAAAG_n9C2BfC2SFc6qSAArMoyKwAbh"></div>
    <input type="submit" name="valider" value="Envoyer" class="envoi">
  </form>

  {/source}