document.writeln('<div style=\"width:500px;border:1px solid black;background:#ffffff;\" id=\"le_formulaire\"><div style=\"font-size:1.2em;width:100%;height:50px;text-align:center;margin:10px;color:#000099;font-style:normal;font-weight:normal;\" id=\"titre_formulaire\"> Cours de cuisine</div><form method=\"post\" action=\"http://www.magic-questionnaire.com/retour_form.php?id_formulaire=167\" accept-charset=\"UTF-8\"><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">1.Qui cuisine chez-vous ?<br /><input type=\"radio\" name=\"repradio_1467\" value=\"4267\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Vous-m&ecirc;me</span><br /><input type=\"radio\" name=\"repradio_1467\" value=\"4268\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Conjoint</span><br /><input type=\"radio\" name=\"repradio_1467\" value=\"4269\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Enfants</span><br /><input type=\"radio\" name=\"repradio_1467\" value=\"4270\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Parents</span><br /><input type=\"radio\" name=\"repradio_1467\" value=\"4271\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Cuisiniers</span><br /><input type=\"radio\" name=\"repradio_1467\" value=\"4272\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Colocataire</span><br /><input type=\"radio\" name=\"repradio_1467\" value=\"4273\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Autres</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">2. A quelle fr&eacute;quence faites vous la cuisine<br /><input type=\"radio\" name=\"repradio_1468\" value=\"4274\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Tous les jours</span><br /><input type=\"radio\" name=\"repradio_1468\" value=\"4275\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Plusieurs fois par semaine</span><br /><input type=\"radio\" name=\"repradio_1468\" value=\"4276\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Au moins 1 fois par semaine</span><br /><input type=\"radio\" name=\"repradio_1468\" value=\"4277\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Moins d une fois par semaine</span><br /><input type=\"radio\" name=\"repradio_1468\" value=\"4278\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Jamais</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">3.Dans le cas de figure o&ugrave; vous ne faites pas la cuisine comment l expliquez-vous ?<br /><input type=\"radio\" name=\"repradio_1469\" value=\"4279\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Manque de temps</span><br /><input type=\"radio\" name=\"repradio_1469\" value=\"4280\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Manque de motivation</span><br /><input type=\"radio\" name=\"repradio_1469\" value=\"4281\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Manque d int&eacute;r&ecirc;t</span><br /><input type=\"radio\" name=\"repradio_1469\" value=\"4282\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Autres</span></div><br /><br /><input type=\"submit\" value=\"Envoyer\" /></form></div>');