document.writeln('<div style=\"width:500px;border:1px solid black;background:#ccff99;\" id=\"le_formulaire\"><div style=\"font-size:1.2em;width:100%;height:50px;text-align:center;margin:10px;color:#006600;font-style:normal;font-weight:bold;\" id=\"titre_formulaire\"> QUESTION du MOIS</div><form method=\"post\" action=\"http://www.magic-questionnaire.com/retour_form.php?id_formulaire=1298\" accept-charset=\"UTF-8\"><input type=\"hidden\" name=\"ieutf8\" value=\"&#153;\" /><div style=\"width:450px;margin:auto;color:#000099;font-style:normal;font-weight:bold;\" class=\"question\">Durant la tr&ecirc;ve on fait rel&acirc;che ... Rendez-vous en mars pour une question sur<br /><input type=\"checkbox\" name=\"repcheckbox_98666\" value=\"98666\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:#cc0000;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > R&egrave;glements</span><br /><input type=\"checkbox\" name=\"repcheckbox_98667\" value=\"98667\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:#cc0000;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Arbitrage</span><br /><input type=\"checkbox\" name=\"repcheckbox_98668\" value=\"98668\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:#cc0000;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > AS Foucherans</span><br /><input type=\"checkbox\" name=\"repcheckbox_324774\" value=\"324774\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:#cc0000;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Foucherans</span><br /><input type=\"checkbox\" name=\"repcheckbox_335741\" value=\"335741\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:#cc0000;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Autres</span></div><br /><div style=\"width:450px;margin:auto;color:#000099;font-style:normal;font-weight:bold;\" class=\"question\">La r&eacute;ponse en regardant la rubrique !!!!<br /><textarea  cols=\"47\" rows=\"5\"  name=\"replibre_13463\"></textarea></div><br /><div style=\"width:450px;margin:auto;color:#ff3300;font-style:normal;font-weight:bold;\" class=\"texte_libre\">Merci de votre participation</div><br /><input type=\"submit\" value=\"Envoyer\" /></form></div>');