document.writeln('<div style=\"width:500px;border:1px solid black;background:;\" id=\"le_formulaire\"><div style=\"font-size:1.2em;width:100%;height:50px;text-align:center;margin:10px;color:;font-style:normal;font-weight:normal;\" id=\"titre_formulaire\"> Votre Cin&eacute;ma Imp&eacute;rial et vous en ...2010</div><form method=\"post\" action=\"http://www.magic-questionnaire.com/retour_form.php?id_formulaire=1800\" accept-charset=\"UTF-8\"><input type=\"hidden\" name=\"ieutf8\" value=\"&#153;\" /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Vous &ecirc;tes<br /><input type=\"radio\" name=\"repradio_16787\" value=\"121491\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Un Homme</span><br /><input type=\"radio\" name=\"repradio_16787\" value=\"121492\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Une Femme</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Vous avez<br /><input type=\"radio\" name=\"repradio_16788\" value=\"121493\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  - de 15 ans</span><br /><input type=\"radio\" name=\"repradio_16788\" value=\"121494\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  de 15 a 25 ans</span><br /><input type=\"radio\" name=\"repradio_16788\" value=\"121495\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  de 25 a 50 ans</span><br /><input type=\"radio\" name=\"repradio_16788\" value=\"121496\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Plus de 50 ans</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Vous habitez...<br /><input type=\"radio\" name=\"repradio_16796\" value=\"121529\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Lun&eacute;ville</span><br /><input type=\"radio\" name=\"repradio_16796\" value=\"121530\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  A moins de 10 kilometres</span><br /><input type=\"radio\" name=\"repradio_16796\" value=\"121531\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Entre 10 et 20 kilom&ecirc;tres</span><br /><input type=\"radio\" name=\"repradio_16796\" value=\"121532\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  A plus de 20 kilom&ecirc;tres</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Vous venez nous voir<br /><input type=\"radio\" name=\"repradio_16797\" value=\"121533\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  A pied</span><br /><input type=\"radio\" name=\"repradio_16797\" value=\"121534\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  En v&eacute;lo / moto</span><br /><input type=\"radio\" name=\"repradio_16797\" value=\"121535\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  En voiture</span><br /><input type=\"radio\" name=\"repradio_16797\" value=\"121536\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  En train</span><br /><input type=\"radio\" name=\"repradio_16797\" value=\"121537\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Autre</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">A quelle fr&eacute;quence ?<br /><input type=\"radio\" name=\"repradio_16798\" value=\"121538\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Une fois par an ou moins</span><br /><input type=\"radio\" name=\"repradio_16798\" value=\"121539\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Une a 2 fois par trimestre</span><br /><input type=\"radio\" name=\"repradio_16798\" value=\"121540\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Une a deux fois par mois</span><br /><input type=\"radio\" name=\"repradio_16798\" value=\"121541\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Une a deux fois par semaine</span><br /><input type=\"radio\" name=\"repradio_16798\" value=\"121542\"/> <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></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Pour voir ...<br /><input type=\"checkbox\" name=\"repcheckbox_121543\" value=\"121543\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  De l&#039;Art et Essai</span><br /><input type=\"checkbox\" name=\"repcheckbox_121544\" value=\"121544\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Des Dessins anim&eacute;s / films enfants</span><br /><input type=\"checkbox\" name=\"repcheckbox_121545\" value=\"121545\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Des com&eacute;dies</span><br /><input type=\"checkbox\" name=\"repcheckbox_121546\" value=\"121546\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Des films d&#039;action / suspense / thrillers</span><br /><input type=\"checkbox\" name=\"repcheckbox_121547\" value=\"121547\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Des films dramatiques</span><br /><input type=\"checkbox\" name=\"repcheckbox_121548\" value=\"121548\"/> <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\">Avec qui ?<br /><input type=\"checkbox\" name=\"repcheckbox_121549\" value=\"121549\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Tout seul / toute seule</span><br /><input type=\"checkbox\" name=\"repcheckbox_121550\" value=\"121550\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  En famille</span><br /><input type=\"checkbox\" name=\"repcheckbox_121551\" value=\"121551\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Avec des amis</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Vous connaissez nos tarifs<br /><input type=\"radio\" name=\"repradio_16808\" value=\"121572\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Oui</span><br /><input type=\"radio\" name=\"repradio_16808\" value=\"121573\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Non</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Les abonnements au cin&eacute;ma Imp&eacute;rial<br /><input type=\"radio\" name=\"repradio_16809\" value=\"121574\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Vous ne connaissez pas et peu importe !</span><br /><input type=\"radio\" name=\"repradio_16809\" value=\"121575\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Vous ne connaissez pas mais ca vous interesse ...</span><br /><input type=\"radio\" name=\"repradio_16809\" value=\"121576\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Vous connaissez &quot;comme &ccedil;a&quot;</span><br /><input type=\"radio\" name=\"repradio_16809\" value=\"121577\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Vous en achetez !</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Votre s&eacute;ance &quot;pr&eacute;f&eacute;r&eacute;e&quot;<br /><input type=\"radio\" name=\"repradio_16810\" value=\"121578\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Mercredi ou Samedi ou Dimanche apr&egrave;s midi</span><br /><input type=\"radio\" name=\"repradio_16810\" value=\"121579\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Mercredi ou Samedi ou Dimanche soir</span><br /><input type=\"radio\" name=\"repradio_16810\" value=\"121580\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Jeudi, Vendredi, Lundi ou Mardi apr&egrave;s midi</span><br /><input type=\"radio\" name=\"repradio_16810\" value=\"121581\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Jeudi Vendredi Lundi ou Mardi soir...</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"texte_libre\">Maintenant nous avons besoin de votre regard sur l&#039;&eacute;tat MATERIEL du cin&eacute;ma et sur les travaux que nous pourrions entreprendre...</div><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Vitrer le 1er hall ( portes donnant sur la rue de la republique<br /><input type=\"radio\" name=\"repradio_16821\" value=\"121609\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Bonne Id&eacute;e...</span><br /><input type=\"radio\" name=\"repradio_16821\" value=\"121610\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Pourquoi pas mais ...</span><br /><input type=\"radio\" name=\"repradio_16821\" value=\"121611\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Franchement, pourquoi faire </span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Refaire la fa&ccedil;ade ( panneaux, affichettes, photos, eclairage...)<br /><input type=\"radio\" name=\"repradio_16822\" value=\"121612\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Enfin !</span><br /><input type=\"radio\" name=\"repradio_16822\" value=\"121613\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Mouais...</span><br /><input type=\"radio\" name=\"repradio_16822\" value=\"121614\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  N&#039;importe quoi, mon pauv&#039;monsieur !</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Changer les fauteuils de la salle 1 / les espacer..<br /><input type=\"radio\" name=\"repradio_16823\" value=\"121615\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Ah, quand m&ecirc;me, vous y venez !</span><br /><input type=\"radio\" name=\"repradio_16823\" value=\"121616\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" > Espacez les, ne les changez pas</span><br /><input type=\"radio\" name=\"repradio_16823\" value=\"121617\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Vous croyez que c&#039;est utile, franchement ?</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">La Salle 1 et la Salle 3 EN PROJECTION NUMERIQUE ( voire 3d quand les films sont tourn&eacute;s ainsi )<br /><input type=\"radio\" name=\"repradio_16824\" value=\"121618\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Gadget, inutile !</span><br /><input type=\"radio\" name=\"repradio_16824\" value=\"121619\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Oui mais pas la priorit&eacute; !</span><br /><input type=\"radio\" name=\"repradio_16824\" value=\"121620\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  De toute urgence !</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Refaire les toilettes / sanitaires...<br /><input type=\"radio\" name=\"repradio_16825\" value=\"121621\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Bonne id&eacute;e</span><br /><input type=\"radio\" name=\"repradio_16825\" value=\"121622\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Mouais</span><br /><input type=\"radio\" name=\"repradio_16825\" value=\"121623\"/> <span style=\"margin-top:5px!important;margin-left:10px!important;color:;font-style:normal;font-weight:normal;\" class=\"reponse_choix\" >  Dans 3 mois ce sera comme si vous aviez rien fait !</span></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Ici vos suggestions quant &agrave; l&#039;am&eacute;lioration de la prestation que vous offre votre cin&eacute;ma... Suggestions et critiques bienvenues, insultes, non merci !<br /><textarea  cols=\"47\" rows=\"5\"  name=\"replibre_16826\"></textarea></div><br /><div style=\"width:450px;margin:auto;color:;font-style:normal;font-weight:normal;\" class=\"question\">Ce questionnaire est anonyme, mais si vous souhaitez participer de fa&ccedil;on concrete a l am&eacute;lioration de votre cin&eacute;ma, vous pouvez nous lasisser ci-dessous vos coordonn&eacute;es ( mail bienvenu !<br /><textarea  cols=\"47\" rows=\"5\"  name=\"replibre_16827\"></textarea></div><br /><br /><input type=\"submit\" value=\"Envoyer\" /></form></div>');