| <%%SELECT%%><%%VALUE(date)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(nom_prenom)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(intermediare)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(pays_residence)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(adresse)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(telephone)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(email)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(destination)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(formule)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(certificat)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(date_depart)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(date_retour)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(passport)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(beneficiaire)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(nom_prenomb)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(date_de_naissance)%%><%%ENDSELECT%%> |
<%%VALUE(nom_prenom)%%> |
<%%SELECT%%><%%VALUE(statut)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(questionnaire_medical)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(question1)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(question2)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(question2a)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(question3)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(question4)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(question5)%%><%%ENDSELECT%%> |
<%%SELECT%%><%%VALUE(prime_total)%%><%%ENDSELECT%%> |