<div style="text-align:center"><br />
<br />
<span style="font-size:20px"><strong>Feuille d&#39;&eacute;margement</strong></span><br />
&nbsp;
<div>Nous, &laquo; {mycompany_name} &raquo;,demeurant {mycompany_address} {mycompany_zip}&nbsp;{mycompany_town}, repr&eacute;sent&eacute;s par {__[AGF_ORGANISME_REPRESENTANT]__} ,</div>
</div>

<div>attestons par la pr&eacute;sente de la r&eacute;alit&eacute; des informations port&eacute;es ci-dessous &agrave; votre connaissance.</div>

<div style="text-align:left"><br />
<strong>La formation</strong></div>

<table border="0.5" cellpadding="1" cellspacing="1" style="width:540px">
	<tbody>
		<tr>
			<td>
			<table border="0" cellpadding="1" cellspacing="1" style="width:540px">
				<tbody>
					<tr>
						<td>
						<div>Intitul&eacute; : <strong>{formation_nom}</strong></div>

						<div>P&eacute;riode : {objvar_object_date_text} ({formation_duree_session}h)</div>
						</td>
						<td>Lieu de formation : {formation_lieu}<br />
						{formation_lieu_adresse}&nbsp;{formation_lieu_cp}&nbsp;{formation_lieu_ville}</td>
					</tr>
				</tbody>
			</table>
			</td>
		</tr>
	</tbody>
</table>
&nbsp;

<div style="text-align:left"><br />
<strong>Le(s)/</strong><strong>La formateur/trice(s)</strong></div>

<table border="0.5" cellpadding="1" cellspacing="1" style="width:540px">
	<tbody>
		<tr>
			<td style="width:100px">Nom et pr&eacute;nom</td>
			<td style="width:440px">
			<div style="text-align:center">Signature<br />
			<span style="font-size:8px"><em>atteste(nt) par la(les) signature(s) avoir dispens&eacute; la formation ci-dessus nomm&eacute;e.</em></span></div>

			<table border="0.5" cellpadding="1" cellspacing="1" style="width:440px">
				<tbody>
					<tr>
						<td style="text-align:left">Date:</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
					<tr>
						<td style="text-align:left">Heure :</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
				</tbody>
			</table>
			[!-- BEGIN TFormateursSession --]</td>
		</tr>
		<tr>
			<td>{line_formateur_nom} {line_formateur_prenom}</td>
			<td>
			<table border="0.5" cellpadding="1" cellspacing="1" style="width:440px">
				<tbody>
					<tr>
						<td style="height:27px">&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
				</tbody>
			</table>
			[!-- END TFormateursSession --]</td>
		</tr>
	</tbody>
</table>
&nbsp;

<div style="text-align:left"><br />
<strong>Le(s)/ La participant(e(s))</strong></div>

<table border="0.5" cellpadding="1" cellspacing="1" style="width:540px">
	<tbody>
		<tr>
			<td style="width:100px">Nom et pr&eacute;nom</td>
			<td style="width:440px">
			<div style="text-align:center">Signature<br />
			<span style="font-size:8px"><em>atteste(nt) par la(les) signature(s) avoir re&ccedil;u la formation ci-dessus nomm&eacute;e</em></span></div>

			<table border="0.5" cellpadding="1" cellspacing="1" style="width:440px">
				<tbody>
					<tr>
						<td style="text-align:left">Date:</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
					<tr>
						<td style="text-align:left">Heure :</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
				</tbody>
			</table>
			[!-- BEGIN TStagiairesSession --]</td>
		</tr>
		<tr>
			<td>{line_nom} {line_prenom}<br />
			({line_nom_societe})</td>
			<td>
			<table border="0.5" style="width:440px">
				<tbody>
					<tr>
						<td style="height:27px">&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
				</tbody>
			</table>
			[!-- END TStagiairesSession --]</td>
		</tr>
	</tbody>
</table>
&nbsp;