diff --git a/layouts/shortcodes/parcoursmob_create_driver.html b/layouts/shortcodes/parcoursmob_create_driver.html
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+<form class="m-10" method="POST" action="">
+  <h2 class=" text-xl text-mms-nightblue my-4 text-center">Rejoignez la communauté de conducteurs solidaires</h2>
+  <div class="grid grid-cols-1 sm:grid-cols-2 mt-4">
+    <div class="flex flex-row align-middle">
+      <label for="first_name" class="text-sm p-1">Prénom :</label>
+      <input type="text" name="first_name" class="flex-1 border-mms-nightblue border-2 rounded-lg mx-2 text-sm px-2 text-mms-darkgray" />
+    </div>
+    <div class="flex flex-row align-middle mt-4 sm:mt-0">
+      <label for="last_name" class="text-sm p-1">Nom :</label>
+      <input type="text" name="last_name" class="flex-1 border-mms-nightblue border-2 rounded-lg mx-2 text-sm px-2 text-mms-darkgray" />
+    </div>
+  </div>
+  <div class="grid grid-cols-1 sm:grid-cols-2 mt-4">
+    <div class="flex flex-row align-middle">
+      <label for="first_name" class="text-sm p-1">Email :</label>
+      <input type="email" name="email" class="flex-1 border-mms-nightblue border-2 rounded-lg mx-2 text-sm px-2 text-mms-darkgray" />
+    </div>
+    <div class="flex flex-row align-middle mt-4 sm:mt-0">
+      <label for="phone_number" class="text-sm p-1">Téléphone :</label>
+      <input type="tel" name="phone_number" class="flex-1 border-mms-nightblue border-2 rounded-lg mx-2 text-sm px-2 text-mms-darkgray" />
+    </div>
+  </div>
+  <div class="grid grid-cols-1 sm:grid-cols-2 mt-4">
+    <div class="flex flex-row align-middle">
+      <label for="birthdate" class="text-sm p-1">Date de naissance :</label>
+      <input type="date" name="birthdate" class="flex-1 border-mms-nightblue border-2 rounded-lg mx-2 text-sm px-2 text-mms-darkgray" />
+    </div>
+    <div class="flex flex-row align-middle">
+    </div>
+  </div>
+  <div class="flex flex-row mt-4">
+    <label for="driver_type" class="text-sm p-1">Je souhaite m'engager pour du :</label>
+    <div class="text-sm mx-4">
+      <input type="radio" name="driver_type" id="solidarity_transport" value="solidarity_transport"> <label for="solidarity_transport">Transport solidaire</label><br />
+      <input type="radio" name="driver_type" id="organized_carpool" value="organized_carpool"> <label for="organized_carpool">Covoiturage solidaire</label><br />
+      <input type="radio" name="driver_type" id="driver_any" value="any"> <label for="driver_any">Je ne sais pas / Les 2</label>
+    </div>
+  </div>
+  <div class="mt-8 text-center">
+    <button type="submit" class="relative inline-flex items-center gap-x-1.5 rounded-lg bg-mms-nightblue px-2 py-1 text-sm font-semibold text-white shadow-xs hover:bg-mms-darkgray focus-visible:outline-2 focus-visible:outline-offset-2 focus-visible:outline-mms-nightblue">
+       Rejoindre la communauté solidaire
+    </button>
+  </div>
+</form>