{"id":883,"date":"2016-04-04T22:01:05","date_gmt":"2016-04-04T21:01:05","guid":{"rendered":"http:\/\/www.hkolthof.eu\/?page_id=883"},"modified":"2023-10-27T15:02:36","modified_gmt":"2023-10-27T14:02:36","slug":"voorverkoop-2021","status":"publish","type":"page","link":"https:\/\/hkolthof.nl\/wp\/","title":{"rendered":"Voorverkoop 2021"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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   <h3 class=\"gform_title\">frmZwembadkaarthouder2<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1' class=' gf_stylespro sp_glass' action='\/wp\/wp-json\/wp\/v2\/pages\/883#gf_1' data-formid='1' novalidate><input type=\"hidden\" name=\"gpuid_existing_value_56\" id=\"gpuid_existing_value_56\" value=\"f06ba34a23e918080a7c0a44e54c8db6\" \/>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_157\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_157'>Phone<\/label><div class='ginput_container'><input name='input_157' id='input_1_157' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_157'>Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.<\/div><\/li><li id=\"field_1_56\" class=\"gfield gfield--type-uid field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_1_56'>Id<\/label><div class='ginput_container ginput_container_hidden'><input name='input_56' id='input_1_56' type='hidden' value=''  \/><\/div><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_1'>CaspioId<\/label><div class='ginput_container ginput_container_number'><input name='input_1' id='input_1_1' type='number' step='any' min='1' max='10000' value='' class='small'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_1\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_1'>Voer een nummer in van <strong>1<\/strong> tot <strong>10000<\/strong>.<\/div><\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_hide_complex_label o_medium\"  data-field-class=\"gf_hide_complex_label o_medium\" ><label class='gfield_label gform-field-label' for='input_1_2'>Datum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_1_2' type='text' value='01-06-2026' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_1_2_date_format gfield_description_1_2\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_2_date_format' class='screen-reader-text'>DD dash MM dash JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_2' class='gform_hidden' value='https:\/\/hkolthof.nl\/wp\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_1_2'>                                      <\/div><\/li><li id=\"field_1_57\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_57'>DatumUpdate<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_57' id='input_1_57' type='text' value='01-06-2026' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_1_57_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_57_date_format' class='screen-reader-text'>DD dash MM dash JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_57' class='gform_hidden' value='https:\/\/hkolthof.nl\/wp\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_1_33\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br>\n<b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Let op : De ingevulde gegevens komen op de kaart! Met de button &#8220;Volgende&#8221; kom je op de pagina waar je een controleoverzicht ziet van de ingevulde gegevens.  Een gemaakte fout kun je met \u201cVorige\u201d herstellen. Onderaan de pagina kies je de bank om vervolgens met de button &#8220;Naar iDEAL&#8221; af te rekenen, nadat je voor de &#8220;SPAMcontrole&#8221; bent geslaagd. <\/FONT><\/b>\n<br>                                                                                                    <br> \n<\/li><li id=\"field_1_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" ><label class='gfield_label gform-field-label' for='input_1_3'>Straat<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield--type-number gfield--width-full gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" ><label class='gfield_label gform-field-label' for='input_1_4'>Huisnr<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_4' id='input_1_4' type='number' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-text gf_right_third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" ><label class='gfield_label gform-field-label' for='input_1_5'>Huisltr\/toev<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_7\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_7'>Postcode<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_1_7' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_8\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_8'>Woonplaats<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_151\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_151'>Geen titel<\/label><div class='ginput_container ginput_container_text'><input name='input_151' id='input_1_151' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_152\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_152'>Geen titel<\/label><div class='ginput_container ginput_container_text'><input name='input_152' id='input_1_152' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_third gf_newline gf_icn_inset o_medium\"  data-field-class=\"gf_third gf_newline gf_icn_inset o_medium\" ><label class='gfield_label gform-field-label' for='input_1_9'>E-mailadres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container has_gfsp_icn ginput_container_email'>\n                            <span class=\"gfsp_icon\"><i  style='color:#34e2e0'class=\"md md-email\"><\/i><\/span><input name='input_9' id='input_1_9' type='email' value='' class='large full'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_154\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" ><label class='gfield_label gform-field-label' >E-mailadres gewijzigd?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_154'>\n\t\t\t<li class='gchoice gchoice_1_154_0'>\n\t\t\t\t<input name='input_154' type='radio' value='Ja'  id='choice_1_154_0'    \/>\n\t\t\t\t<label for='choice_1_154_0' id='label_1_154_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_154_1'>\n\t\t\t\t<input name='input_154' type='radio' value='Nee' checked='checked' id='choice_1_154_1'    \/>\n\t\t\t\t<label for='choice_1_154_1' id='label_1_154_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_10\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_third gf_icn_inset o_medium\"  data-field-class=\"gf_third gf_icn_inset o_medium\" ><label class='gfield_label gform-field-label' for='input_1_10'>Telefoon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container has_gfsp_icn ginput_container_phone'><span class=\"gfsp_icon\"><i  style='color:#dd9933'class=\"md md-phone\"><\/i><\/span><input name='input_10' id='input_1_10' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_59\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">1e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_11'>Voorltr(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_1_11' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_12'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_13\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_13' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_13_2_container'>\n                                            <input type='number' maxlength='2' name='input_13[]' id='input_1_13_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_13_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_13_1_container'>\n                                        <input type='number' maxlength='2' name='input_13[]' id='input_1_13_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_13_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_13_3_container'>\n                                        <input type='number' maxlength='4' name='input_13[]' id='input_1_13_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_13_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_80\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_80 gfield_product_1_80 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_80'>\n\t\t\t<li class='gchoice gchoice_1_80_0'>\n\t\t\t\t<input name='input_80' type='radio' value='Basiskaart1|80'  id='choice_1_80_0'    \/>\n\t\t\t\t<label for='choice_1_80_0' id='label_1_80_0' class='gform-field-label gform-field-label--type-inline'>Basiskaart1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_80_1'>\n\t\t\t\t<input name='input_80' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_80_1'    \/>\n\t\t\t\t<label for='choice_1_80_1' id='label_1_80_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_80'>Basiskaart1 (Ouder\/verzorger) \u20ac 80,00\nPersoonlijk abonnement          \u20ac 60,00<\/div><\/li><li id=\"field_1_84\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_82\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_82'>\n\t\t\t<li class='gchoice gchoice_1_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='Ja'  id='choice_1_82_0'    \/>\n\t\t\t\t<label for='choice_1_82_0' id='label_1_82_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='Nee' checked='checked' id='choice_1_82_1'    \/>\n\t\t\t\t<label for='choice_1_82_1' id='label_1_82_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_85\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_85 gfield_product_1_85 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_85'>\n\t\t\t<li class='gchoice gchoice_1_85_0'>\n\t\t\t\t<input name='input_85' type='radio' value='Leskaart|87'  id='choice_1_85_0'    \/>\n\t\t\t\t<label for='choice_1_85_0' id='label_1_85_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_85_1'>\n\t\t\t\t<input name='input_85' type='radio' value='Aquasportkaart|45'  id='choice_1_85_1'    \/>\n\t\t\t\t<label for='choice_1_85_1' id='label_1_85_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_85'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00\n<\/div><\/li><li id=\"field_1_86\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#1e73be\"\nFACE=\"Verdana\">Volgende kaart?<\/FONT><\/b>\n<\/li><li id=\"field_1_87\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_87'>\n\t\t\t<li class='gchoice gchoice_1_87_0'>\n\t\t\t\t<input name='input_87' type='radio' value='Ja'  id='choice_1_87_0'    \/>\n\t\t\t\t<label for='choice_1_87_0' id='label_1_87_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_87_1'>\n\t\t\t\t<input name='input_87' type='radio' value='Nee' checked='checked' id='choice_1_87_1'    \/>\n\t\t\t\t<label for='choice_1_87_1' id='label_1_87_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_60\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">2e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_15\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_15'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_1_15' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_16'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_1_16' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_17' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_17_2_container'>\n                                            <input type='number' maxlength='2' name='input_17[]' id='input_1_17_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_17_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_17_1_container'>\n                                        <input type='number' maxlength='2' name='input_17[]' id='input_1_17_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_17_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_17_3_container'>\n                                        <input type='number' maxlength='4' name='input_17[]' id='input_1_17_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_17_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_88\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_88 gfield_product_1_88 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_88'>\n\t\t\t<li class='gchoice gchoice_1_88_0'>\n\t\t\t\t<input name='input_88' type='radio' value='Basiskaart2|0'  id='choice_1_88_0'    \/>\n\t\t\t\t<label for='choice_1_88_0' id='label_1_88_0' class='gform-field-label gform-field-label--type-inline'>Basiskaart2<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_88'>Basiskaart2 (Ouder\/verzorger) \u20ac 0,00\n<\/div><\/li><li id=\"field_1_89\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_89 gfield_product_1_89 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_89'>\n\t\t\t<li class='gchoice gchoice_1_89_0'>\n\t\t\t\t<input name='input_89' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_89_0'    \/>\n\t\t\t\t<label for='choice_1_89_0' id='label_1_89_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_90\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_91\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_91'>\n\t\t\t<li class='gchoice gchoice_1_91_0'>\n\t\t\t\t<input name='input_91' type='radio' value='Ja'  id='choice_1_91_0'    \/>\n\t\t\t\t<label for='choice_1_91_0' id='label_1_91_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_91_1'>\n\t\t\t\t<input name='input_91' type='radio' value='Nee' checked='checked' id='choice_1_91_1'    \/>\n\t\t\t\t<label for='choice_1_91_1' id='label_1_91_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_92\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_92 gfield_product_1_92 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_92'>\n\t\t\t<li class='gchoice gchoice_1_92_0'>\n\t\t\t\t<input name='input_92' type='radio' value='Leskaart|87'  id='choice_1_92_0'    \/>\n\t\t\t\t<label for='choice_1_92_0' id='label_1_92_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_92_1'>\n\t\t\t\t<input name='input_92' type='radio' value='Aquasportkaart|45'  id='choice_1_92_1'    \/>\n\t\t\t\t<label for='choice_1_92_1' id='label_1_92_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_92'>Leskaart \u20ac 87,00\nAquasportkaart \u20ac 45,00<\/div><\/li><li id=\"field_1_71\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende kaart? <\/FONT><\/b>\n             <\/li><li id=\"field_1_93\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_93'>\n\t\t\t<li class='gchoice gchoice_1_93_0'>\n\t\t\t\t<input name='input_93' type='radio' value='Ja'  id='choice_1_93_0'    \/>\n\t\t\t\t<label for='choice_1_93_0' id='label_1_93_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_93_1'>\n\t\t\t\t<input name='input_93' type='radio' value='Nee' checked='checked' id='choice_1_93_1'    \/>\n\t\t\t\t<label for='choice_1_93_1' id='label_1_93_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_95\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement? <\/FONT><\/b>\n             <\/li><li id=\"field_1_94\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_94'>\n\t\t\t<li class='gchoice gchoice_1_94_0'>\n\t\t\t\t<input name='input_94' type='radio' value='Ja'  id='choice_1_94_0'    \/>\n\t\t\t\t<label for='choice_1_94_0' id='label_1_94_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_94_1'>\n\t\t\t\t<input name='input_94' type='radio' value='Nee' checked='checked' id='choice_1_94_1'    \/>\n\t\t\t\t<label for='choice_1_94_1' id='label_1_94_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_61\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">3e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_19\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_19'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_1_19' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_20'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_1_20' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_21\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_21' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_21_2_container'>\n                                            <input type='number' maxlength='2' name='input_21[]' id='input_1_21_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_21_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_21_1_container'>\n                                        <input type='number' maxlength='2' name='input_21[]' id='input_1_21_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_21_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_21_3_container'>\n                                        <input type='number' maxlength='4' name='input_21[]' id='input_1_21_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_21_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_96\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_96 gfield_product_1_96 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_96'>\n\t\t\t<li class='gchoice gchoice_1_96_0'>\n\t\t\t\t<input name='input_96' type='radio' value='Bijkaart|15'  id='choice_1_96_0'    \/>\n\t\t\t\t<label for='choice_1_96_0' id='label_1_96_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_96_1'>\n\t\t\t\t<input name='input_96' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_96_1'    \/>\n\t\t\t\t<label for='choice_1_96_1' id='label_1_96_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_96'>Bijkaart \u20ac 15,00\n<\/div><\/li><li id=\"field_1_97\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_97 gfield_product_1_97 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_97'>\n\t\t\t<li class='gchoice gchoice_1_97_0'>\n\t\t\t\t<input name='input_97' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_97_0'    \/>\n\t\t\t\t<label for='choice_1_97_0' id='label_1_97_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_99\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_100\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_100'>\n\t\t\t<li class='gchoice gchoice_1_100_0'>\n\t\t\t\t<input name='input_100' type='radio' value='Ja'  id='choice_1_100_0'    \/>\n\t\t\t\t<label for='choice_1_100_0' id='label_1_100_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_100_1'>\n\t\t\t\t<input name='input_100' type='radio' value='Nee' checked='checked' id='choice_1_100_1'    \/>\n\t\t\t\t<label for='choice_1_100_1' id='label_1_100_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_101\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_101 gfield_product_1_101 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_101'>\n\t\t\t<li class='gchoice gchoice_1_101_0'>\n\t\t\t\t<input name='input_101' type='radio' value='Leskaart|87'  id='choice_1_101_0'    \/>\n\t\t\t\t<label for='choice_1_101_0' id='label_1_101_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_101_1'>\n\t\t\t\t<input name='input_101' type='radio' value='Aquasportkaart|45'  id='choice_1_101_1'    \/>\n\t\t\t\t<label for='choice_1_101_1' id='label_1_101_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_101'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00\n<\/div><\/li><li id=\"field_1_98\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende kaart? <\/FONT><\/b>\n             <\/li><li id=\"field_1_102\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_102'>\n\t\t\t<li class='gchoice gchoice_1_102_0'>\n\t\t\t\t<input name='input_102' type='radio' value='Ja'  id='choice_1_102_0'    \/>\n\t\t\t\t<label for='choice_1_102_0' id='label_1_102_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_102_1'>\n\t\t\t\t<input name='input_102' type='radio' value='Nee' checked='checked' id='choice_1_102_1'    \/>\n\t\t\t\t<label for='choice_1_102_1' id='label_1_102_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_72\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement? <\/FONT><\/b>\n             <\/li><li id=\"field_1_103\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_103'>\n\t\t\t<li class='gchoice gchoice_1_103_0'>\n\t\t\t\t<input name='input_103' type='radio' value='Ja'  id='choice_1_103_0'    \/>\n\t\t\t\t<label for='choice_1_103_0' id='label_1_103_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_103_1'>\n\t\t\t\t<input name='input_103' type='radio' value='Nee' checked='checked' id='choice_1_103_1'    \/>\n\t\t\t\t<label for='choice_1_103_1' id='label_1_103_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_62\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">4e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_23\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_23'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_24\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_24'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_1_24' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_25\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_25' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_25_2_container'>\n                                            <input type='number' maxlength='2' name='input_25[]' id='input_1_25_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_25_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_25_1_container'>\n                                        <input type='number' maxlength='2' name='input_25[]' id='input_1_25_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_25_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_25_3_container'>\n                                        <input type='number' maxlength='4' name='input_25[]' id='input_1_25_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_25_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_104\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_104 gfield_product_1_104 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_104'>\n\t\t\t<li class='gchoice gchoice_1_104_0'>\n\t\t\t\t<input name='input_104' type='radio' value='Bijkaart|15'  id='choice_1_104_0'    \/>\n\t\t\t\t<label for='choice_1_104_0' id='label_1_104_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_104_1'>\n\t\t\t\t<input name='input_104' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_104_1'    \/>\n\t\t\t\t<label for='choice_1_104_1' id='label_1_104_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_105\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_105 gfield_product_1_105 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_105'>\n\t\t\t<li class='gchoice gchoice_1_105_0'>\n\t\t\t\t<input name='input_105' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_105_0'    \/>\n\t\t\t\t<label for='choice_1_105_0' id='label_1_105_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_106\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart\nbij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_107\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_107'>\n\t\t\t<li class='gchoice gchoice_1_107_0'>\n\t\t\t\t<input name='input_107' type='radio' value='Ja'  id='choice_1_107_0'    \/>\n\t\t\t\t<label for='choice_1_107_0' id='label_1_107_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_107_1'>\n\t\t\t\t<input name='input_107' type='radio' value='Nee' checked='checked' id='choice_1_107_1'    \/>\n\t\t\t\t<label for='choice_1_107_1' id='label_1_107_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_108\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_108 gfield_product_1_108 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_108'>\n\t\t\t<li class='gchoice gchoice_1_108_0'>\n\t\t\t\t<input name='input_108' type='radio' value='Leskaart|87'  id='choice_1_108_0'    \/>\n\t\t\t\t<label for='choice_1_108_0' id='label_1_108_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_108_1'>\n\t\t\t\t<input name='input_108' type='radio' value='Aquasportkaart|45'  id='choice_1_108_1'    \/>\n\t\t\t\t<label for='choice_1_108_1' id='label_1_108_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_108'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00\n<\/div><\/li><li id=\"field_1_73\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende kaart?<\/FONT><\/b>\n             <\/li><li id=\"field_1_109\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_109'>\n\t\t\t<li class='gchoice gchoice_1_109_0'>\n\t\t\t\t<input name='input_109' type='radio' value='Ja'  id='choice_1_109_0'    \/>\n\t\t\t\t<label for='choice_1_109_0' id='label_1_109_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_109_1'>\n\t\t\t\t<input name='input_109' type='radio' value='Nee' checked='checked' id='choice_1_109_1'    \/>\n\t\t\t\t<label for='choice_1_109_1' id='label_1_109_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_110\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement?<\/FONT><\/b>\n             <\/li><li id=\"field_1_111\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_111'>\n\t\t\t<li class='gchoice gchoice_1_111_0'>\n\t\t\t\t<input name='input_111' type='radio' value='Ja'  id='choice_1_111_0'    \/>\n\t\t\t\t<label for='choice_1_111_0' id='label_1_111_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_111_1'>\n\t\t\t\t<input name='input_111' type='radio' value='Nee' checked='checked' id='choice_1_111_1'    \/>\n\t\t\t\t<label for='choice_1_111_1' id='label_1_111_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_63\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">5e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_29\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_29'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_1_29' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_30\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_30'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_1_30' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_31' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_31_2_container'>\n                                            <input type='number' maxlength='2' name='input_31[]' id='input_1_31_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_31_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_31_1_container'>\n                                        <input type='number' maxlength='2' name='input_31[]' id='input_1_31_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_31_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_31_3_container'>\n                                        <input type='number' maxlength='4' name='input_31[]' id='input_1_31_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_31_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_112\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_112 gfield_product_1_112 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_112'>\n\t\t\t<li class='gchoice gchoice_1_112_0'>\n\t\t\t\t<input name='input_112' type='radio' value='Bijkaart|15'  id='choice_1_112_0'    \/>\n\t\t\t\t<label for='choice_1_112_0' id='label_1_112_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_112_1'>\n\t\t\t\t<input name='input_112' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_112_1'    \/>\n\t\t\t\t<label for='choice_1_112_1' id='label_1_112_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_113\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_113 gfield_product_1_113 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_113'>\n\t\t\t<li class='gchoice gchoice_1_113_0'>\n\t\t\t\t<input name='input_113' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_113_0'    \/>\n\t\t\t\t<label for='choice_1_113_0' id='label_1_113_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_114\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaartkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_115\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_115'>\n\t\t\t<li class='gchoice gchoice_1_115_0'>\n\t\t\t\t<input name='input_115' type='radio' value='Ja'  id='choice_1_115_0'    \/>\n\t\t\t\t<label for='choice_1_115_0' id='label_1_115_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_115_1'>\n\t\t\t\t<input name='input_115' type='radio' value='Nee' checked='checked' id='choice_1_115_1'    \/>\n\t\t\t\t<label for='choice_1_115_1' id='label_1_115_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_116\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_116 gfield_product_1_116 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_116'>\n\t\t\t<li class='gchoice gchoice_1_116_0'>\n\t\t\t\t<input name='input_116' type='radio' value='Leskaart|87'  id='choice_1_116_0'    \/>\n\t\t\t\t<label for='choice_1_116_0' id='label_1_116_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_116_1'>\n\t\t\t\t<input name='input_116' type='radio' value='Aquasportkaart|45'  id='choice_1_116_1'    \/>\n\t\t\t\t<label for='choice_1_116_1' id='label_1_116_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_116'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00\n<\/div><\/li><li id=\"field_1_74\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#1e73be\"\nFACE=\"Verdana\">Volgende kaart?<\/FONT><\/b><\/li><li id=\"field_1_117\" class=\"gfield gfield--type-radio gfield--type-choice gf_middle_third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_117'>\n\t\t\t<li class='gchoice gchoice_1_117_0'>\n\t\t\t\t<input name='input_117' type='radio' value='Ja'  id='choice_1_117_0'    \/>\n\t\t\t\t<label for='choice_1_117_0' id='label_1_117_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_117_1'>\n\t\t\t\t<input name='input_117' type='radio' value='Nee' checked='checked' id='choice_1_117_1'    \/>\n\t\t\t\t<label for='choice_1_117_1' id='label_1_117_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_118\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement?<\/FONT><\/b>\n<\/li><li id=\"field_1_119\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_119'>\n\t\t\t<li class='gchoice gchoice_1_119_0'>\n\t\t\t\t<input name='input_119' type='radio' value='Ja'  id='choice_1_119_0'    \/>\n\t\t\t\t<label for='choice_1_119_0' id='label_1_119_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_119_1'>\n\t\t\t\t<input name='input_119' type='radio' value='Nee' checked='checked' id='choice_1_119_1'    \/>\n\t\t\t\t<label for='choice_1_119_1' id='label_1_119_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_64\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible o_medium\"  data-field-class=\"o_medium\" ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">6e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_34\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_34'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_35\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_35'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_36\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_36' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_36_2_container'>\n                                            <input type='number' maxlength='2' name='input_36[]' id='input_1_36_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_36_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_36_1_container'>\n                                        <input type='number' maxlength='2' name='input_36[]' id='input_1_36_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_36_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_36_3_container'>\n                                        <input type='number' maxlength='4' name='input_36[]' id='input_1_36_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_36_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_120\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_120 gfield_product_1_120 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_120'>\n\t\t\t<li class='gchoice gchoice_1_120_0'>\n\t\t\t\t<input name='input_120' type='radio' value='Bijkaart|15'  id='choice_1_120_0'    \/>\n\t\t\t\t<label for='choice_1_120_0' id='label_1_120_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_120_1'>\n\t\t\t\t<input name='input_120' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_120_1'    \/>\n\t\t\t\t<label for='choice_1_120_1' id='label_1_120_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_121\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_121 gfield_product_1_121 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_121'>\n\t\t\t<li class='gchoice gchoice_1_121_0'>\n\t\t\t\t<input name='input_121' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_121_0'    \/>\n\t\t\t\t<label for='choice_1_121_0' id='label_1_121_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_122\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart\nbij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_123\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_123'>\n\t\t\t<li class='gchoice gchoice_1_123_0'>\n\t\t\t\t<input name='input_123' type='radio' value='Ja'  id='choice_1_123_0'    \/>\n\t\t\t\t<label for='choice_1_123_0' id='label_1_123_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_123_1'>\n\t\t\t\t<input name='input_123' type='radio' value='Nee' checked='checked' id='choice_1_123_1'    \/>\n\t\t\t\t<label for='choice_1_123_1' id='label_1_123_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_124\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_124 gfield_product_1_124 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_124'>\n\t\t\t<li class='gchoice gchoice_1_124_0'>\n\t\t\t\t<input name='input_124' type='radio' value='Leskaart|87'  id='choice_1_124_0'    \/>\n\t\t\t\t<label for='choice_1_124_0' id='label_1_124_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_124_1'>\n\t\t\t\t<input name='input_124' type='radio' value='Aquasportkaart|45'  id='choice_1_124_1'    \/>\n\t\t\t\t<label for='choice_1_124_1' id='label_1_124_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_124'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00\n<\/div><\/li><li id=\"field_1_75\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#1e73be\"\nFACE=\"Verdana\">Volgende kaart?<\/FONT><\/b><\/li><li id=\"field_1_125\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_125'>\n\t\t\t<li class='gchoice gchoice_1_125_0'>\n\t\t\t\t<input name='input_125' type='radio' value='Ja'  id='choice_1_125_0'    \/>\n\t\t\t\t<label for='choice_1_125_0' id='label_1_125_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_125_1'>\n\t\t\t\t<input name='input_125' type='radio' value='Nee' checked='checked' id='choice_1_125_1'    \/>\n\t\t\t\t<label for='choice_1_125_1' id='label_1_125_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_126\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement?<\/FONT><\/b>\n<\/li><li id=\"field_1_127\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_127'>\n\t\t\t<li class='gchoice gchoice_1_127_0'>\n\t\t\t\t<input name='input_127' type='radio' value='Ja'  id='choice_1_127_0'    \/>\n\t\t\t\t<label for='choice_1_127_0' id='label_1_127_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_127_1'>\n\t\t\t\t<input name='input_127' type='radio' value='Nee' checked='checked' id='choice_1_127_1'    \/>\n\t\t\t\t<label for='choice_1_127_1' id='label_1_127_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_65\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">7e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_40\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_40'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_1_40' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_41\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_41'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_1_41' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_43\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_43' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_43_2_container'>\n                                            <input type='number' maxlength='2' name='input_43[]' id='input_1_43_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_43_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_43_1_container'>\n                                        <input type='number' maxlength='2' name='input_43[]' id='input_1_43_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_43_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_43_3_container'>\n                                        <input type='number' maxlength='4' name='input_43[]' id='input_1_43_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_43_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_128\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_128 gfield_product_1_128 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_128'>\n\t\t\t<li class='gchoice gchoice_1_128_0'>\n\t\t\t\t<input name='input_128' type='radio' value='Bijkaart|15'  id='choice_1_128_0'    \/>\n\t\t\t\t<label for='choice_1_128_0' id='label_1_128_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_128_1'>\n\t\t\t\t<input name='input_128' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_128_1'    \/>\n\t\t\t\t<label for='choice_1_128_1' id='label_1_128_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_129\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_129 gfield_product_1_129 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_129'>\n\t\t\t<li class='gchoice gchoice_1_129_0'>\n\t\t\t\t<input name='input_129' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_129_0'    \/>\n\t\t\t\t<label for='choice_1_129_0' id='label_1_129_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_130\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_131\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_131'>\n\t\t\t<li class='gchoice gchoice_1_131_0'>\n\t\t\t\t<input name='input_131' type='radio' value='Ja'  id='choice_1_131_0'    \/>\n\t\t\t\t<label for='choice_1_131_0' id='label_1_131_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_131_1'>\n\t\t\t\t<input name='input_131' type='radio' value='Nee' checked='checked' id='choice_1_131_1'    \/>\n\t\t\t\t<label for='choice_1_131_1' id='label_1_131_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_132\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_132 gfield_product_1_132 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_132'>\n\t\t\t<li class='gchoice gchoice_1_132_0'>\n\t\t\t\t<input name='input_132' type='radio' value='Leskaart|87'  id='choice_1_132_0'    \/>\n\t\t\t\t<label for='choice_1_132_0' id='label_1_132_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_132_1'>\n\t\t\t\t<input name='input_132' type='radio' value='Aquasportkaart|45'  id='choice_1_132_1'    \/>\n\t\t\t\t<label for='choice_1_132_1' id='label_1_132_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_132'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00\n<\/div><\/li><li id=\"field_1_76\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#1e73be\"\nFACE=\"Verdana\">Volgende kaart?<\/FONT><\/b><\/li><li id=\"field_1_134\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_134'>\n\t\t\t<li class='gchoice gchoice_1_134_0'>\n\t\t\t\t<input name='input_134' type='radio' value='Ja'  id='choice_1_134_0'    \/>\n\t\t\t\t<label for='choice_1_134_0' id='label_1_134_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_134_1'>\n\t\t\t\t<input name='input_134' type='radio' value='Nee' checked='checked' id='choice_1_134_1'    \/>\n\t\t\t\t<label for='choice_1_134_1' id='label_1_134_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_136\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement?<\/FONT><\/b>\n<\/li><li id=\"field_1_135\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_135'>\n\t\t\t<li class='gchoice gchoice_1_135_0'>\n\t\t\t\t<input name='input_135' type='radio' value='Ja'  id='choice_1_135_0'    \/>\n\t\t\t\t<label for='choice_1_135_0' id='label_1_135_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_135_1'>\n\t\t\t\t<input name='input_135' type='radio' value='Nee' checked='checked' id='choice_1_135_1'    \/>\n\t\t\t\t<label for='choice_1_135_1' id='label_1_135_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_66\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">8e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_44\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_44'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_1_44' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_45\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_45'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_1_45' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_46\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_46' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_46_2_container'>\n                                            <input type='number' maxlength='2' name='input_46[]' id='input_1_46_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_46_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_46_1_container'>\n                                        <input type='number' maxlength='2' name='input_46[]' id='input_1_46_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_46_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_46_3_container'>\n                                        <input type='number' maxlength='4' name='input_46[]' id='input_1_46_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_46_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_137\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_137 gfield_product_1_137 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_137'>\n\t\t\t<li class='gchoice gchoice_1_137_0'>\n\t\t\t\t<input name='input_137' type='radio' value='Bijkaart|15'  id='choice_1_137_0'    \/>\n\t\t\t\t<label for='choice_1_137_0' id='label_1_137_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_137_1'>\n\t\t\t\t<input name='input_137' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_137_1'    \/>\n\t\t\t\t<label for='choice_1_137_1' id='label_1_137_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_138\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_138 gfield_product_1_138 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_138'>\n\t\t\t<li class='gchoice gchoice_1_138_0'>\n\t\t\t\t<input name='input_138' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_138_0'    \/>\n\t\t\t\t<label for='choice_1_138_0' id='label_1_138_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_139\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_140\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_140'>\n\t\t\t<li class='gchoice gchoice_1_140_0'>\n\t\t\t\t<input name='input_140' type='radio' value='Ja'  id='choice_1_140_0'    \/>\n\t\t\t\t<label for='choice_1_140_0' id='label_1_140_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_140_1'>\n\t\t\t\t<input name='input_140' type='radio' value='Nee' checked='checked' id='choice_1_140_1'    \/>\n\t\t\t\t<label for='choice_1_140_1' id='label_1_140_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_141\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_141 gfield_product_1_141 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_141'>\n\t\t\t<li class='gchoice gchoice_1_141_0'>\n\t\t\t\t<input name='input_141' type='radio' value='Leskaart|87'  id='choice_1_141_0'    \/>\n\t\t\t\t<label for='choice_1_141_0' id='label_1_141_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_141_1'>\n\t\t\t\t<input name='input_141' type='radio' value='Aquasportkaart|45'  id='choice_1_141_1'    \/>\n\t\t\t\t<label for='choice_1_141_1' id='label_1_141_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_141'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00<\/div><\/li><li id=\"field_1_77\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#1e73be\"\nFACE=\"Verdana\">Volgende kaart?<\/FONT><\/b><\/li><li id=\"field_1_142\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_142'>\n\t\t\t<li class='gchoice gchoice_1_142_0'>\n\t\t\t\t<input name='input_142' type='radio' value='Ja'  id='choice_1_142_0'    \/>\n\t\t\t\t<label for='choice_1_142_0' id='label_1_142_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_142_1'>\n\t\t\t\t<input name='input_142' type='radio' value='Nee' checked='checked' id='choice_1_142_1'    \/>\n\t\t\t\t<label for='choice_1_142_1' id='label_1_142_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_143\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\" FACE=\"Verdana\">Volgende bijkaart of persoonlijk abonnement?<\/FONT><\/b>\n<\/li><li id=\"field_1_144\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_144'>\n\t\t\t<li class='gchoice gchoice_1_144_0'>\n\t\t\t\t<input name='input_144' type='radio' value='Ja'  id='choice_1_144_0'    \/>\n\t\t\t\t<label for='choice_1_144_0' id='label_1_144_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_144_1'>\n\t\t\t\t<input name='input_144' type='radio' value='Nee' checked='checked' id='choice_1_144_1'    \/>\n\t\t\t\t<label for='choice_1_144_1' id='label_1_144_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_67\" class=\"gfield gfield--type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"3\" COLOR=\"#003399\" FACE=\"Verdana\">9e Kaarthouder<\/FONT><\/b><\/li><li id=\"field_1_48\" class=\"gfield gfield--type-text gf_first_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter gf_newline o_medium\"  data-field-class=\"gf_quarter gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_1_48'>Voorletter(s)\/Roepnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_1_48' type='text' value='' class='medium' maxlength='15'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_49\" class=\"gfield gfield--type-text gf_second_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' for='input_1_49'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_1_49' type='text' value='' class='large full'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_50\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_third_quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_50' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_50_2_container'>\n                                            <input type='number' maxlength='2' name='input_50[]' id='input_1_50_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_50_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_50_1_container'>\n                                        <input type='number' maxlength='2' name='input_50[]' id='input_1_50_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_50_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_50_3_container'>\n                                        <input type='number' maxlength='4' name='input_50[]' id='input_1_50_3' value=''   aria-required='true'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_50_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_145\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_145 gfield_product_1_145 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_145'>\n\t\t\t<li class='gchoice gchoice_1_145_0'>\n\t\t\t\t<input name='input_145' type='radio' value='Bijkaart|15'  id='choice_1_145_0'    \/>\n\t\t\t\t<label for='choice_1_145_0' id='label_1_145_0' class='gform-field-label gform-field-label--type-inline'>Bijkaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_145_1'>\n\t\t\t\t<input name='input_145' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_145_1'    \/>\n\t\t\t\t<label for='choice_1_145_1' id='label_1_145_1' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_146\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_fourth_quarter gfield_price gfield_price_1_146 gfield_product_1_146 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" ><label class='gfield_label gform-field-label' >Soort abonnement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_146'>\n\t\t\t<li class='gchoice gchoice_1_146_0'>\n\t\t\t\t<input name='input_146' type='radio' value='Persoonlijk abonnement|60'  id='choice_1_146_0'    \/>\n\t\t\t\t<label for='choice_1_146_0' id='label_1_146_0' class='gform-field-label gform-field-label--type-inline'>Persoonlijk abonnement<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_147\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline gf_newline o_medium\"  data-field-class=\"gf_inline gf_newline o_medium\" ><b><FONT SIZE=\"2\"COLOR=\"#009900\"\nFACE=\"Verdana\">Wilt u een Les- of Aquasportkaart bij dit abonnement?\n<\/FONT><\/b><\/li><li id=\"field_1_148\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_148'>\n\t\t\t<li class='gchoice gchoice_1_148_0'>\n\t\t\t\t<input name='input_148' type='radio' value='Ja'  id='choice_1_148_0'    \/>\n\t\t\t\t<label for='choice_1_148_0' id='label_1_148_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_148_1'>\n\t\t\t\t<input name='input_148' type='radio' value='Nee' checked='checked' id='choice_1_148_1'    \/>\n\t\t\t\t<label for='choice_1_148_1' id='label_1_148_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_149\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_1_149 gfield_product_1_149 gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" ><label class='gfield_label gform-field-label' >Les- of Aquasportkaart<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_149'>\n\t\t\t<li class='gchoice gchoice_1_149_0'>\n\t\t\t\t<input name='input_149' type='radio' value='Leskaart|87'  id='choice_1_149_0'    \/>\n\t\t\t\t<label for='choice_1_149_0' id='label_1_149_0' class='gform-field-label gform-field-label--type-inline'>Leskaart<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_149_1'>\n\t\t\t\t<input name='input_149' type='radio' value='Aquasportkaart|45'  id='choice_1_149_1'    \/>\n\t\t\t\t<label for='choice_1_149_1' id='label_1_149_1' class='gform-field-label gform-field-label--type-inline'>Aquasportkaart<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_149'>Leskaart \u20ac 87,00\nAquasportkaart  \u20ac 45,00<\/div><\/li><li id=\"field_1_27\" class=\"gfield gfield--type-total gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_1_27'>Totaal<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_1'>0,00 &#8364;<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_27' id='input_1_27' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_1_156\" class=\"gfield gfield--type-ideal_issuer_drop_down gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_156'>Kies een bank voor iDEAL-betaling<\/label><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_38' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-38' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_52\" class=\"gfield gfield--type-text gf_left_third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_52'>Voorletter(s)\/Roepnaam<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_1_52' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_53\" class=\"gfield gfield--type-text gf_middle_third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_53'>Naam<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_54\" class=\"gfield gfield--type-date gfield--input-type-datefield gf_right_third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label gfield_label_before_complex' >Geboortedatum<\/label><div id='input_1_54' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                        <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_54_2_container'>\n                                            <input type='number' maxlength='2' name='input_54[]' id='input_1_54_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_54_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Dag<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_54_1_container'>\n                                        <input type='number' maxlength='2' name='input_54[]' id='input_1_54_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_1_54_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Maand<\/label>\n                                   <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_54_3_container'>\n                                        <input type='number' maxlength='4' name='input_54[]' id='input_1_54_3' value=''   aria-required='false'   placeholder='JJJJ' min='1920' max='2027' step='1'\/>\n                                        <label for='input_1_54_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jaar<\/label>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_55\" class=\"gfield gfield--type-product gfield--input-type-select gfield_price gfield_price_1_55 gfield_product_1_55 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_55'>Soort abonnement<\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_1_55' class='small gfield_select'     aria-invalid=\"false\" ><option value='Maak keuze|0' >Maak keuze<\/option><option value='Bijkaart|18' >Bijkaart<\/option><option value='Persoonlijk abonnement|67' >Persoonlijk abonnement<\/option><option value='Leskaart|87' >Leskaart<\/option><\/select><\/div><\/li><li id=\"field_1_83\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >{all_fields}<\/li><li id=\"field_1_39\" class=\"gfield gfield--type-total gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_1_39'>Totaal<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_1'>0,00 &#8364;<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_39' id='input_1_39' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_1_155\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b><FONT SIZE=\"2\" COLOR=\"#1e73be\">Bij het plaatsen van deze bestelling gaat u akkoord met de <A HREF=\"http:\/\/www.heuveltjesbosbad.nl\/privacyverklaring\/\" TARGET=\"_blank\">privacyverklaring <\/A>van het Heuveltjesbosbad. <\/FONT><\/b>                                                                         <\/li><li id=\"field_1_69\" class=\"gfield gfield--type-ideal_issuer_drop_down field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_69'>Kies een bank voor iDEAL-betaling<\/label><\/li><li id=\"field_1_68\" class=\"gfield gfield--type-gf_no_captcha_recaptcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_68'>SPAMcontrole<\/label><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' 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