{"id":1114,"date":"2016-01-21T17:13:58","date_gmt":"2016-01-21T16:13:58","guid":{"rendered":"http:\/\/www.verderinbalans.nl\/?page_id=1114"},"modified":"2016-01-21T17:57:25","modified_gmt":"2016-01-21T16:57:25","slug":"aanmeldformulier-vriend-van-vib","status":"publish","type":"page","link":"https:\/\/www.verderinbalans.nl\/?page_id=1114","title":{"rendered":"Aanmelden Vriend van ViB"},"content":{"rendered":"<p><b><script>jQuery(document).ready(function(){});<\/script><script type=\"text\/javascript\">\nfunction xyz_cfm_1_1_showcaptcha()\n{\ndocument.getElementById(\"captcha_div_1_1\").innerHTML=\"<br\/><iframe   src=https:\/\/www.verderinbalans.nl\/wp-content\/plugins\/contact-form-manager\/captcha\/random.php?formName=1&formId=_1 marginheight=0 width=120 marginwidth=0 height=35 align=middle frameborder=0 scrolling=no  ><\/iframe>\";\n}\n<\/script><script type=\"text\/javascript\"> var xyz_cfm_date_format = \"m\/d\/Y\";function xyz_cfm_1_1_check(){var firstErrorId = \"\"; var xyz_cfm_client_error = 0;var name_eerstekeuze_8_1 = document.getElementById(\"eerstekeuze_8_1\").value;\nif(name_eerstekeuze_8_1 == \"\"){\ndocument.getElementById(\"dropdown_eerstekeuze_8_1\").innerHTML = \"Select dropdown field\";\nif(firstErrorId ==  \"\"){\nfirstErrorId = \n\"eerstekeuze_8_1\";\n}\nxyz_cfm_client_error = 1;\n}else{\ndocument.getElementById(\"dropdown_eerstekeuze_8_1\").innerHTML = \"\";\n}var xyz_cfm_name_bedrag_9_1 = document.getElementById(\"bedrag_9_1\").value;\nif(xyz_cfm_name_bedrag_9_1.trim() == \"\"){\ndocument.getElementById(\"text_bedrag_9_1\").innerHTML = \"Fill text field\";\nif(firstErrorId ==  \"\"){\nfirstErrorId = \n\"bedrag_9_1\";\n}\nxyz_cfm_client_error = 1;\n}else{\ndocument.getElementById(\"text_bedrag_9_1\").innerHTML = \"\";\n}var xyz_cfm_name_Jenaam_1_1 = document.getElementById(\"Jenaam_1_1\").value;\nif(xyz_cfm_name_Jenaam_1_1.trim() == \"\"){\ndocument.getElementById(\"text_Jenaam_1_1\").innerHTML = \"Fill text field\";\nif(firstErrorId == 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= \"\";\n}var xyz_cfm_name_Adres_13_1 = document.getElementById(\"Adres_13_1\").value;\nif(xyz_cfm_name_Adres_13_1.trim() == \"\"){\ndocument.getElementById(\"text_Adres_13_1\").innerHTML = \"Fill text field\";\nif(firstErrorId ==  \"\"){\nfirstErrorId = \n\"Adres_13_1\";\n}\nxyz_cfm_client_error = 1;\n}else{\ndocument.getElementById(\"text_Adres_13_1\").innerHTML = \"\";\n}var xyz_cfm_name_PCenplaats_14_1 = document.getElementById(\"PCenplaats_14_1\").value;\nif(xyz_cfm_name_PCenplaats_14_1.trim() == \"\"){\ndocument.getElementById(\"text_PCenplaats_14_1\").innerHTML = \"Fill text field\";\nif(firstErrorId ==  \"\"){\nfirstErrorId = \n\"PCenplaats_14_1\";\n}\nxyz_cfm_client_error = 1;\n}else{\ndocument.getElementById(\"text_PCenplaats_14_1\").innerHTML = \"\";\n}var xyz_cfm_name_telefoon_15_1 = document.getElementById(\"telefoon_15_1\").value;\nif(xyz_cfm_name_telefoon_15_1.trim() == \"\"){\ndocument.getElementById(\"text_telefoon_15_1\").innerHTML = \"Fill text field\";\nif(firstErrorId ==  \"\"){\nfirstErrorId = \n\"telefoon_15_1\";\n}\nxyz_cfm_client_error = 1;\n}else{\ndocument.getElementById(\"text_telefoon_15_1\").innerHTML = \"\";\n}\nvar xyz_cfm_captcha_captcha_38_1 = document.getElementById(\"captcha_38_1\").value;\nif(xyz_cfm_captcha_captcha_38_1.trim() == \"\"){\ndocument.getElementById(\"captcha_captcha_38_1\").innerHTML = \"Fill captcha field\";\nif(firstErrorId ==  \"\"){\nfirstErrorId = \n\"captcha_38_1\";\n}\nxyz_cfm_client_error = 1;\n}else{\ndocument.getElementById(\"captcha_captcha_38_1\").innerHTML = \"\";\n}\nif(xyz_cfm_client_error == 1){\nif(firstErrorId !=  \"\"){\ndocument.getElementById(firstErrorId).focus();\n}\nreturn false;\n}}<\/script>\n<div id=\"xyz_cfm_AanmeldenVriendvanViB_1_success\" style=\"background: #C8FCBB;  text-align: center;  border-radius: 15px; margin-bottom: 20px;\"><\/div>\n<form name=\"xyz_cfm_1_1\" method=\"POST\" id=\"xyz_cfm_1_1\" enctype=\"multipart\/form-data\" onSubmit=\"return xyz_cfm_1_1_check();\">\n<div class=\"xyz_cfm_theme_div_id_0\"><p>Ja, ik wil <strong>De Stichting<\/strong>\u00a0<strong>Verder in Balans in Amsterdam\u00a0<\/strong>graag steunen met een\u00a0<select id=\"eerstekeuze_8_1\" name=\"eerstekeuze\" class=\"\" ><option value=\"\">Select<\/option><option value=\"eenmalige\">eenmalige<\/option><option value=\" jaarlijkse\"> jaarlijkse<\/option><\/select><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red; \" id=\"dropdown_eerstekeuze_8_1\"><\/div> bijdrage van \u20ac\u00a0<input  class=\"\"  type=\"text\" id=\"bedrag_9_1\" name=\"bedrag\"  value=\"\"   maxlength=\"6\"><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red;\" id=\"text_bedrag_9_1\"><\/div>\n <span style=\"color: #008000;\">\u00a0(*<em>Een bedrag naar keuze, maar graag minimaal \u20ac 10,- per bijdrage)<\/em><\/span><\/p><p>Ik maak deze <span style=\"color: #000000;\">bijdrage<\/span>\u00a0over op bankrekening NL51 KNAB 0732 1257 90 t.n.v. de Stichting Verder in Balans te Amsterdam.<\/p><p>&nbsp;<\/p><table width=\"100%\"><tbody><tr><td>Mijn naam is<\/td><td>\u00a0:\u00a0<\/td><td><input  class=\"\"  type=\"text\" id=\"Jenaam_1_1\" name=\"Jenaam\"  value=\"\"  ><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red;\" id=\"text_Jenaam_1_1\"><\/div>\n<\/td><\/tr><tr><td>Email<\/td><td>\u00a0:\u00a0<\/td><td><input  class=\"\"  type=\"text\" id=\"yourEmail_2_1\" name=\"yourEmail\"  value=\"\"  ><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red;\" id=\"email_yourEmail_2_1\"><\/div>\n<\/td><\/tr><tr><td>Adres<\/td><td>\u00a0:\u00a0<\/td><td>\u00a0<input  class=\"\"  type=\"text\" id=\"Adres_13_1\" name=\"Adres\"  value=\"\"  ><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red;\" id=\"text_Adres_13_1\"><\/div>\n<\/td><\/tr><tr><td>Postcode\/plaats<\/td><td>\u00a0:\u00a0<\/td><td><input  class=\"\"  type=\"text\" id=\"PCenplaats_14_1\" name=\"PCenplaats\"  value=\"\"  ><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red;\" id=\"text_PCenplaats_14_1\"><\/div>\n<\/td><\/tr><tr><td colspan=\"2\">Telefoon\/mobiel<\/td><td><input  class=\"\"  type=\"text\" id=\"telefoon_15_1\" name=\"telefoon\"  value=\"\"  ><span style=\"color:red;\">*<\/span><div style=\"font-weight: normal;color:red;\" id=\"text_telefoon_15_1\"><\/div>\n<\/td><\/tr><\/tbody><\/table><p>Om spam te voorkomen verzoeken we u onderstaande code over te typen<strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/strong><\/p><p><strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<b><input style=\"margin-bottom:5px;\"   class=\"\"  type=\"text\" id=\"captcha_38_1\" name=\"captcha\"><span style=\"color:red;\">*<\/span><span id=\"captcha_div_1_1\"><br\/>\n<iframe loading=\"lazy\" frameborder=\"0\" 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ViB\" 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