document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"479263679\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"vhgioc2008subs\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_e3c28e1b6dff7c8a265fa07b428339e4\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"custom Cursuscode,name,custom Voornaam,custom Telefoon,from,custom Adres,custom Postcode,custom Woonplaats,custom Land\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div><div class=\"MsoNormal\"><strong><u><span style=\"color: red;\"><span style=\"text-decoration: underline;\"></span></span></u><span style=\"color: red; text-decoration: underline;\"><span style=\"color: rgb(255, 0, 0);\">INSCHRIJVEN 'LEEF JE WAARHEID' INTENSIVE ONLINE CURSUS</span></span><span style=\"color: red; text-decoration: underline;\">:</span></strong><span style=\"color: red;\"></span> </div><div class=\"MsoNormal\"><font size=\"2\">&nbsp;</font></div><div class=\"MsoNormal\"><font size=\"2\">Reservatie is pas definitief na inschrijving via onderstaand formulier en na bevestiging en betaling van het juiste bedrag op KBC rekening Juvenesco: 734-0070438-25 met vermelding: Emailadres en cursuscode IOC (pdf+mp3)&nbsp; OF&nbsp; VOC (VIP).</font></div><div class=\"MsoNormal\"><font size=\"2\">&nbsp;</font></div>    </div></center></td></tr><tr><td>Cursuscode:</td><td><select name=\"custom Cursuscode\"><option value=\"IOC\">IOC</option><option value=\"VOC\" selected>VOC</option></select></td></tr><tr><td>Voornaam:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Naam:</td><td><input type=\"text\" name=\"custom Voornaam\" value=\"\" size=\"20\"></td></tr><tr><td>Telefoon:</td><td><input type=\"text\" name=\"custom Telefoon\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Adres:</td><td><input type=\"text\" name=\"custom Adres\" value=\"\" size=\"20\"></td></tr><tr><td>Postcode:</td><td><input type=\"text\" name=\"custom Postcode\" value=\"\" size=\"20\"></td></tr><tr><td>Woonplaats:</td><td><input type=\"text\" name=\"custom Woonplaats\" value=\"\" size=\"20\"></td></tr><tr><td>Land:</td><td><input type=\"text\" name=\"custom Land\" value=\"\" size=\"20\"></td></tr><tr><td>Firmanaam:</td><td><input type=\"text\" name=\"custom Firmanaam\" value=\"\" size=\"20\"></td></tr><tr><td>BTW NR:</td><td><input type=\"text\" name=\"custom BTW NR\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Verstuur\"></td></tr></table></form></center>");

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