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=\"611857493\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"vhg2008subs\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou.htm?m=default\" 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=\"name,custom Naam,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 style=\"color: rgb(255, 0, 0);\"><font size=\"3\"><strong><u> INSCHRIJVEN '</u></strong></font><strong><span style=\"color: red; text-decoration: underline;\"><span style=\"color: rgb(255, 0, 0);\">LEEF JE WAARHEID</span></span></strong><font size=\"3\"><strong><u>' BASIS ONLINE CURSUS</u>:</strong></font> </div><div>&nbsp;</div><div><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 BOC (enkel pdf-versie).</font></div><br></center></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 Naam\" 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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