From: <Opgeslagen met Windows Internet Explorer 8>
Subject: Aanmeldingsformulier
Date: Sun, 6 Sep 2009 16:36:32 +0200
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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD><TITLE>Aanmeldingsformulier</TITLE>
<META content=3D"text/html; charset=3Diso-8859-1" =
http-equiv=3DContent-Type>
<SCRIPT language=3DJavaScript><!--=0A=
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<META name=3DGENERATOR content=3D"MSHTML 8.00.6001.18812"></HEAD>
<BODY>
<FORM onsubmit=3D"return validate()" method=3Dpost name=3Dformgenerator=20
action=3Dhttp://www.formgenerator.nl/script/sendmail.php3><INPUT=20
value=3Djustusvanloon@quicknet.nl type=3Dhidden name=3Dstd_adres[0]> =
<INPUT value=3D1=20
type=3Dhidden name=3Dstd_adres_teller> <INPUT=20
value=3Dwww.de-weergever.nl/pagina21.html type=3Dhidden =
name=3Dthankyoupage> <INPUT=20
value=3D"Weergever nieuw lid" type=3Dhidden name=3Dsubject>=20
<TABLE cellPadding=3D0 width=3D"100%" celspacing=3D"0">
  <TBODY>
  <TR>
    <TD>Voornaam:</TD>
    <TD><INPUT name=3Dvoornaam></TD></TR>
  <TR>
    <TD>Achternaam:</TD>
    <TD><INPUT name=3Dachternaam></TD></TR>
  <TR>
    <TD>Geslacht:</TD>
    <TD><SELECT name=3Dgeslacht><OPTION selected value=3D"">Maak uw=20
        keuze</OPTION><OPTION value=3Dman>Man</OPTION><OPTION=20
        value=3Dvrouw>Vrouw</OPTION></SELECT></TD></TR>
  <TR>
    <TD>Adres:</TD>
    <TD><INPUT name=3Dadres></TD></TR>
  <TR>
    <TD>Postcode:</TD>
    <TD><INPUT name=3Dpostcode></TD></TR>
  <TR>
    <TD>Woonplaats:</TD>
    <TD><INPUT name=3Dwoonplaats></TD></TR>
  <TR>
    <TD>Telefoon:</TD>
    <TD><INPUT name=3Dtelefoon></TD></TR>
  <TR>
    <TD>Email:</TD>
    <TD><INPUT name=3Demailafzender></TD></TR>
  <TR>
    <TD>Uw leeftijd (optioneel)</TD>
    <TD><INPUT name=3Dextra_veld_1><INPUT value=3Dleeftijd: =
type=3Dhidden=20
      name=3Dextra_veld_naam[1]></TD></TR>
  <TR>
    <TD>Hoe kwam u ons op het spoor</TD>
    <TD><INPUT name=3Dextra_veld_2><INPUT type=3Dhidden=20
  name=3Dextra_veld_naam[2]></TD></TR><INPUT value=3D3 type=3Dhidden=20
  name=3Dextra_veld_teller> </TBODY></TABLE></TABLE>
<TABLE cellPadding=3D0 width=3D"100%" celspacing=3D"0">
  <TBODY>
  <TR>
    <TD><B></B></TD><INPUT type=3Dhidden name=3Dgroep_naam[1]><INPUT =
type=3Dhidden=20
    name=3Dgroep_email[1]></TR><INPUT value=3D97 type=3Dhidden=20
  name=3Dgroep_interesses[1]><INPUT value=3D1 type=3Dhidden=20
name=3Dgroep_teller></TBODY></TABLE><INPUT value=3Dloon204 type=3Dhidden =

name=3Dlogin><BR><INPUT value=3Dverstuur type=3Dsubmit> </FORM><!-- =
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<DIV style=3D"Z-INDEX: 10; WIDTH: 744px; HEIGHT: 12px; VISIBILITY: =
hidden" id=3Did>
<TABLE border=3D0 cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD bgColor=3D#ffffcc><B>Let op: </B>Laat de "<B>powered by</B>" =
link=20
      onderin het formulier staan voor de juiste werking van het=20
      formulier.Formgenerator controleert op de aanwezigheid hiervan op =
het=20
      formulier voor de juiste werking. Deze gele tabel is op het =
formulier niet=20
      zichtbaar. <B>Attention: </B>Do not delete the<B> "powered by" =
</B>link at=20
      the bottom of this form, Formgenerator will check if this link is =
on your=20
      form before processing. If you delete the link your form will not=20
  work!</TD></TR></TBODY></TABLE></DIV>
<P align=3Dcenter><FONT size=3D-1><A href=3D"http://www.yourhosting.nl/" =

target=3D_blank>Domeinnaam registratie en hosting via =
Yourhosting</A></FONT></P><!-- End Formgenerator Footer =
--></BODY></HTML>
