{"id":4,"date":"2015-02-15T13:17:21","date_gmt":"2015-02-15T13:17:21","guid":{"rendered":"http:\/\/www.pcschermer.nl\/test\/?page_id=4"},"modified":"2026-01-02T10:26:13","modified_gmt":"2026-01-02T10:26:13","slug":"inschrijfformulier","status":"publish","type":"page","link":"https:\/\/www.gegevensformulier.nl\/vonk\/","title":{"rendered":"Gegevensformulier bpv"},"content":{"rendered":"<p><a href=\"https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-148 \" src=\"https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK-1024x432.png\" alt=\"\" width=\"347\" height=\"146\" srcset=\"https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK-1024x432.png 1024w, https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK-300x127.png 300w, https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK-768x324.png 768w, https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK-1536x648.png 1536w, https:\/\/www.gegevensformulier.nl\/vonk\/wp-content\/uploads\/2022\/08\/Logo-Vonk-CMYK-2048x864.png 2048w\" sizes=\"auto, (max-width: 347px) 100vw, 347px\" \/><\/a><\/p>\n<div id=\"iphorm-outer-69d9cbf7de578\" class=\"iphorm-outer iphorm-outer-2 iphorm-theme-light-rounded iphorm-has-logic iphorm-responsive\" style='font-family: tahoma;font-size: large;text-transform: uppercase;font-weight: 500;'>\n    <script type=\"text\/javascript\">\n        jQuery(document).ready(function($) {\n                            iPhorm.logic[2] = {\"logic\":{\"54\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"60\",\"operator\":\"eq\",\"value\":\"Nee\"}]},\"12\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"60\",\"operator\":\"eq\",\"value\":\"Nee\"}]},\"58\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"57\",\"operator\":\"eq\",\"value\":\"BBL\"}]},\"48\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"35\",\"operator\":\"eq\",\"value\":\"Ja\"}]},\"37\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"35\",\"operator\":\"eq\",\"value\":\"Ja\"}]},\"36\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"35\",\"operator\":\"eq\",\"value\":\"Ja\"}]},\"52\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"35\",\"operator\":\"eq\",\"value\":\"Ja\"}]}},\"dependents\":{\"60\":[54,12],\"57\":[58],\"35\":[48,37,36,52]},\"animate\":true};\n                        $('#iphorm-69d9cbf7de578').iPhorm({\"id\":2,\"uniqueId\":\"69d9cbf7de578\",\"useAjax\":true,\"successMessageTimeout\":0,\"resetFormValues\":\"\",\"clElementIds\":[54,12,58,48,37,36,52],\"clDependentElementIds\":[60,57,35],\"centerFancybox\":true,\"centerFancyboxSpeed\":true});\n                        if ($.isFunction($.fn.qtip)) {\n                $('.iphorm-tooltip-hover', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-dark qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    }\n                });\n                $('.iphorm-tooltip-click', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-dark qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    },\n                    show: {\n                        event: 'focus'\n                    },\n                    hide: {\n                        event: 'unfocus'\n                    }\n                });\n                $('.iphorm-tooltip-icon-hover', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-dark qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    },\n                    content: {\n                        text: function (api) {\n                            return $(this).find('.iphorm-tooltip-icon-content').html();\n                        }\n                    }\n                });\n                $('.iphorm-tooltip-icon-click', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-dark qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    },\n                    show: {\n                        event: 'click'\n                    },\n                    hide: {\n                        event: 'unfocus'\n                    },\n                    content: {\n                        text: function (api) {\n                            return $(this).find('.iphorm-tooltip-icon-content').html();\n                        }\n                    }\n                });\n                $('.iphorm-labels-inside > .iphorm-element-spacer > label').hover(function () {\n                    $(this).siblings('.iphorm-input-wrap').find('.iphorm-tooltip-hover').qtip('show');\n                }, function () {\n                    $(this).siblings('.iphorm-input-wrap').find('.iphorm-tooltip-hover').qtip('hide');\n                });\n            }\n                                    if ($.isFunction($.fn.inFieldLabels)) {\n                $('.iphorm-labels-inside:not(.iphorm-element-wrap-recaptcha) > .iphorm-element-spacer > label', iPhorm.instance.$form).inFieldLabels();\n            }\n                            if ($.isFunction($.fn.datepicker)) {\n                                            if (!$('#iphorm-jqueryui-theme').length) {\n                            var themeUrl = iphormL10n.plugin_url + '\/js\/jqueryui\/themes\/ui-lightness\/jquery-ui.min.css?ver=1.12.1';\n                            $('head').append('<link id=\"iphorm-jqueryui-theme\" rel=\"stylesheet\" href=\"' + themeUrl + '\" type=\"text\/css\" \/>');\n                        }\n                                                                 $.getScript(iphormL10n.plugin_url + '\/js\/jqueryui\/i18n\/jquery.ui.datepicker-nl.js');\n                                    }\n                        $('.iphorm-group-row > div:last-child:not(:first-child)', iPhorm.instance.$form).add('.iphorm-group-row:last-child', iPhorm.instance.$form).addClass('last-child');\n                            iPhorm.instance.applyAllLogic(true);\n                $('#iphorm-outer-69d9cbf7de578').css('visibility', 'visible');\n                    });\n    <\/script>\n    <form id=\"iphorm-69d9cbf7de578\" class=\"iphorm iphorm-form-2\" action=\"\/vonk\/wp-json\/wp\/v2\/pages\/4#iphorm-69d9cbf7de578\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\">\n        <div class=\"iphorm-inner iphorm-inner-2\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n            <input type=\"hidden\" name=\"iphorm_id\" value=\"2\" \/>\n            <input type=\"hidden\" name=\"iphorm_uid\" value=\"69d9cbf7de578\" \/>\n            <input type=\"hidden\" name=\"form_url\" value=\"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/pages\/4\" \/>\n            <input type=\"hidden\" name=\"referring_url\" value=\"\" \/>\n            <input type=\"hidden\" name=\"post_id\" value=\"\" \/>\n            <input type=\"hidden\" name=\"post_title\" value=\"\" \/>\n                                                                        <div class=\"iphorm-success-message iphorm-hidden\" ><\/div>\n                                        <div class=\"iphorm-elements iphorm-elements-2 iphorm-clearfix\" >\n                <div class=\"iphorm-group-wrap iphorm_2_32-group-wrap iphorm-clearfix iphorm-labels-left iphorm-group-style-plain iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='background-color: rgb(255, 255, 255);color: rgb(242, 140, 49);'>GEGEVENS STUDENT<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_1-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_1-element-spacer\">\n        <label for=\"iphorm_2_1_69d9cbf7de578\" class=\"iphorm_2_1-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Voor- & Achternaam<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_1-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_1\" id=\"iphorm_2_1_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_1\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_55-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_55-element-spacer\">\n        <label for=\"iphorm_2_55_69d9cbf7de578\" class=\"iphorm_2_55-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Telefoonnummer<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_55-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_55\" id=\"iphorm_2_55_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_55\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_56-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_56-element-spacer\">\n        <label for=\"iphorm_2_56_69d9cbf7de578\" class=\"iphorm_2_56-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Vonk e-mailadres<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_56-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_56\" id=\"iphorm_2_56_69d9cbf7de578\" type=\"email\" name=\"iphorm_2_56\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_23-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_23-element-spacer\">\n        <label for=\"iphorm_2_23_69d9cbf7de578\" class=\"iphorm_2_23-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Studentnummer<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_23-input-wrap\" >\n            <input class=\"iphorm-element-text iphorm-tooltip iphorm-tooltip-hover iphorm_2_23\" id=\"iphorm_2_23_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_23\" title=\"Moet bestaan uit 5 cijfers. Studentnummer is onder andere te vinden via CheckIt.\" value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-date iphorm_2_3-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-date iphorm_2_3-element-spacer\">\r\n        <label id=\"iphorm_2_3_69d9cbf7de578_date_label\" class=\"iphorm_2_3-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Geboortedatum<span class=\"iphorm-required\">*<\/span><\/label>        <div id=\"iphorm_2_3_69d9cbf7de578\" class=\"iphorm-input-wrap iphorm-input-wrap-date iphorm_2_3-input-wrap\" >\r\n        \t<div class=\"iphorm-clearfix\">\r\n                <div class=\"iphorm-input-wrap-date-select-wrap\">\r\n                                                                                <label id=\"iphorm_2_3_69d9cbf7de578_day_label\" class=\"iphorm-screen-reader-text\">Dag<\/label>\r\n                    <select id=\"iphorm_2_3_69d9cbf7de578_day\" name=\"iphorm_2_3[day]\" class=\"iphorm_2_3-input-day\" aria-labelledby=\"iphorm_2_3_69d9cbf7de578_date_label iphorm_2_3_69d9cbf7de578_day_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Dag<\/option>                                                    <option value=\"1\" >1<\/option>\r\n                                                    <option value=\"2\" >2<\/option>\r\n                                                    <option value=\"3\" >3<\/option>\r\n                                                    <option value=\"4\" >4<\/option>\r\n                                                    <option value=\"5\" >5<\/option>\r\n                                                    <option value=\"6\" >6<\/option>\r\n                                                    <option value=\"7\" >7<\/option>\r\n                                                    <option value=\"8\" >8<\/option>\r\n                                                    <option value=\"9\" >9<\/option>\r\n                                                    <option value=\"10\" >10<\/option>\r\n                                                    <option value=\"11\" >11<\/option>\r\n                                                    <option value=\"12\" >12<\/option>\r\n                                                    <option value=\"13\" >13<\/option>\r\n                                                    <option value=\"14\" >14<\/option>\r\n                                                    <option value=\"15\" >15<\/option>\r\n                                                    <option value=\"16\" >16<\/option>\r\n                                                    <option value=\"17\" >17<\/option>\r\n                                                    <option value=\"18\" >18<\/option>\r\n                                                    <option value=\"19\" >19<\/option>\r\n                                                    <option value=\"20\" >20<\/option>\r\n                                                    <option value=\"21\" >21<\/option>\r\n                                                    <option value=\"22\" >22<\/option>\r\n                                                    <option value=\"23\" >23<\/option>\r\n                                                    <option value=\"24\" >24<\/option>\r\n                                                    <option value=\"25\" >25<\/option>\r\n                                                    <option value=\"26\" >26<\/option>\r\n                                                    <option value=\"27\" >27<\/option>\r\n                                                    <option value=\"28\" >28<\/option>\r\n                                                    <option value=\"29\" >29<\/option>\r\n                                                    <option value=\"30\" >30<\/option>\r\n                                                    <option value=\"31\" >31<\/option>\r\n                                            <\/select>\r\n                                        <label id=\"iphorm_2_3_69d9cbf7de578_month_label\" class=\"iphorm-screen-reader-text\">Maand<\/label>\r\n                    <select id=\"iphorm_2_3_69d9cbf7de578_month\" name=\"iphorm_2_3[month]\" class=\"iphorm_2_3-input-month\" aria-labelledby=\"iphorm_2_3_69d9cbf7de578_date_label iphorm_2_3_69d9cbf7de578_month_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Maand<\/option>                                                    <option value=\"1\" >Januari<\/option>\r\n                                                    <option value=\"2\" >Februari<\/option>\r\n                                                    <option value=\"3\" >Maart<\/option>\r\n                                                    <option value=\"4\" >April<\/option>\r\n                                                    <option value=\"5\" >Mei<\/option>\r\n                                                    <option value=\"6\" >Juni<\/option>\r\n                                                    <option value=\"7\" >Juli<\/option>\r\n                                                    <option value=\"8\" >Augustus<\/option>\r\n                                                    <option value=\"9\" >September<\/option>\r\n                                                    <option value=\"10\" >Oktober<\/option>\r\n                                                    <option value=\"11\" >November<\/option>\r\n                                                    <option value=\"12\" >December<\/option>\r\n                                            <\/select>\r\n                                        <label id=\"iphorm_2_3_69d9cbf7de578_year_label\" class=\"iphorm-screen-reader-text\">Jaar<\/label>\r\n                    <select id=\"iphorm_2_3_69d9cbf7de578_year\" name=\"iphorm_2_3[year]\" class=\"iphorm_2_3-input-year\" aria-labelledby=\"iphorm_2_3_69d9cbf7de578_date_label iphorm_2_3_69d9cbf7de578_year_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Jaar<\/option>                                                                                    <option value=\"2030\" >2030<\/option>\r\n                                                            <option value=\"2029\" >2029<\/option>\r\n                                                            <option value=\"2028\" >2028<\/option>\r\n                                                            <option value=\"2027\" >2027<\/option>\r\n                                                            <option value=\"2026\" >2026<\/option>\r\n                                                            <option value=\"2025\" >2025<\/option>\r\n                                                            <option value=\"2024\" >2024<\/option>\r\n                                                            <option value=\"2023\" >2023<\/option>\r\n                                                            <option value=\"2022\" >2022<\/option>\r\n                                                            <option value=\"2021\" >2021<\/option>\r\n                                                            <option value=\"2020\" >2020<\/option>\r\n                                                            <option value=\"2019\" >2019<\/option>\r\n                                                            <option value=\"2018\" >2018<\/option>\r\n                                                            <option value=\"2017\" >2017<\/option>\r\n                                                            <option value=\"2016\" >2016<\/option>\r\n                                                            <option value=\"2015\" >2015<\/option>\r\n                                                            <option value=\"2014\" >2014<\/option>\r\n                                                            <option value=\"2013\" >2013<\/option>\r\n                                                            <option value=\"2012\" >2012<\/option>\r\n                                                            <option value=\"2011\" >2011<\/option>\r\n                                                            <option value=\"2010\" >2010<\/option>\r\n                                                            <option value=\"2009\" >2009<\/option>\r\n                                                            <option value=\"2008\" >2008<\/option>\r\n                                                            <option value=\"2007\" >2007<\/option>\r\n                                                            <option value=\"2006\" >2006<\/option>\r\n                                                            <option value=\"2005\" >2005<\/option>\r\n                                                            <option value=\"2004\" >2004<\/option>\r\n                                                            <option value=\"2003\" >2003<\/option>\r\n                                                            <option value=\"2002\" >2002<\/option>\r\n                                                            <option value=\"2001\" >2001<\/option>\r\n                                                            <option value=\"2000\" >2000<\/option>\r\n                                                            <option value=\"1999\" >1999<\/option>\r\n                                                            <option value=\"1998\" >1998<\/option>\r\n                                                            <option value=\"1997\" >1997<\/option>\r\n                                                            <option value=\"1996\" >1996<\/option>\r\n                                                            <option value=\"1995\" >1995<\/option>\r\n                                                            <option value=\"1994\" >1994<\/option>\r\n                                                            <option value=\"1993\" >1993<\/option>\r\n                                                            <option value=\"1992\" >1992<\/option>\r\n                                                            <option value=\"1991\" >1991<\/option>\r\n                                                            <option value=\"1990\" >1990<\/option>\r\n                                                            <option value=\"1989\" >1989<\/option>\r\n                                                            <option value=\"1988\" >1988<\/option>\r\n                                                            <option value=\"1987\" >1987<\/option>\r\n                                                            <option value=\"1986\" >1986<\/option>\r\n                                                            <option value=\"1985\" >1985<\/option>\r\n                                                            <option value=\"1984\" >1984<\/option>\r\n                                                            <option value=\"1983\" >1983<\/option>\r\n                                                            <option value=\"1982\" >1982<\/option>\r\n                                                            <option value=\"1981\" >1981<\/option>\r\n                                                            <option value=\"1980\" >1980<\/option>\r\n                                                            <option value=\"1979\" >1979<\/option>\r\n                                                            <option value=\"1978\" >1978<\/option>\r\n                                                            <option value=\"1977\" >1977<\/option>\r\n                                                            <option value=\"1976\" >1976<\/option>\r\n                                                            <option value=\"1975\" >1975<\/option>\r\n                                                            <option value=\"1974\" >1974<\/option>\r\n                                                            <option value=\"1973\" >1973<\/option>\r\n                                                            <option value=\"1972\" >1972<\/option>\r\n                                                            <option value=\"1971\" >1971<\/option>\r\n                                                            <option value=\"1970\" >1970<\/option>\r\n                                                            <option value=\"1969\" >1969<\/option>\r\n                                                            <option value=\"1968\" >1968<\/option>\r\n                                                            <option value=\"1967\" >1967<\/option>\r\n                                                            <option value=\"1966\" >1966<\/option>\r\n                                                            <option value=\"1965\" >1965<\/option>\r\n                                                            <option value=\"1964\" >1964<\/option>\r\n                                                            <option value=\"1963\" >1963<\/option>\r\n                                                            <option value=\"1962\" >1962<\/option>\r\n                                                            <option value=\"1961\" >1961<\/option>\r\n                                                            <option value=\"1960\" >1960<\/option>\r\n                                                            <option value=\"1959\" >1959<\/option>\r\n                                                            <option value=\"1958\" >1958<\/option>\r\n                                                            <option value=\"1957\" >1957<\/option>\r\n                                                            <option value=\"1956\" >1956<\/option>\r\n                                                            <option value=\"1955\" >1955<\/option>\r\n                                                            <option value=\"1954\" >1954<\/option>\r\n                                                            <option value=\"1953\" >1953<\/option>\r\n                                                            <option value=\"1952\" >1952<\/option>\r\n                                                            <option value=\"1951\" >1951<\/option>\r\n                                                            <option value=\"1950\" >1950<\/option>\r\n                                                            <option value=\"1949\" >1949<\/option>\r\n                                                            <option value=\"1948\" >1948<\/option>\r\n                                                            <option value=\"1947\" >1947<\/option>\r\n                                                            <option value=\"1946\" >1946<\/option>\r\n                                                            <option value=\"1945\" >1945<\/option>\r\n                                                            <option value=\"1944\" >1944<\/option>\r\n                                                            <option value=\"1943\" >1943<\/option>\r\n                                                            <option value=\"1942\" >1942<\/option>\r\n                                                            <option value=\"1941\" >1941<\/option>\r\n                                                            <option value=\"1940\" >1940<\/option>\r\n                                                            <option value=\"1939\" >1939<\/option>\r\n                                                            <option value=\"1938\" >1938<\/option>\r\n                                                            <option value=\"1937\" >1937<\/option>\r\n                                                            <option value=\"1936\" >1936<\/option>\r\n                                                            <option value=\"1935\" >1935<\/option>\r\n                                                            <option value=\"1934\" >1934<\/option>\r\n                                                            <option value=\"1933\" >1933<\/option>\r\n                                                            <option value=\"1932\" >1932<\/option>\r\n                                                            <option value=\"1931\" >1931<\/option>\r\n                                                            <option value=\"1930\" >1930<\/option>\r\n                                                            <option value=\"1929\" >1929<\/option>\r\n                                                            <option value=\"1928\" >1928<\/option>\r\n                                                            <option value=\"1927\" >1927<\/option>\r\n                                                            <option value=\"1926\" >1926<\/option>\r\n                                                            <option value=\"1925\" >1925<\/option>\r\n                                                            <option value=\"1924\" >1924<\/option>\r\n                                                            <option value=\"1923\" >1923<\/option>\r\n                                                            <option value=\"1922\" >1922<\/option>\r\n                                                            <option value=\"1921\" >1921<\/option>\r\n                                                            <option value=\"1920\" >1920<\/option>\r\n                                                            <option value=\"1919\" >1919<\/option>\r\n                                                            <option value=\"1918\" >1918<\/option>\r\n                                                            <option value=\"1917\" >1917<\/option>\r\n                                                            <option value=\"1916\" >1916<\/option>\r\n                                                            <option value=\"1915\" >1915<\/option>\r\n                                                            <option value=\"1914\" >1914<\/option>\r\n                                                            <option value=\"1913\" >1913<\/option>\r\n                                                            <option value=\"1912\" >1912<\/option>\r\n                                                            <option value=\"1911\" >1911<\/option>\r\n                                                            <option value=\"1910\" >1910<\/option>\r\n                                                            <option value=\"1909\" >1909<\/option>\r\n                                                            <option value=\"1908\" >1908<\/option>\r\n                                                            <option value=\"1907\" >1907<\/option>\r\n                                                            <option value=\"1906\" >1906<\/option>\r\n                                                            <option value=\"1905\" >1905<\/option>\r\n                                                            <option value=\"1904\" >1904<\/option>\r\n                                                            <option value=\"1903\" >1903<\/option>\r\n                                                            <option value=\"1902\" >1902<\/option>\r\n                                                            <option value=\"1901\" >1901<\/option>\r\n                                                            <option value=\"1900\" >1900<\/option>\r\n                                                                        <\/select>\r\n                <\/div>\r\n                                    <input type=\"hidden\" class=\"iphorm-datepicker\" name=\"iphorm_datepicker_iphorm_2_3_69d9cbf7de578\" value=\"\" \/>\r\n                    <div class=\"iphorm-datepicker-icon\"><\/div>\r\n                    <script type=\"text\/javascript\">\r\n                    jQuery(document).ready(function ($) {\r\n                        iPhorm.instance.addDatepicker('iphorm_2_3_69d9cbf7de578', {\r\n                            minDate: new Date(1900, 1 - 1, 1),\r\n                            maxDate: new Date(2030, 12 - 1, 31)\r\n                        });\r\n                    });\r\n                    <\/script>\r\n                            <\/div>\r\n                    <\/div>\r\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\r\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-radio iphorm_2_60-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-radio iphorm_2_60-element-spacer\">\n        <label class=\"iphorm_2_60-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Ben je 16 jaar of ouder?<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-radio iphorm_2_60-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-radio-ul iphorm_2_60-input-radio-ul iphorm-options-block iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_60-input-li\" >\n                    <label for=\"iphorm_2_60_69d9cbf7de578_1\"  class=\"iphorm_2_60_1_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_60 iphorm_2_60_1\" type=\"radio\" name=\"iphorm_2_60\" id=\"iphorm_2_60_69d9cbf7de578_1\" value=\"Ja\"  \/>\n                        Ja                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_60-input-li\" >\n                    <label for=\"iphorm_2_60_69d9cbf7de578_2\"  class=\"iphorm_2_60_2_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_60 iphorm_2_60_2\" type=\"radio\" name=\"iphorm_2_60\" id=\"iphorm_2_60_69d9cbf7de578_2\" value=\"Nee\"  \/>\n                        Nee                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_54-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_54-element-spacer\">\n        <label for=\"iphorm_2_54_69d9cbf7de578\" class=\"iphorm_2_54-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Naam ouder die gaat ondertekenen<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_54-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_54\" id=\"iphorm_2_54_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_54\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_12-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_12-element-spacer\">\n        <label for=\"iphorm_2_12_69d9cbf7de578\" class=\"iphorm_2_12-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>E-mailadres Ouder<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_12-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_12\" id=\"iphorm_2_12_69d9cbf7de578\" type=\"email\" name=\"iphorm_2_12\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_4-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_4-element-spacer\">\n        <label for=\"iphorm_2_4_69d9cbf7de578\" class=\"iphorm_2_4-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Klascode<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_4-input-wrap\" >\n            <input class=\"iphorm-element-text iphorm-tooltip iphorm-tooltip-hover iphorm_2_4\" id=\"iphorm_2_4_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_4\" title=\"bv. 2PLT14B of 14DV13B\" value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-radio iphorm_2_57-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-radio iphorm_2_57-element-spacer\">\n        <label class=\"iphorm_2_57-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Type student<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-radio iphorm_2_57-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-radio-ul iphorm_2_57-input-radio-ul iphorm-options-inline iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_57-input-li\" >\n                    <label for=\"iphorm_2_57_69d9cbf7de578_1\"  class=\"iphorm_2_57_1_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_57 iphorm_2_57_1\" type=\"radio\" name=\"iphorm_2_57\" id=\"iphorm_2_57_69d9cbf7de578_1\" value=\"BOL\"  \/>\n                        BOL                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_57-input-li\" >\n                    <label for=\"iphorm_2_57_69d9cbf7de578_2\"  class=\"iphorm_2_57_2_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_57 iphorm_2_57_2\" type=\"radio\" name=\"iphorm_2_57\" id=\"iphorm_2_57_69d9cbf7de578_2\" value=\"BBL\"  \/>\n                        BBL                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-radio iphorm_2_58-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-radio iphorm_2_58-element-spacer\">\n        <label class=\"iphorm_2_58-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Arbeidscontract<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-radio iphorm_2_58-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-radio-ul iphorm_2_58-input-radio-ul iphorm-options-inline iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_58-input-li\" >\n                    <label for=\"iphorm_2_58_69d9cbf7de578_1\"  class=\"iphorm_2_58_1_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_58 iphorm_2_58_1\" type=\"radio\" name=\"iphorm_2_58\" id=\"iphorm_2_58_69d9cbf7de578_1\" value=\"Ja\"  \/>\n                        Ja                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_58-input-li\" >\n                    <label for=\"iphorm_2_58_69d9cbf7de578_2\"  class=\"iphorm_2_58_2_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_58 iphorm_2_58_2\" type=\"radio\" name=\"iphorm_2_58\" id=\"iphorm_2_58_69d9cbf7de578_2\" value=\"Nee\"  \/>\n                        Nee                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_2_30-group-wrap iphorm-clearfix iphorm-labels-left iphorm-group-style-plain iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='background-color: rgb(255, 255, 255);color: rgb(242, 140, 49);'>GEGEVENS LEERBEDRIJF\/PRAKTIJKOPLEIDER<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_5-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_5-element-spacer\">\n        <label for=\"iphorm_2_5_69d9cbf7de578\" class=\"iphorm_2_5-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Naam leerbedrijf<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_5-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_5\" id=\"iphorm_2_5_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_5\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_47-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_47-element-spacer\">\n        <label for=\"iphorm_2_47_69d9cbf7de578\" class=\"iphorm_2_47-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Adres<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_47-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_47\" id=\"iphorm_2_47_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_47\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_28-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_28-element-spacer\">\n        <label for=\"iphorm_2_28_69d9cbf7de578\" class=\"iphorm_2_28-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Huisnummer<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_28-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_28\" id=\"iphorm_2_28_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_28\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_27-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_27-element-spacer\">\n        <label for=\"iphorm_2_27_69d9cbf7de578\" class=\"iphorm_2_27-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Postcode<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_27-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_27\" id=\"iphorm_2_27_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_27\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_51-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_51-element-spacer\">\n        <label for=\"iphorm_2_51_69d9cbf7de578\" class=\"iphorm_2_51-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Plaats<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_51-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_51\" id=\"iphorm_2_51_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_51\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_29-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_29-element-spacer\">\n        <label for=\"iphorm_2_29_69d9cbf7de578\" class=\"iphorm_2_29-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Land<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_29-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_29\" id=\"iphorm_2_29_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_29\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-radio iphorm_2_35-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-radio iphorm_2_35-element-spacer\">\n        <label class=\"iphorm_2_35-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Verschilt het postadres van het bezoekadres? <span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-radio iphorm_2_35-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-radio-ul iphorm_2_35-input-radio-ul iphorm-options-inline iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_35-input-li\" >\n                    <label for=\"iphorm_2_35_69d9cbf7de578_1\"  class=\"iphorm_2_35_1_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_35 iphorm_2_35_1\" type=\"radio\" name=\"iphorm_2_35\" id=\"iphorm_2_35_69d9cbf7de578_1\" value=\"Ja\"  \/>\n                        Ja                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_2_35-input-li\" >\n                    <label for=\"iphorm_2_35_69d9cbf7de578_2\"  class=\"iphorm_2_35_2_label\">\n                        <input class=\"iphorm-element-radio iphorm_2_35 iphorm_2_35_2\" type=\"radio\" name=\"iphorm_2_35\" id=\"iphorm_2_35_69d9cbf7de578_2\" value=\"Nee\"  \/>\n                        Nee                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_48-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_48-element-spacer\">\n        <label for=\"iphorm_2_48_69d9cbf7de578\" class=\"iphorm_2_48-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Postadres adres<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_48-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_48\" id=\"iphorm_2_48_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_48\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_37-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_37-element-spacer\">\n        <label for=\"iphorm_2_37_69d9cbf7de578\" class=\"iphorm_2_37-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Postadres Huisnummer<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_37-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_37\" id=\"iphorm_2_37_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_37\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_36-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_36-element-spacer\">\n        <label for=\"iphorm_2_36_69d9cbf7de578\" class=\"iphorm_2_36-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Postadres postcode<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_36-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_36\" id=\"iphorm_2_36_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_36\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_52-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_52-element-spacer\">\n        <label for=\"iphorm_2_52_69d9cbf7de578\" class=\"iphorm_2_52-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Postadres plaats<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_52-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_52\" id=\"iphorm_2_52_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_52\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_2_44-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_2_44-element-spacer\">\n        <label for=\"iphorm_2_44_69d9cbf7de578\" class=\"iphorm_2_44-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Aanhef praktijkopleider<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_2_44-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_2_44\" name=\"iphorm_2_44\" id=\"iphorm_2_44_69d9cbf7de578\"  style='font-family: tahoma;font-size: small;text-transform: normal;'>\n                                    <option value=\"Dhr.\" >Dhr.<\/option>\n                                    <option value=\"Mevr.\" >Mevr.<\/option>\n                            <\/select>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_61-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_61-element-spacer\">\n        <label for=\"iphorm_2_61_69d9cbf7de578\" class=\"iphorm_2_61-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Naam praktijkopleider<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_61-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_61\" id=\"iphorm_2_61_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_61\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_46-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_46-element-spacer\">\n        <label for=\"iphorm_2_46_69d9cbf7de578\" class=\"iphorm_2_46-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>E-mail praktijkopleider<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_46-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_46\" id=\"iphorm_2_46_69d9cbf7de578\" type=\"email\" name=\"iphorm_2_46\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_10-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_10-element-spacer\">\n        <label for=\"iphorm_2_10_69d9cbf7de578\" class=\"iphorm_2_10-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Telefoon praktijkopleider<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_10-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_10\" id=\"iphorm_2_10_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_10\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_62-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_62-element-spacer\">\n        <label for=\"iphorm_2_62_69d9cbf7de578\" class=\"iphorm_2_62-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Naam contactpersoon<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_62-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_62\" id=\"iphorm_2_62_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_62\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_45-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_45-element-spacer\">\n        <label for=\"iphorm_2_45_69d9cbf7de578\" class=\"iphorm_2_45-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>E-mailadres contactpersoon<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_45-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_45\" id=\"iphorm_2_45_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_45\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><input type=\"hidden\" class=\"iphorm_2_19\" name=\"iphorm_2_19\" value=\"\" \/><input type=\"hidden\" class=\"iphorm_2_20\" name=\"iphorm_2_20\" value=\"\" \/><input type=\"hidden\" class=\"iphorm_2_21\" name=\"iphorm_2_21\" value=\"\" \/><input type=\"hidden\" class=\"iphorm_2_22\" name=\"iphorm_2_22\" value=\"\" \/><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_11-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_11-element-spacer\">\n        <label for=\"iphorm_2_11_69d9cbf7de578\" class=\"iphorm_2_11-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Leerbedrijf ID (zie stagemarkt)<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_11-input-wrap\" >\n            <input class=\"iphorm-element-text iphorm-tooltip iphorm-tooltip-hover iphorm_2_11\" id=\"iphorm_2_11_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_11\" title=\"Te vinden op stagemarkt.nl onder contactgegevens leerbedrijf\" value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-date iphorm_2_24-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-date iphorm_2_24-element-spacer\">\r\n        <label id=\"iphorm_2_24_69d9cbf7de578_date_label\" class=\"iphorm_2_24-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Startdatum bpv-periode<\/label>        <div id=\"iphorm_2_24_69d9cbf7de578\" class=\"iphorm-input-wrap iphorm-input-wrap-date iphorm_2_24-input-wrap\" >\r\n        \t<div class=\"iphorm-clearfix\">\r\n                <div class=\"iphorm-input-wrap-date-select-wrap\">\r\n                                                                                <label id=\"iphorm_2_24_69d9cbf7de578_day_label\" class=\"iphorm-screen-reader-text\">Dag<\/label>\r\n                    <select id=\"iphorm_2_24_69d9cbf7de578_day\" name=\"iphorm_2_24[day]\" class=\"iphorm_2_24-input-day\" aria-labelledby=\"iphorm_2_24_69d9cbf7de578_date_label iphorm_2_24_69d9cbf7de578_day_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Dag<\/option>                                                    <option value=\"1\"  selected='selected'>1<\/option>\r\n                                                    <option value=\"2\" >2<\/option>\r\n                                                    <option value=\"3\" >3<\/option>\r\n                                                    <option value=\"4\" >4<\/option>\r\n                                                    <option value=\"5\" >5<\/option>\r\n                                                    <option value=\"6\" >6<\/option>\r\n                                                    <option value=\"7\" >7<\/option>\r\n                                                    <option value=\"8\" >8<\/option>\r\n                                                    <option value=\"9\" >9<\/option>\r\n                                                    <option value=\"10\" >10<\/option>\r\n                                                    <option value=\"11\" >11<\/option>\r\n                                                    <option value=\"12\" >12<\/option>\r\n                                                    <option value=\"13\" >13<\/option>\r\n                                                    <option value=\"14\" >14<\/option>\r\n                                                    <option value=\"15\" >15<\/option>\r\n                                                    <option value=\"16\" >16<\/option>\r\n                                                    <option value=\"17\" >17<\/option>\r\n                                                    <option value=\"18\" >18<\/option>\r\n                                                    <option value=\"19\" >19<\/option>\r\n                                                    <option value=\"20\" >20<\/option>\r\n                                                    <option value=\"21\" >21<\/option>\r\n                                                    <option value=\"22\" >22<\/option>\r\n                                                    <option value=\"23\" >23<\/option>\r\n                                                    <option value=\"24\" >24<\/option>\r\n                                                    <option value=\"25\" >25<\/option>\r\n                                                    <option value=\"26\" >26<\/option>\r\n                                                    <option value=\"27\" >27<\/option>\r\n                                                    <option value=\"28\" >28<\/option>\r\n                                                    <option value=\"29\" >29<\/option>\r\n                                                    <option value=\"30\" >30<\/option>\r\n                                                    <option value=\"31\" >31<\/option>\r\n                                            <\/select>\r\n                                        <label id=\"iphorm_2_24_69d9cbf7de578_month_label\" class=\"iphorm-screen-reader-text\">Maand<\/label>\r\n                    <select id=\"iphorm_2_24_69d9cbf7de578_month\" name=\"iphorm_2_24[month]\" class=\"iphorm_2_24-input-month\" aria-labelledby=\"iphorm_2_24_69d9cbf7de578_date_label iphorm_2_24_69d9cbf7de578_month_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Maand<\/option>                                                    <option value=\"1\" >Januari<\/option>\r\n                                                    <option value=\"2\" >Februari<\/option>\r\n                                                    <option value=\"3\" >Maart<\/option>\r\n                                                    <option value=\"4\" >April<\/option>\r\n                                                    <option value=\"5\" >Mei<\/option>\r\n                                                    <option value=\"6\" >Juni<\/option>\r\n                                                    <option value=\"7\" >Juli<\/option>\r\n                                                    <option value=\"8\" >Augustus<\/option>\r\n                                                    <option value=\"9\"  selected='selected'>September<\/option>\r\n                                                    <option value=\"10\" >Oktober<\/option>\r\n                                                    <option value=\"11\" >November<\/option>\r\n                                                    <option value=\"12\" >December<\/option>\r\n                                            <\/select>\r\n                                        <label id=\"iphorm_2_24_69d9cbf7de578_year_label\" class=\"iphorm-screen-reader-text\">Jaar<\/label>\r\n                    <select id=\"iphorm_2_24_69d9cbf7de578_year\" name=\"iphorm_2_24[year]\" class=\"iphorm_2_24-input-year\" aria-labelledby=\"iphorm_2_24_69d9cbf7de578_date_label iphorm_2_24_69d9cbf7de578_year_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Jaar<\/option>                                                                                    <option value=\"2030\" >2030<\/option>\r\n                                                            <option value=\"2029\" >2029<\/option>\r\n                                                            <option value=\"2028\" >2028<\/option>\r\n                                                            <option value=\"2027\" >2027<\/option>\r\n                                                            <option value=\"2026\"  selected='selected'>2026<\/option>\r\n                                                            <option value=\"2025\" >2025<\/option>\r\n                                                            <option value=\"2024\" >2024<\/option>\r\n                                                            <option value=\"2023\" >2023<\/option>\r\n                                                            <option value=\"2022\" >2022<\/option>\r\n                                                            <option value=\"2021\" >2021<\/option>\r\n                                                            <option value=\"2020\" >2020<\/option>\r\n                                                            <option value=\"2019\" >2019<\/option>\r\n                                                            <option value=\"2018\" >2018<\/option>\r\n                                                            <option value=\"2017\" >2017<\/option>\r\n                                                            <option value=\"2016\" >2016<\/option>\r\n                                                            <option value=\"2015\" >2015<\/option>\r\n                                                            <option value=\"2014\" >2014<\/option>\r\n                                                            <option value=\"2013\" >2013<\/option>\r\n                                                            <option value=\"2012\" >2012<\/option>\r\n                                                            <option value=\"2011\" >2011<\/option>\r\n                                                            <option value=\"2010\" >2010<\/option>\r\n                                                            <option value=\"2009\" >2009<\/option>\r\n                                                            <option value=\"2008\" >2008<\/option>\r\n                                                            <option value=\"2007\" >2007<\/option>\r\n                                                            <option value=\"2006\" >2006<\/option>\r\n                                                            <option value=\"2005\" >2005<\/option>\r\n                                                            <option value=\"2004\" >2004<\/option>\r\n                                                            <option value=\"2003\" >2003<\/option>\r\n                                                            <option value=\"2002\" >2002<\/option>\r\n                                                            <option value=\"2001\" >2001<\/option>\r\n                                                            <option value=\"2000\" >2000<\/option>\r\n                                                            <option value=\"1999\" >1999<\/option>\r\n                                                            <option value=\"1998\" >1998<\/option>\r\n                                                            <option value=\"1997\" >1997<\/option>\r\n                                                            <option value=\"1996\" >1996<\/option>\r\n                                                            <option value=\"1995\" >1995<\/option>\r\n                                                            <option value=\"1994\" >1994<\/option>\r\n                                                            <option value=\"1993\" >1993<\/option>\r\n                                                            <option value=\"1992\" >1992<\/option>\r\n                                                            <option value=\"1991\" >1991<\/option>\r\n                                                            <option value=\"1990\" >1990<\/option>\r\n                                                            <option value=\"1989\" >1989<\/option>\r\n                                                            <option value=\"1988\" >1988<\/option>\r\n                                                            <option value=\"1987\" >1987<\/option>\r\n                                                            <option value=\"1986\" >1986<\/option>\r\n                                                            <option value=\"1985\" >1985<\/option>\r\n                                                            <option value=\"1984\" >1984<\/option>\r\n                                                            <option value=\"1983\" >1983<\/option>\r\n                                                            <option value=\"1982\" >1982<\/option>\r\n                                                            <option value=\"1981\" >1981<\/option>\r\n                                                            <option value=\"1980\" >1980<\/option>\r\n                                                            <option value=\"1979\" >1979<\/option>\r\n                                                            <option value=\"1978\" >1978<\/option>\r\n                                                            <option value=\"1977\" >1977<\/option>\r\n                                                            <option value=\"1976\" >1976<\/option>\r\n                                                            <option value=\"1975\" >1975<\/option>\r\n                                                            <option value=\"1974\" >1974<\/option>\r\n                                                            <option value=\"1973\" >1973<\/option>\r\n                                                            <option value=\"1972\" >1972<\/option>\r\n                                                            <option value=\"1971\" >1971<\/option>\r\n                                                            <option value=\"1970\" >1970<\/option>\r\n                                                            <option value=\"1969\" >1969<\/option>\r\n                                                            <option value=\"1968\" >1968<\/option>\r\n                                                            <option value=\"1967\" >1967<\/option>\r\n                                                            <option value=\"1966\" >1966<\/option>\r\n                                                            <option value=\"1965\" >1965<\/option>\r\n                                                            <option value=\"1964\" >1964<\/option>\r\n                                                            <option value=\"1963\" >1963<\/option>\r\n                                                            <option value=\"1962\" >1962<\/option>\r\n                                                            <option value=\"1961\" >1961<\/option>\r\n                                                            <option value=\"1960\" >1960<\/option>\r\n                                                            <option value=\"1959\" >1959<\/option>\r\n                                                            <option value=\"1958\" >1958<\/option>\r\n                                                            <option value=\"1957\" >1957<\/option>\r\n                                                            <option value=\"1956\" >1956<\/option>\r\n                                                            <option value=\"1955\" >1955<\/option>\r\n                                                            <option value=\"1954\" >1954<\/option>\r\n                                                            <option value=\"1953\" >1953<\/option>\r\n                                                            <option value=\"1952\" >1952<\/option>\r\n                                                            <option value=\"1951\" >1951<\/option>\r\n                                                            <option value=\"1950\" >1950<\/option>\r\n                                                            <option value=\"1949\" >1949<\/option>\r\n                                                            <option value=\"1948\" >1948<\/option>\r\n                                                            <option value=\"1947\" >1947<\/option>\r\n                                                            <option value=\"1946\" >1946<\/option>\r\n                                                            <option value=\"1945\" >1945<\/option>\r\n                                                            <option value=\"1944\" >1944<\/option>\r\n                                                            <option value=\"1943\" >1943<\/option>\r\n                                                            <option value=\"1942\" >1942<\/option>\r\n                                                            <option value=\"1941\" >1941<\/option>\r\n                                                            <option value=\"1940\" >1940<\/option>\r\n                                                            <option value=\"1939\" >1939<\/option>\r\n                                                            <option value=\"1938\" >1938<\/option>\r\n                                                            <option value=\"1937\" >1937<\/option>\r\n                                                            <option value=\"1936\" >1936<\/option>\r\n                                                            <option value=\"1935\" >1935<\/option>\r\n                                                            <option value=\"1934\" >1934<\/option>\r\n                                                            <option value=\"1933\" >1933<\/option>\r\n                                                            <option value=\"1932\" >1932<\/option>\r\n                                                            <option value=\"1931\" >1931<\/option>\r\n                                                            <option value=\"1930\" >1930<\/option>\r\n                                                            <option value=\"1929\" >1929<\/option>\r\n                                                            <option value=\"1928\" >1928<\/option>\r\n                                                            <option value=\"1927\" >1927<\/option>\r\n                                                            <option value=\"1926\" >1926<\/option>\r\n                                                            <option value=\"1925\" >1925<\/option>\r\n                                                            <option value=\"1924\" >1924<\/option>\r\n                                                            <option value=\"1923\" >1923<\/option>\r\n                                                            <option value=\"1922\" >1922<\/option>\r\n                                                            <option value=\"1921\" >1921<\/option>\r\n                                                            <option value=\"1920\" >1920<\/option>\r\n                                                            <option value=\"1919\" >1919<\/option>\r\n                                                            <option value=\"1918\" >1918<\/option>\r\n                                                            <option value=\"1917\" >1917<\/option>\r\n                                                            <option value=\"1916\" >1916<\/option>\r\n                                                            <option value=\"1915\" >1915<\/option>\r\n                                                            <option value=\"1914\" >1914<\/option>\r\n                                                            <option value=\"1913\" >1913<\/option>\r\n                                                            <option value=\"1912\" >1912<\/option>\r\n                                                            <option value=\"1911\" >1911<\/option>\r\n                                                            <option value=\"1910\" >1910<\/option>\r\n                                                            <option value=\"1909\" >1909<\/option>\r\n                                                            <option value=\"1908\" >1908<\/option>\r\n                                                            <option value=\"1907\" >1907<\/option>\r\n                                                            <option value=\"1906\" >1906<\/option>\r\n                                                            <option value=\"1905\" >1905<\/option>\r\n                                                            <option value=\"1904\" >1904<\/option>\r\n                                                            <option value=\"1903\" >1903<\/option>\r\n                                                            <option value=\"1902\" >1902<\/option>\r\n                                                            <option value=\"1901\" >1901<\/option>\r\n                                                            <option value=\"1900\" >1900<\/option>\r\n                                                                        <\/select>\r\n                <\/div>\r\n                                    <input type=\"hidden\" class=\"iphorm-datepicker\" name=\"iphorm_datepicker_iphorm_2_24_69d9cbf7de578\" value=\"\" \/>\r\n                    <div class=\"iphorm-datepicker-icon\"><\/div>\r\n                    <script type=\"text\/javascript\">\r\n                    jQuery(document).ready(function ($) {\r\n                        iPhorm.instance.addDatepicker('iphorm_2_24_69d9cbf7de578', {\r\n                            minDate: new Date(1900, 1 - 1, 1),\r\n                            maxDate: new Date(2030, 12 - 1, 31)\r\n                        });\r\n                    });\r\n                    <\/script>\r\n                            <\/div>\r\n                    <\/div>\r\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\r\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-date iphorm_2_25-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-date iphorm_2_25-element-spacer\">\r\n        <label id=\"iphorm_2_25_69d9cbf7de578_date_label\" class=\"iphorm_2_25-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Einddatum bpv-periode<\/label>        <div id=\"iphorm_2_25_69d9cbf7de578\" class=\"iphorm-input-wrap iphorm-input-wrap-date iphorm_2_25-input-wrap\" >\r\n        \t<div class=\"iphorm-clearfix\">\r\n                <div class=\"iphorm-input-wrap-date-select-wrap\">\r\n                                                                                <label id=\"iphorm_2_25_69d9cbf7de578_day_label\" class=\"iphorm-screen-reader-text\">Dag<\/label>\r\n                    <select id=\"iphorm_2_25_69d9cbf7de578_day\" name=\"iphorm_2_25[day]\" class=\"iphorm_2_25-input-day\" aria-labelledby=\"iphorm_2_25_69d9cbf7de578_date_label iphorm_2_25_69d9cbf7de578_day_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Dag<\/option>                                                    <option value=\"1\"  selected='selected'>1<\/option>\r\n                                                    <option value=\"2\" >2<\/option>\r\n                                                    <option value=\"3\" >3<\/option>\r\n                                                    <option value=\"4\" >4<\/option>\r\n                                                    <option value=\"5\" >5<\/option>\r\n                                                    <option value=\"6\" >6<\/option>\r\n                                                    <option value=\"7\" >7<\/option>\r\n                                                    <option value=\"8\" >8<\/option>\r\n                                                    <option value=\"9\" >9<\/option>\r\n                                                    <option value=\"10\" >10<\/option>\r\n                                                    <option value=\"11\" >11<\/option>\r\n                                                    <option value=\"12\" >12<\/option>\r\n                                                    <option value=\"13\" >13<\/option>\r\n                                                    <option value=\"14\" >14<\/option>\r\n                                                    <option value=\"15\" >15<\/option>\r\n                                                    <option value=\"16\" >16<\/option>\r\n                                                    <option value=\"17\" >17<\/option>\r\n                                                    <option value=\"18\" >18<\/option>\r\n                                                    <option value=\"19\" >19<\/option>\r\n                                                    <option value=\"20\" >20<\/option>\r\n                                                    <option value=\"21\" >21<\/option>\r\n                                                    <option value=\"22\" >22<\/option>\r\n                                                    <option value=\"23\" >23<\/option>\r\n                                                    <option value=\"24\" >24<\/option>\r\n                                                    <option value=\"25\" >25<\/option>\r\n                                                    <option value=\"26\" >26<\/option>\r\n                                                    <option value=\"27\" >27<\/option>\r\n                                                    <option value=\"28\" >28<\/option>\r\n                                                    <option value=\"29\" >29<\/option>\r\n                                                    <option value=\"30\" >30<\/option>\r\n                                                    <option value=\"31\" >31<\/option>\r\n                                            <\/select>\r\n                                        <label id=\"iphorm_2_25_69d9cbf7de578_month_label\" class=\"iphorm-screen-reader-text\">Maand<\/label>\r\n                    <select id=\"iphorm_2_25_69d9cbf7de578_month\" name=\"iphorm_2_25[month]\" class=\"iphorm_2_25-input-month\" aria-labelledby=\"iphorm_2_25_69d9cbf7de578_date_label iphorm_2_25_69d9cbf7de578_month_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Maand<\/option>                                                    <option value=\"1\" >Januari<\/option>\r\n                                                    <option value=\"2\" >Februari<\/option>\r\n                                                    <option value=\"3\" >Maart<\/option>\r\n                                                    <option value=\"4\" >April<\/option>\r\n                                                    <option value=\"5\" >Mei<\/option>\r\n                                                    <option value=\"6\" >Juni<\/option>\r\n                                                    <option value=\"7\" >Juli<\/option>\r\n                                                    <option value=\"8\" >Augustus<\/option>\r\n                                                    <option value=\"9\"  selected='selected'>September<\/option>\r\n                                                    <option value=\"10\" >Oktober<\/option>\r\n                                                    <option value=\"11\" >November<\/option>\r\n                                                    <option value=\"12\" >December<\/option>\r\n                                            <\/select>\r\n                                        <label id=\"iphorm_2_25_69d9cbf7de578_year_label\" class=\"iphorm-screen-reader-text\">Jaar<\/label>\r\n                    <select id=\"iphorm_2_25_69d9cbf7de578_year\" name=\"iphorm_2_25[year]\" class=\"iphorm_2_25-input-year\" aria-labelledby=\"iphorm_2_25_69d9cbf7de578_date_label iphorm_2_25_69d9cbf7de578_year_label\" style='font-family: tahoma;font-size: small;text-transform: uppercase;'>\r\n                        <option value=\"\">Jaar<\/option>                                                                                    <option value=\"2030\" >2030<\/option>\r\n                                                            <option value=\"2029\" >2029<\/option>\r\n                                                            <option value=\"2028\" >2028<\/option>\r\n                                                            <option value=\"2027\" >2027<\/option>\r\n                                                            <option value=\"2026\"  selected='selected'>2026<\/option>\r\n                                                            <option value=\"2025\" >2025<\/option>\r\n                                                            <option value=\"2024\" >2024<\/option>\r\n                                                            <option value=\"2023\" >2023<\/option>\r\n                                                            <option value=\"2022\" >2022<\/option>\r\n                                                            <option value=\"2021\" >2021<\/option>\r\n                                                            <option value=\"2020\" >2020<\/option>\r\n                                                            <option value=\"2019\" >2019<\/option>\r\n                                                            <option value=\"2018\" >2018<\/option>\r\n                                                            <option value=\"2017\" >2017<\/option>\r\n                                                            <option value=\"2016\" >2016<\/option>\r\n                                                            <option value=\"2015\" >2015<\/option>\r\n                                                            <option value=\"2014\" >2014<\/option>\r\n                                                            <option value=\"2013\" >2013<\/option>\r\n                                                            <option value=\"2012\" >2012<\/option>\r\n                                                            <option value=\"2011\" >2011<\/option>\r\n                                                            <option value=\"2010\" >2010<\/option>\r\n                                                            <option value=\"2009\" >2009<\/option>\r\n                                                            <option value=\"2008\" >2008<\/option>\r\n                                                            <option value=\"2007\" >2007<\/option>\r\n                                                            <option value=\"2006\" >2006<\/option>\r\n                                                            <option value=\"2005\" >2005<\/option>\r\n                                                            <option value=\"2004\" >2004<\/option>\r\n                                                            <option value=\"2003\" >2003<\/option>\r\n                                                            <option value=\"2002\" >2002<\/option>\r\n                                                            <option value=\"2001\" >2001<\/option>\r\n                                                            <option value=\"2000\" >2000<\/option>\r\n                                                            <option value=\"1999\" >1999<\/option>\r\n                                                            <option value=\"1998\" >1998<\/option>\r\n                                                            <option value=\"1997\" >1997<\/option>\r\n                                                            <option value=\"1996\" >1996<\/option>\r\n                                                            <option value=\"1995\" >1995<\/option>\r\n                                                            <option value=\"1994\" >1994<\/option>\r\n                                                            <option value=\"1993\" >1993<\/option>\r\n                                                            <option value=\"1992\" >1992<\/option>\r\n                                                            <option value=\"1991\" >1991<\/option>\r\n                                                            <option value=\"1990\" >1990<\/option>\r\n                                                            <option value=\"1989\" >1989<\/option>\r\n                                                            <option value=\"1988\" >1988<\/option>\r\n                                                            <option value=\"1987\" >1987<\/option>\r\n                                                            <option value=\"1986\" >1986<\/option>\r\n                                                            <option value=\"1985\" >1985<\/option>\r\n                                                            <option value=\"1984\" >1984<\/option>\r\n                                                            <option value=\"1983\" >1983<\/option>\r\n                                                            <option value=\"1982\" >1982<\/option>\r\n                                                            <option value=\"1981\" >1981<\/option>\r\n                                                            <option value=\"1980\" >1980<\/option>\r\n                                                            <option value=\"1979\" >1979<\/option>\r\n                                                            <option value=\"1978\" >1978<\/option>\r\n                                                            <option value=\"1977\" >1977<\/option>\r\n                                                            <option value=\"1976\" >1976<\/option>\r\n                                                            <option value=\"1975\" >1975<\/option>\r\n                                                            <option value=\"1974\" >1974<\/option>\r\n                                                            <option value=\"1973\" >1973<\/option>\r\n                                                            <option value=\"1972\" >1972<\/option>\r\n                                                            <option value=\"1971\" >1971<\/option>\r\n                                                            <option value=\"1970\" >1970<\/option>\r\n                                                            <option value=\"1969\" >1969<\/option>\r\n                                                            <option value=\"1968\" >1968<\/option>\r\n                                                            <option value=\"1967\" >1967<\/option>\r\n                                                            <option value=\"1966\" >1966<\/option>\r\n                                                            <option value=\"1965\" >1965<\/option>\r\n                                                            <option value=\"1964\" >1964<\/option>\r\n                                                            <option value=\"1963\" >1963<\/option>\r\n                                                            <option value=\"1962\" >1962<\/option>\r\n                                                            <option value=\"1961\" >1961<\/option>\r\n                                                            <option value=\"1960\" >1960<\/option>\r\n                                                            <option value=\"1959\" >1959<\/option>\r\n                                                            <option value=\"1958\" >1958<\/option>\r\n                                                            <option value=\"1957\" >1957<\/option>\r\n                                                            <option value=\"1956\" >1956<\/option>\r\n                                                            <option value=\"1955\" >1955<\/option>\r\n                                                            <option value=\"1954\" >1954<\/option>\r\n                                                            <option value=\"1953\" >1953<\/option>\r\n                                                            <option value=\"1952\" >1952<\/option>\r\n                                                            <option value=\"1951\" >1951<\/option>\r\n                                                            <option value=\"1950\" >1950<\/option>\r\n                                                            <option value=\"1949\" >1949<\/option>\r\n                                                            <option value=\"1948\" >1948<\/option>\r\n                                                            <option value=\"1947\" >1947<\/option>\r\n                                                            <option value=\"1946\" >1946<\/option>\r\n                                                            <option value=\"1945\" >1945<\/option>\r\n                                                            <option value=\"1944\" >1944<\/option>\r\n                                                            <option value=\"1943\" >1943<\/option>\r\n                                                            <option value=\"1942\" >1942<\/option>\r\n                                                            <option value=\"1941\" >1941<\/option>\r\n                                                            <option value=\"1940\" >1940<\/option>\r\n                                                            <option value=\"1939\" >1939<\/option>\r\n                                                            <option value=\"1938\" >1938<\/option>\r\n                                                            <option value=\"1937\" >1937<\/option>\r\n                                                            <option value=\"1936\" >1936<\/option>\r\n                                                            <option value=\"1935\" >1935<\/option>\r\n                                                            <option value=\"1934\" >1934<\/option>\r\n                                                            <option value=\"1933\" >1933<\/option>\r\n                                                            <option value=\"1932\" >1932<\/option>\r\n                                                            <option value=\"1931\" >1931<\/option>\r\n                                                            <option value=\"1930\" >1930<\/option>\r\n                                                            <option value=\"1929\" >1929<\/option>\r\n                                                            <option value=\"1928\" >1928<\/option>\r\n                                                            <option value=\"1927\" >1927<\/option>\r\n                                                            <option value=\"1926\" >1926<\/option>\r\n                                                            <option value=\"1925\" >1925<\/option>\r\n                                                            <option value=\"1924\" >1924<\/option>\r\n                                                            <option value=\"1923\" >1923<\/option>\r\n                                                            <option value=\"1922\" >1922<\/option>\r\n                                                            <option value=\"1921\" >1921<\/option>\r\n                                                            <option value=\"1920\" >1920<\/option>\r\n                                                            <option value=\"1919\" >1919<\/option>\r\n                                                            <option value=\"1918\" >1918<\/option>\r\n                                                            <option value=\"1917\" >1917<\/option>\r\n                                                            <option value=\"1916\" >1916<\/option>\r\n                                                            <option value=\"1915\" >1915<\/option>\r\n                                                            <option value=\"1914\" >1914<\/option>\r\n                                                            <option value=\"1913\" >1913<\/option>\r\n                                                            <option value=\"1912\" >1912<\/option>\r\n                                                            <option value=\"1911\" >1911<\/option>\r\n                                                            <option value=\"1910\" >1910<\/option>\r\n                                                            <option value=\"1909\" >1909<\/option>\r\n                                                            <option value=\"1908\" >1908<\/option>\r\n                                                            <option value=\"1907\" >1907<\/option>\r\n                                                            <option value=\"1906\" >1906<\/option>\r\n                                                            <option value=\"1905\" >1905<\/option>\r\n                                                            <option value=\"1904\" >1904<\/option>\r\n                                                            <option value=\"1903\" >1903<\/option>\r\n                                                            <option value=\"1902\" >1902<\/option>\r\n                                                            <option value=\"1901\" >1901<\/option>\r\n                                                            <option value=\"1900\" >1900<\/option>\r\n                                                                        <\/select>\r\n                <\/div>\r\n                                    <input type=\"hidden\" class=\"iphorm-datepicker\" name=\"iphorm_datepicker_iphorm_2_25_69d9cbf7de578\" value=\"\" \/>\r\n                    <div class=\"iphorm-datepicker-icon\"><\/div>\r\n                    <script type=\"text\/javascript\">\r\n                    jQuery(document).ready(function ($) {\r\n                        iPhorm.instance.addDatepicker('iphorm_2_25_69d9cbf7de578', {\r\n                            minDate: new Date(1900, 1 - 1, 1),\r\n                            maxDate: new Date(2030, 12 - 1, 31)\r\n                        });\r\n                    });\r\n                    <\/script>\r\n                            <\/div>\r\n                    <\/div>\r\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\r\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_2_39-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-optional\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_2_39-element-spacer\">\n        <label for=\"iphorm_2_39_69d9cbf7de578\" class=\"iphorm_2_39-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>bpv-omvang (uren)<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_2_39-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_2_39\" id=\"iphorm_2_39_69d9cbf7de578\" type=\"text\" name=\"iphorm_2_39\"  value=\"\" style='background-color: rgb(247, 247, 247);border: 1px solid rgb(0, 160, 96);color: rgb(0, 0, 0);font-family: tahoma;font-size: medium;text-transform: normal;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_2_26-element-wrap iphorm-clearfix iphorm-labels-left iphorm-element-required\" style='font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;'>\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_2_26-element-spacer\">\n        <label for=\"iphorm_2_26_69d9cbf7de578\" class=\"iphorm_2_26-outer-label\" style='color: rgb(0, 0, 0);font-family: tahoma;font-size: small;text-transform: uppercase;font-weight: 500;text-shadow: 1px 1px lightgrey;'>Bpv-begeleider (maak je keuze uit het dropdown menu)<span class=\"iphorm-required\">*<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_2_26-input-wrap\" style='font-size: 8px;text-transform: capitalize;'>\n            <select class=\"iphorm-element-select iphorm-tooltip iphorm-tooltip-hover iphorm_2_26\" name=\"iphorm_2_26\" id=\"iphorm_2_26_69d9cbf7de578\" title=\"Dit veld is verplicht\" style='font-family: tahoma;font-size: 15px;text-transform: capitalize;'>\n                                    <option value=\"Kies BPV-begeleider\" >Kies BPV-begeleider<\/option>\n                                    <option value=\"Arjen Schenk\" >Arjen Schenk<\/option>\n                                    <option value=\"Anita van Duin\" >Anita van Duin<\/option>\n                                    <option value=\"Anton Rentenaar\" >Anton Rentenaar<\/option>\n                                    <option value=\"Debbie Moons\" >Debbie Moons<\/option>\n                                    <option value=\"Desir\u00e9e de Bekker \" >Desir\u00e9e de Bekker <\/option>\n                                    <option value=\"Evert Jeurink\" >Evert Jeurink<\/option>\n                                    <option value=\"Fenna Herrema\" >Fenna Herrema<\/option>\n                                    <option value=\"Gerard Wanders\" >Gerard Wanders<\/option>\n                                    <option value=\"Hans Laan\" >Hans Laan<\/option>\n                                    <option value=\"Ilse van Hoff \" >Ilse van Hoff <\/option>\n                                    <option value=\"Ingeborg van Osch\" >Ingeborg van Osch<\/option>\n                                    <option value=\"Jeroen Bousma\" >Jeroen Bousma<\/option>\n                                    <option value=\"Joyce Roosdorp\" >Joyce Roosdorp<\/option>\n                                    <option value=\"Karin Bekema-Datema\" >Karin Bekema-Datema<\/option>\n                                    <option value=\"Leon Bakker\" >Leon Bakker<\/option>\n                                    <option value=\"Leontien van der Veen\" >Leontien van der Veen<\/option>\n                                    <option value=\"Marion Blaauboer \" >Marion Blaauboer <\/option>\n                                    <option value=\"Marinus Hovius\" >Marinus Hovius<\/option>\n                                    <option value=\"Marjan Haan\" >Marjan Haan<\/option>\n                                    <option value=\"Marjan van Tartwijk-Reefhuis \" >Marjan van Tartwijk-Reefhuis <\/option>\n                                    <option value=\"Marketa Wijnker\" >Marketa Wijnker<\/option>\n                                    <option value=\"Martijn Lansdaal\" >Martijn Lansdaal<\/option>\n                                    <option value=\"Martine Wijnants\" >Martine Wijnants<\/option>\n                                    <option value=\"Monica Bleijendaal\" >Monica Bleijendaal<\/option>\n                                    <option value=\"Monique Zonneveld\" >Monique Zonneveld<\/option>\n                                    <option value=\"Nikki Kop\" >Nikki Kop<\/option>\n                                    <option value=\"Patricia Veerkamp\" >Patricia Veerkamp<\/option>\n                                    <option value=\"Robert Kranenburg\" >Robert Kranenburg<\/option>\n                                    <option value=\"Wilma Boerdijk \" >Wilma Boerdijk <\/option>\n                            <\/select>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-hidden\">\n    <label>Dit veld moet leeg blijven<input type=\"text\" name=\"iphorm_2_0\" \/><\/label>\n<\/div>                <div class=\"iphorm-submit-wrap iphorm-submit-wrap-2 iphorm-clearfix\" >\n                    <div class=\"iphorm-submit-input-wrap iphorm-submit-input-wrap-2\" >\n                        <button class=\"iphorm-submit-element\" type=\"submit\" name=\"iphorm_submit\" style='font-weight: normal;margin-top: 15px;text-align: center;'><span ><em >VERZEND FORMULIER<\/em><\/span><\/button>\n                    <\/div>\n                    <div class=\"iphorm-loading-wrap\"><span class=\"iphorm-loading\">Een moment geduld aub.<\/span><\/div>\n                <\/div>\n            <\/div>\n                                            <\/div>\n            <\/form>\n    <script type=\"text\/javascript\">\n    jQuery('#iphorm-outer-69d9cbf7de578 script').remove();\n    <\/script>\n<\/div>\n<p><span style=\"color: #999999; font-size: 11px;\"><em>\u00a9 2026 \/ Dit formulier wordt ondersteund door <a style=\"color: #999999;\" href=\"http:\/\/www.modernemeesters.nl\" target=\"_blank\" rel=\"noopener noreferrer\">Moderne Meesters<\/a><\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00a9 2026 \/ Dit formulier wordt ondersteund door Moderne Meesters<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/pages\/4","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/comments?post=4"}],"version-history":[{"count":35,"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/pages\/4\/revisions"}],"predecessor-version":[{"id":200,"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/pages\/4\/revisions\/200"}],"wp:attachment":[{"href":"https:\/\/www.gegevensformulier.nl\/vonk\/wp-json\/wp\/v2\/media?parent=4"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}