Nieuwsbrief
Logo Antwerpen mailchimp :
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<form action="https://vlaamse-logos.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=4bc3477b58" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam <span class="asterisk">*</span>
</label>
<input type="text" value="" name="FNAME" class="required" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam <span class="asterisk">*</span>
</label>
<input type="text" value="" name="LNAME" class="required" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19481][1]" id="mce-group[19481]-19481-0"><label for="mce-group[19481]-19481-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19481][2]" id="mce-group[19481]-19481-1"><label for="mce-group[19481]-19481-1">in de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19481][4]" id="mce-group[19481]-19481-2"><label for="mce-group[19481]-19481-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19481][8]" id="mce-group[19481]-19481-3"><label for="mce-group[19481]-19481-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19481][16]" id="mce-group[19481]-19481-4"><label for="mce-group[19481]-19481-4">in de zorg</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
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Logo Kempen mailchimp:
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<div id="mc_embed_signup_scroll">
<h2>Subscribe</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE4">Functie </label>
<input type="text" value="" name="MMERGE4" class="" id="mce-MMERGE4">
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_757025f547" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
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<script type='text/javascript' src='//s3.amazonaws.com/downloads.mailchimp.com/js/mc-validate.js'></script><script type='text/javascript'>(function($) {window.fnames = new Array(); window.ftypes = new Array();fnames[1]='FNAME';ftypes[1]='text';fnames[2]='LNAME';ftypes[2]='text';fnames[0]='EMAIL';ftypes[0]='email';fnames[3]='ORG';ftypes[3]='text';fnames[4]='MMERGE4';ftypes[4]='text'; /*
* Translated default messages for the $ validation plugin.
* Locale: NL
*/
$.extend($.validator.messages, {
required: "Dit is een verplicht veld.",
remote: "Controleer dit veld.",
email: "Vul hier een geldig e-mailadres in.",
url: "Vul hier een geldige URL in.",
date: "Vul hier een geldige datum in.",
dateISO: "Vul hier een geldige datum in (ISO-formaat).",
number: "Vul hier een geldig getal in.",
digits: "Vul hier alleen getallen in.",
creditcard: "Vul hier een geldig creditcardnummer in.",
equalTo: "Vul hier dezelfde waarde in.",
accept: "Vul hier een waarde in met een geldige extensie.",
maxlength: $.validator.format("Vul hier maximaal {0} tekens in."),
minlength: $.validator.format("Vul hier minimaal {0} tekens in."),
rangelength: $.validator.format("Vul hier een waarde in van minimaal {0} en maximaal {1} tekens."),
range: $.validator.format("Vul hier een waarde in van minimaal {0} en maximaal {1}."),
max: $.validator.format("Vul hier een waarde in kleiner dan of gelijk aan {0}."),
min: $.validator.format("Vul hier een waarde in groter dan of gelijk aan {0}.")
});}(jQuery));var $mcj = jQuery.noConflict(true);</script>
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Logo Mechelen mailchimp:
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<form action="https://logomechelen.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=8246e83431" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Subscribe</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik werk in de eerstelijnszone </strong>
<ul><li><input type="checkbox" value="32" name="group[29234][32]" id="mce-group[29234]-29234-0"><label for="mce-group[29234]-29234-0">Aartselaar, Boom, Hemiksem, Niel, Rumst, Schelle</label></li>
<li><input type="checkbox" value="64" name="group[29234][64]" id="mce-group[29234]-29234-1"><label for="mce-group[29234]-29234-1">Berlaar, Duffel, Lier, Nijlen</label></li>
<li><input type="checkbox" value="128" name="group[29234][128]" id="mce-group[29234]-29234-2"><label for="mce-group[29234]-29234-2">Bonheiden, Heist-op-den-Berg, Putte</label></li>
<li><input type="checkbox" value="256" name="group[29234][256]" id="mce-group[29234]-29234-3"><label for="mce-group[29234]-29234-3">Bornem, Puurs-Sint-Amands, Willebroek</label></li>
<li><input type="checkbox" value="512" name="group[29234][512]" id="mce-group[29234]-29234-4"><label for="mce-group[29234]-29234-4">Mechelen, Sint-Katelijne-Waver</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Ik wil informatie ontvangen over gezondheid ... </strong>
<ul><li><input type="checkbox" value="1" name="group[19501][1]" id="mce-group[19501]-19501-0"><label for="mce-group[19501]-19501-0">in de zorg</label></li>
<li><input type="checkbox" value="2" name="group[19501][2]" id="mce-group[19501]-19501-1"><label for="mce-group[19501]-19501-1">op school</label></li>
<li><input type="checkbox" value="4" name="group[19501][4]" id="mce-group[19501]-19501-2"><label for="mce-group[19501]-19501-2">op het werk</label></li>
<li><input type="checkbox" value="8" name="group[19501][8]" id="mce-group[19501]-19501-3"><label for="mce-group[19501]-19501-3">in de gemeente</label></li>
<li><input type="checkbox" value="16" name="group[19501][16]" id="mce-group[19501]-19501-4"><label for="mce-group[19501]-19501-4">en milieu</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
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<div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
<script type='text/javascript' src='//s3.amazonaws.com/downloads.mailchimp.com/js/mc-validate.js'></script><script type='text/javascript'>(function($) {window.fnames = new Array(); window.ftypes = new Array();fnames[1]='FNAME';ftypes[1]='text';fnames[2]='LNAME';ftypes[2]='text';fnames[0]='EMAIL';ftypes[0]='email';fnames[3]='ORG';ftypes[3]='text'; /*
* Translated default messages for the $ validation plugin.
* Locale: NL
*/
$.extend($.validator.messages, {
required: "Dit is een verplicht veld.",
remote: "Controleer dit veld.",
email: "Vul hier een geldig e-mailadres in.",
url: "Vul hier een geldige URL in.",
date: "Vul hier een geldige datum in.",
dateISO: "Vul hier een geldige datum in (ISO-formaat).",
number: "Vul hier een geldig getal in.",
digits: "Vul hier alleen getallen in.",
creditcard: "Vul hier een geldig creditcardnummer in.",
equalTo: "Vul hier dezelfde waarde in.",
accept: "Vul hier een waarde in met een geldige extensie.",
maxlength: $.validator.format("Vul hier maximaal {0} tekens in."),
minlength: $.validator.format("Vul hier minimaal {0} tekens in."),
rangelength: $.validator.format("Vul hier een waarde in van minimaal {0} en maximaal {1} tekens."),
range: $.validator.format("Vul hier een waarde in van minimaal {0} en maximaal {1}."),
max: $.validator.format("Vul hier een waarde in kleiner dan of gelijk aan {0}."),
min: $.validator.format("Vul hier een waarde in groter dan of gelijk aan {0}.")
});}(jQuery));var $mcj = jQuery.noConflict(true);</script>
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Logo Limburg mailchimp:
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<form action="https://logolimburg.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=7132dbda5c" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE4">Functie </label>
<input type="text" value="" name="MMERGE4" class="" id="mce-MMERGE4">
</div>
<div class="mc-field-group input-group">
<strong>Nieuwsbrief Logo Limburg </strong>
<ul><li><input type="radio" value="32" name="group[23613]" id="mce-group[23613]-23613-0"><label for="mce-group[23613]-23613-0">Algemene nieuwsbrief (tweewekelijks)</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Speciale edities (4-5x/jaar) </strong>
<ul><li><input type="checkbox" value="1" name="group[23617][1]" id="mce-group[23617]-23617-0"><label for="mce-group[23617]-23617-0">Gezonde Gemeente</label></li>
<li><input type="checkbox" value="2" name="group[23617][2]" id="mce-group[23617]-23617-1"><label for="mce-group[23617]-23617-1">Gezondheid in de zorg</label></li>
<li><input type="checkbox" value="4" name="group[23617][4]" id="mce-group[23617]-23617-2"><label for="mce-group[23617]-23617-2">Gezonde School</label></li>
<li><input type="checkbox" value="8" name="group[23617][8]" id="mce-group[23617]-23617-3"><label for="mce-group[23617]-23617-3">Gezond Werk</label></li>
<li><input type="checkbox" value="16" name="group[23617][16]" id="mce-group[23617]-23617-4"><label for="mce-group[23617]-23617-4">Nieuwsbrief voor artsen</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Woonzorgcentra </strong>
<ul><li><input type="checkbox" value="64" name="group[29073][64]" id="mce-group[29073]-29073-0"><label for="mce-group[29073]-29073-0">Valpreventie</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_7132dbda5c" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Oost-Brabant mailchimp:
<div id="mc_embed_signup">
<form action="https://logo-oostbrabant.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=9643ddb0b6" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Subscribe</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik wil me graag inschrijven voor </strong>
<ul><li><input type="checkbox" value="32" name="group[29206][32]" id="mce-group[29206]-29206-0"><label for="mce-group[29206]-29206-0">De Gezonde Gazet (maandelijks)</label></li>
<li><input type="checkbox" value="64" name="group[29206][64]" id="mce-group[29206]-29206-1"><label for="mce-group[29206]-29206-1">Scholennieuwsbrief (3x per jaar)</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19509][1]" id="mce-group[19509]-19509-0"><label for="mce-group[19509]-19509-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19509][2]" id="mce-group[19509]-19509-1"><label for="mce-group[19509]-19509-1">de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19509][4]" id="mce-group[19509]-19509-2"><label for="mce-group[19509]-19509-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19509][8]" id="mce-group[19509]-19509-3"><label for="mce-group[19509]-19509-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19509][16]" id="mce-group[19509]-19509-4"><label for="mce-group[19509]-19509-4">in de zorg</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Specifieke thema's </strong>
<ul><li><input type="checkbox" value="128" name="group[29210][128]" id="mce-group[29210]-29210-0"><label for="mce-group[29210]-29210-0">Griepvaccinatie</label></li>
<li><input type="checkbox" value="256" name="group[29210][256]" id="mce-group[29210]-29210-1"><label for="mce-group[29210]-29210-1">Valpreventie</label></li>
<li><input type="checkbox" value="512" name="group[29210][512]" id="mce-group[29210]-29210-2"><label for="mce-group[29210]-29210-2">Bullshitfree Generation</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_9643ddb0b6" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Brussel mailchimp:
<div id="mc_embed_signup">
<form action="https://vlaamse-logos.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=fec2da6f21" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19517][1]" id="mce-group[19517]-19517-0"><label for="mce-group[19517]-19517-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19517][2]" id="mce-group[19517]-19517-1"><label for="mce-group[19517]-19517-1">in de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19517][4]" id="mce-group[19517]-19517-2"><label for="mce-group[19517]-19517-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19517][8]" id="mce-group[19517]-19517-3"><label for="mce-group[19517]-19517-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19517][16]" id="mce-group[19517]-19517-4"><label for="mce-group[19517]-19517-4">in de zorg</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_fec2da6f21" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Waasland mailchimp:
<div id="mc_embed_signup">
<form action="https://logowaasland.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=1c3ceaa4ef" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam <span class="asterisk">*</span>
</label>
<input type="text" value="" name="FNAME" class="required" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam <span class="asterisk">*</span>
</label>
<input type="text" value="" name="LNAME" class="required" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie <span class="asterisk">*</span>
</label>
<input type="text" value="" name="ORG" class="required" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19521][1]" id="mce-group[19521]-19521-0"><label for="mce-group[19521]-19521-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19521][2]" id="mce-group[19521]-19521-1"><label for="mce-group[19521]-19521-1">in de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19521][4]" id="mce-group[19521]-19521-2"><label for="mce-group[19521]-19521-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19521][8]" id="mce-group[19521]-19521-3"><label for="mce-group[19521]-19521-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19521][16]" id="mce-group[19521]-19521-4"><label for="mce-group[19521]-19521-4">in de zorg</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_1c3ceaa4ef" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Dender mailchimp:
<div id="mc_embed_signup">
<form action="https://logodender.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=7be3b6c886" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19525][1]" id="mce-group[19525]-19525-0"><label for="mce-group[19525]-19525-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19525][2]" id="mce-group[19525]-19525-1"><label for="mce-group[19525]-19525-1">in de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19525][4]" id="mce-group[19525]-19525-2"><label for="mce-group[19525]-19525-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19525][8]" id="mce-group[19525]-19525-3"><label for="mce-group[19525]-19525-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19525][16]" id="mce-group[19525]-19525-4"><label for="mce-group[19525]-19525-4">in de zorg</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_7be3b6c886" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Gezondplus mailchimp:
<div id="mc_embed_signup">
<form action="https://vlaamse-logos.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=ad6a4767d2" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Subscribe</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik wens mij te abonneren op deze nieuwsbrieven </strong>
<ul><li><input type="checkbox" value="1" name="group[19529][1]" id="mce-group[19529]-19529-0"><label for="mce-group[19529]-19529-0">algemene nieuwsbrief</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Ik ben geïnteresseerd in nieuws specifiek voor </strong>
<ul><li><input type="checkbox" value="4" name="group[29222][4]" id="mce-group[29222]-29222-0"><label for="mce-group[29222]-29222-0">alle settings</label></li>
<li><input type="checkbox" value="8" name="group[29222][8]" id="mce-group[29222]-29222-1"><label for="mce-group[29222]-29222-1">lokale besturen</label></li>
<li><input type="checkbox" value="16" name="group[29222][16]" id="mce-group[29222]-29222-2"><label for="mce-group[29222]-29222-2">onderwijs</label></li>
<li><input type="checkbox" value="32" name="group[29222][32]" id="mce-group[29222]-29222-3"><label for="mce-group[29222]-29222-3">bedrijven</label></li>
<li><input type="checkbox" value="64" name="group[29222][64]" id="mce-group[29222]-29222-4"><label for="mce-group[29222]-29222-4">zorg & welzijn</label></li>
<li><input type="checkbox" value="128" name="group[29222][128]" id="mce-group[29222]-29222-5"><label for="mce-group[29222]-29222-5">kwetsbare groepen</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Ik ben geïntereseerd in nieuws over </strong>
<ul><li><input type="checkbox" value="256" name="group[29226][256]" id="mce-group[29226]-29226-0"><label for="mce-group[29226]-29226-0">alle thema's</label></li>
<li><input type="checkbox" value="512" name="group[29226][512]" id="mce-group[29226]-29226-1"><label for="mce-group[29226]-29226-1">voeding & bewegen en sedentair gedrag</label></li>
<li><input type="checkbox" value="1024" name="group[29226][1024]" id="mce-group[29226]-29226-2"><label for="mce-group[29226]-29226-2">geestelijke gezondheid</label></li>
<li><input type="checkbox" value="2048" name="group[29226][2048]" id="mce-group[29226]-29226-3"><label for="mce-group[29226]-29226-3">gezondheid & milieu en gezonde mobiliteit</label></li>
<li><input type="checkbox" value="4096" name="group[29226][4096]" id="mce-group[29226]-29226-4"><label for="mce-group[29226]-29226-4">tabak, alcohol en andere drugs</label></li>
<li><input type="checkbox" value="8192" name="group[29226][8192]" id="mce-group[29226]-29226-5"><label for="mce-group[29226]-29226-5">vaccinatie en infectieziekten</label></li>
<li><input type="checkbox" value="16384" name="group[29226][16384]" id="mce-group[29226]-29226-6"><label for="mce-group[29226]-29226-6">valpreventie</label></li>
<li><input type="checkbox" value="32768" name="group[29226][32768]" id="mce-group[29226]-29226-7"><label for="mce-group[29226]-29226-7">de bevolkingsonderzoeken naar kanker</label></li>
<li><input type="checkbox" value="65536" name="group[29226][65536]" id="mce-group[29226]-29226-8"><label for="mce-group[29226]-29226-8">gezond opvoeden</label></li>
<li><input type="checkbox" value="131072" name="group[29226][131072]" id="mce-group[29226]-29226-9"><label for="mce-group[29226]-29226-9">gezonde publieke ruimte</label></li>
<li><input type="checkbox" value="262144" name="group[29226][262144]" id="mce-group[29226]-29226-10"><label for="mce-group[29226]-29226-10">mondgezondheid</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_ad6a4767d2" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Leieland mailchimp:
<div id="mc_embed_signup">
<form action="https://logoleieland.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=b7e5efcd73" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE4">Type contact </label>
<input type="text" value="" name="MMERGE4" class="" id="mce-MMERGE4">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE5">Functie </label>
<input type="text" value="" name="MMERGE5" class="" id="mce-MMERGE5">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE6">Telefoonnummer </label>
<input type="text" value="" name="MMERGE6" class="" id="mce-MMERGE6">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE7">Straat + nr </label>
<input type="text" value="" name="MMERGE7" class="" id="mce-MMERGE7">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE8">Locatie </label>
<input type="text" value="" name="MMERGE8" class="" id="mce-MMERGE8">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE9">Organisatiegroep </label>
<input type="text" value="" name="MMERGE9" class="" id="mce-MMERGE9">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE10">Project </label>
<input type="text" value="" name="MMERGE10" class="" id="mce-MMERGE10">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE11">GSM </label>
<input type="text" value="" name="MMERGE11" class="" id="mce-MMERGE11">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE12">E-mail ZOCO </label>
<input type="text" value="" name="MMERGE12" class="" id="mce-MMERGE12">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE13">ZOCO Naam </label>
<input type="text" value="" name="MMERGE13" class="" id="mce-MMERGE13">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE14">Afdeling ZOCO </label>
<input type="text" value="" name="MMERGE14" class="" id="mce-MMERGE14">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE15">Type onderwijs </label>
<input type="text" value="" name="MMERGE15" class="" id="mce-MMERGE15">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE16">GSM </label>
<input type="text" value="" name="MMERGE16" class="" id="mce-MMERGE16">
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19533][1]" id="mce-group[19533]-19533-0"><label for="mce-group[19533]-19533-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19533][2]" id="mce-group[19533]-19533-1"><label for="mce-group[19533]-19533-1">in de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19533][4]" id="mce-group[19533]-19533-2"><label for="mce-group[19533]-19533-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19533][8]" id="mce-group[19533]-19533-3"><label for="mce-group[19533]-19533-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19533][16]" id="mce-group[19533]-19533-4"><label for="mce-group[19533]-19533-4">in de zorg</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Setting </strong>
<ul><li><input type="checkbox" value="32" name="group[23305][32]" id="mce-group[23305]-23305-0"><label for="mce-group[23305]-23305-0">Lokaal bestuur</label></li>
<li><input type="checkbox" value="64" name="group[23305][64]" id="mce-group[23305]-23305-1"><label for="mce-group[23305]-23305-1">Onderwijs</label></li>
<li><input type="checkbox" value="128" name="group[23305][128]" id="mce-group[23305]-23305-2"><label for="mce-group[23305]-23305-2">Zorg</label></li>
<li><input type="checkbox" value="256" name="group[23305][256]" id="mce-group[23305]-23305-3"><label for="mce-group[23305]-23305-3">Bedrijf</label></li>
<li><input type="checkbox" value="512" name="group[23305][512]" id="mce-group[23305]-23305-4"><label for="mce-group[23305]-23305-4">Bevolkingsonderzoek Baarmoederhalskanker</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_b7e5efcd73" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Midden WVL mailchimp:
<div id="mc_embed_signup">
<form action="https://logomiddenwvl.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=fa4bd33f2d" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Subscribe</h2>
<div class="indicates-required"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group input-group">
<strong>Ik heb interesse in </strong>
<ul><li><input type="checkbox" value="1" name="group[19537][1]" id="mce-group[19537]-19537-0"><label for="mce-group[19537]-19537-0">gezondheid</label></li>
<li><input type="checkbox" value="2" name="group[19537][2]" id="mce-group[19537]-19537-1"><label for="mce-group[19537]-19537-1">in de gemeente</label></li>
<li><input type="checkbox" value="4" name="group[19537][4]" id="mce-group[19537]-19537-2"><label for="mce-group[19537]-19537-2">op school</label></li>
<li><input type="checkbox" value="8" name="group[19537][8]" id="mce-group[19537]-19537-3"><label for="mce-group[19537]-19537-3">op het werk</label></li>
<li><input type="checkbox" value="16" name="group[19537][16]" id="mce-group[19537]-19537-4"><label for="mce-group[19537]-19537-4">in de zorg</label></li>
</ul>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_fa4bd33f2d" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
<script type='text/javascript' src='//s3.amazonaws.com/downloads.mailchimp.com/js/mc-validate.js'></script><script type='text/javascript'>(function($) {window.fnames = new Array(); window.ftypes = new Array();fnames[1]='FNAME';ftypes[1]='text';fnames[2]='LNAME';ftypes[2]='text';fnames[0]='EMAIL';ftypes[0]='email';fnames[3]='ORG';ftypes[3]='text'; /*
* Translated default messages for the $ validation plugin.
* Locale: NL
*/
$.extend($.validator.messages, {
required: "Dit is een verplicht veld.",
remote: "Controleer dit veld.",
email: "Vul hier een geldig e-mailadres in.",
url: "Vul hier een geldige URL in.",
date: "Vul hier een geldige datum in.",
dateISO: "Vul hier een geldige datum in (ISO-formaat).",
number: "Vul hier een geldig getal in.",
digits: "Vul hier alleen getallen in.",
creditcard: "Vul hier een geldig creditcardnummer in.",
equalTo: "Vul hier dezelfde waarde in.",
accept: "Vul hier een waarde in met een geldige extensie.",
maxlength: $.validator.format("Vul hier maximaal {0} tekens in."),
minlength: $.validator.format("Vul hier minimaal {0} tekens in."),
rangelength: $.validator.format("Vul hier een waarde in van minimaal {0} en maximaal {1} tekens."),
range: $.validator.format("Vul hier een waarde in van minimaal {0} en maximaal {1}."),
max: $.validator.format("Vul hier een waarde in kleiner dan of gelijk aan {0}."),
min: $.validator.format("Vul hier een waarde in groter dan of gelijk aan {0}.")
});}(jQuery));var $mcj = jQuery.noConflict(true);</script>
<!--End mc_embed_signup-->
Logo Brugge-Oostende mailchimp:
<div id="mc_embed_signup">
<form action="https://logobrugge-oostende.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=bdbc8a89d0" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-EMAIL">E-mailadres <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-FNAME">Voornaam </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Naam </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div class="mc-field-group">
<label for="mce-ORG">Organisatie </label>
<input type="text" value="" name="ORG" class="" id="mce-ORG">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE4">Gemeente/Stad </label>
<input type="text" value="" name="MMERGE4" class="" id="mce-MMERGE4">
</div>
<div class="mc-field-group">
<label for="mce-MMERGE5">Functie </label>
<input type="text" value="" name="MMERGE5" class="" id="mce-MMERGE5">
</div>
<div class="mc-field-group input-group">
<strong>Ik wens mij te abonneren op deze nieuwsbrieven </strong>
<ul><li><input type="checkbox" value="1" name="group[19541][1]" id="mce-group[19541]-19541-0"><label for="mce-group[19541]-19541-0">algemene nieuwsbrief (1 x per maand)</label></li>
<li><input type="checkbox" value="32" name="group[19541][32]" id="mce-group[19541]-19541-1"><label for="mce-group[19541]-19541-1">nieuwsbrief voor basisonderwijs (3à4 x per jaar)</label></li>
<li><input type="checkbox" value="2" name="group[19541][2]" id="mce-group[19541]-19541-2"><label for="mce-group[19541]-19541-2">nieuwsbrief voor secundair onderwijs (3à4 x per jaar)</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Ik ben geïnteresseerd in nieuws specifiek voor </strong>
<ul><li><input type="checkbox" value="1024" name="group[29185][1024]" id="mce-group[29185]-29185-0"><label for="mce-group[29185]-29185-0">lokale besturen</label></li>
<li><input type="checkbox" value="128" name="group[29185][128]" id="mce-group[29185]-29185-1"><label for="mce-group[29185]-29185-1">bedrijven</label></li>
<li><input type="checkbox" value="256" name="group[29185][256]" id="mce-group[29185]-29185-2"><label for="mce-group[29185]-29185-2">zorgverleners</label></li>
<li><input type="checkbox" value="512" name="group[29185][512]" id="mce-group[29185]-29185-3"><label for="mce-group[29185]-29185-3">kwetsbare groepen</label></li>
</ul>
</div>
<div class="mc-field-group input-group">
<strong>Ik ben geïntereseerd in mailings over de thema's </strong>
<ul><li><input type="checkbox" value="4" name="group[26521][4]" id="mce-group[26521]-26521-0"><label for="mce-group[26521]-26521-0">bewegen</label></li>
<li><input type="checkbox" value="8" name="group[26521][8]" id="mce-group[26521]-26521-1"><label for="mce-group[26521]-26521-1">geestelijke gezondheid</label></li>
<li><input type="checkbox" value="64" name="group[26521][64]" id="mce-group[26521]-26521-2"><label for="mce-group[26521]-26521-2">gezondheid & milieu</label></li>
<li><input type="checkbox" value="8192" name="group[26521][8192]" id="mce-group[26521]-26521-3"><label for="mce-group[26521]-26521-3">tabak, alcohol & drugs</label></li>
<li><input type="checkbox" value="16384" name="group[26521][16384]" id="mce-group[26521]-26521-4"><label for="mce-group[26521]-26521-4">vaccinatie</label></li>
<li><input type="checkbox" value="32768" name="group[26521][32768]" id="mce-group[26521]-26521-5"><label for="mce-group[26521]-26521-5">valpreventie</label></li>
<li><input type="checkbox" value="65536" name="group[26521][65536]" id="mce-group[26521]-26521-6"><label for="mce-group[26521]-26521-6">voeding</label></li>
</ul>
</div>
<div id="mergeRow-gdpr" class="mergeRow gdpr-mergeRow content__gdprBlock mc-field-group">
<div class="content__gdpr">
<label>Marketing Toestemming</label>
<p>Selecteer langs welke weg je graag informatie wenst te ontvangen van Logo Brugge-Oostende:</p>
<fieldset class="mc_fieldset gdprRequired mc-field-group" name="interestgroup_field">
<label class="checkbox subfield" for="gdpr_1"><input type="checkbox" id="gdpr_1" name="gdpr[1]" value="Y" class="av-checkbox "><span>Emails</span> </label><label class="checkbox subfield" for="gdpr_5"><input type="checkbox" id="gdpr_5" name="gdpr[5]" value="Y" class="av-checkbox "><span>Nieuwsbrieven</span> </label><label class="checkbox subfield" for="gdpr_9"><input type="checkbox" id="gdpr_9" name="gdpr[9]" value="Y" class="av-checkbox "><span>Gepersonaliseerde online boodschappen</span> </label>
</fieldset>
<p>Je kan op elk ogenblik uitschrijven door te klikken op de link in de footer van je emails. Informatie over onze privacy policy vind je op onze website.</p>
</div>
<div class="content__gdprLegal">
<p>We use Mailchimp as our marketing platform. By clicking below to subscribe, you acknowledge that your information will be transferred to Mailchimp for processing. <a href="https://mailchimp.com/legal/" target="_blank">Learn more about Mailchimp's privacy practices here.</a></p>
</div>
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_bdbc8a89d0" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>
Logo Zenneland mailchimp:
<div id="mc_embed_signup">
<form action="https://vlaamse-logos.us9.list-manage.com/subscribe/post?u=5fabdfb944297194e20b620bd&id=e22697d103" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate>
<div id="mc_embed_signup_scroll">
<h2>Nieuwsbrief</h2>
<div class="indicates-required"><span class="asterisk">*</span> verplichte velden</div>
<div class="mc-field-group">
<label for="mce-EMAIL">Email Address <span class="asterisk">*</span>
</label>
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL">
</div>
<div class="mc-field-group">
<label for="mce-FNAME">First Name </label>
<input type="text" value="" name="FNAME" class="" id="mce-FNAME">
</div>
<div class="mc-field-group">
<label for="mce-LNAME">Last Name </label>
<input type="text" value="" name="LNAME" class="" id="mce-LNAME">
</div>
<div id="mce-responses" class="clear">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none"></div>
</div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups-->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_5fabdfb944297194e20b620bd_e22697d103" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Abonneren" name="subscribe" id="mc-embedded-subscribe" class="button"></div>
</div>
</form>
</div>