{"id":89,"date":"2017-12-01T08:58:18","date_gmt":"2017-12-01T08:58:18","guid":{"rendered":"https:\/\/www.fleetmanageroftheyear.be\/?page_id=89"},"modified":"2026-09-30T11:10:00","modified_gmt":"2026-09-30T11:10:00","slug":"inschrijven","status":"publish","type":"page","link":"https:\/\/www.fleetmanageroftheyear.be\/nl\/inschrijven\/","title":{"rendered":"Inschrijven"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework fmy-registratie_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_11' ><div id='gf_11' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; geeft vereiste velden aan<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_11' id='gform_11' class='fmy-registratie' action='\/nl\/wp-json\/wp\/v2\/pages\/89#gf_11' data-formid='11' novalidate><div class='gf_invisible ginput_recaptchav3'  data-tabindex='0'><input id=\"input_e85d73a21a0b46b4c09a843dddcafe5f\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e85d73a21a0b46b4c09a843dddcafe5f\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_11_1\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_1'><span class='gform-field-label__text'>Bedrijf<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_11_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_22\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_22'><span class='gform-field-label__text'>Rechtsvorm<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_11_22' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_2\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_2'><span class='gform-field-label__text'>Contactpersoon<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_11_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_5\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_5'><span class='gform-field-label__text'>E-mailadres<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_11_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_11_4\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adres<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_11_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_11_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_11_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_11_4_1' id='input_11_4_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_11_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_11_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_11_4_3' id='input_11_4_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_4.4' id='input_11_4_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_11_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_11_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_11_4_5' id='input_11_4_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_11_4_6_container' >\n                                        <select name='input_4.6' id='input_11_4_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' selected='selected'>Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_11_4_6' id='input_11_4_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_11_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_6'><span class='gform-field-label__text'>BTW-nummer<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_11_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_11_7\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Facturatieadres (indien afwijkend van adres)<\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_11_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_11_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_11_7_1' value=''    aria-required='false'    \/>\n                                        <label for='input_11_7_1' id='input_11_7_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_11_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_11_7_3' value=''    aria-required='false'    \/>\n                                    <label for='input_11_7_3' id='input_11_7_3_label' class='gform-field-label gform-field-label--type-sub '>Plaats<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_7.4' id='input_11_7_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_11_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_11_7_5' value=''    aria-required='false'    \/>\n                                    <label for='input_11_7_5' id='input_11_7_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_11_7_6_container' >\n                                        <select name='input_7.6' id='input_11_7_6'   aria-required='false'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland-eilanden<\/option><option value='AL' >Albani\u00eb<\/option><option value='DZ' >Algerije<\/option><option value='AS' >Amerikaans Samoa<\/option><option value='VI' >Amerikaanse Maagdeneilanden<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua en Barbuda<\/option><option value='SY' >Arabische Republiek Syri\u00eb<\/option><option value='AR' >Argentini\u00eb<\/option><option value='AM' >Armeni\u00eb<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australi\u00eb<\/option><option value='AZ' >Azerbeidzjan<\/option><option value='BS' >Bahama&#039;s<\/option><option value='BH' >Bahrein<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BE' selected='selected'>Belgi\u00eb<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius en Saba<\/option><option value='BA' >Bosni\u00eb en Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet eiland<\/option><option value='BR' >Brazili\u00eb<\/option><option value='IO' >Brits-Indisch oceaan gebied<\/option><option value='VG' >Britse Maagdeneilanden<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarije<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodja<\/option><option value='CA' >Canada<\/option><option value='CF' >Centraal-Afrikaanse Republiek<\/option><option value='CL' >Chili<\/option><option value='CN' >China<\/option><option value='CC' >Cocoseilanden<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoren<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratische Republiek<\/option><option value='CK' >Cook eilanden<\/option><option value='CR' >Costa Rica<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='DK' >Denemarken<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominicaanse Republiek<\/option><option value='DE' >Duitsland<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatoriaal-Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estland<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopi\u00eb<\/option><option value='FO' >Faer\u00f6er<\/option><option value='FK' >Falkland eilanden<\/option><option value='FJ' >Fiji<\/option><option value='PH' >Filipijnen<\/option><option value='FI' >Finland<\/option><option value='FR' >Frankrijk<\/option><option value='GF' >Frans Guyana<\/option><option value='PF' >Frans-Polynesi\u00eb<\/option><option value='TF' >Franse zuidelijke gebieden<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgi\u00eb<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenada<\/option><option value='GR' >Griekenland<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinee<\/option><option value='GW' >Guinee-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >Heard Eiland en McDonald Eilanden<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongarije<\/option><option value='IE' >Ierland<\/option><option value='IS' >IJsland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesi\u00eb<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Itali\u00eb<\/option><option value='CI' >Ivoorkust<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='GS' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='JO' >Jordani\u00eb<\/option><option value='KY' >Kaaimaneilanden<\/option><option value='CV' >Kaapverdi\u00eb<\/option><option value='CM' >Kameroen<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='CX' >Kersteiland<\/option><option value='KG' >Kirgizi\u00eb<\/option><option value='KI' >Kiribati<\/option><option value='UM' >Kleine eilanden van de Verenigde Staten<\/option><option value='KW' >Koeweit<\/option><option value='KP' >Korea, Democratische Volksrepubliek<\/option><option value='KR' >Korea, Republiek van<\/option><option value='HR' >Kroati\u00eb<\/option><option value='LA' >Lao Democratische Volksrepubliek<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Letland<\/option><option value='LB' >Libanon<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libi\u00eb<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litouwen<\/option><option value='LU' >Luxemburg<\/option><option value='MO' >Macau<\/option><option value='MG' >Madagaskar<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldiven<\/option><option value='MY' >Maleisi\u00eb<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='IM' >Man<\/option><option value='MA' >Marokko<\/option><option value='MH' >Marshalleilanden<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritani\u00eb<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavi\u00eb<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongoli\u00eb<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibi\u00eb<\/option><option value='NR' >Nauru<\/option><option value='NL' >Nederland<\/option><option value='NP' >Nepal<\/option><option value='NI' >Nicaragua<\/option><option value='NC' >Nieuw-Caledoni\u00eb<\/option><option value='NZ' >Nieuw-Zeeland<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='MK' >Noord-Macedoni\u00eb<\/option><option value='MP' >Noordelijke Marianen<\/option><option value='NO' >Noorwegen<\/option><option value='NF' >Norfolk eiland<\/option><option value='UG' >Oeganda<\/option><option value='UA' >Oekra\u00efne<\/option><option value='UZ' >Oezbekistan<\/option><option value='OM' >Oman<\/option><option value='AT' >Oostenrijk<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestina, Staat<\/option><option value='PA' >Panama<\/option><option value='PG' >Papoea-Nieuw-Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polen<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roemeni\u00eb<\/option><option value='RU' >Russische Federatie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='KN' >Saint Kitts en Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre en Miquelon<\/option><option value='VC' >Saint Vincent en de Grenadines<\/option><option value='SB' >Salomonseilanden<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tom\u00e9 en Principe<\/option><option value='SA' >Saoedi-Arabi\u00eb<\/option><option value='SN' >Senegal<\/option><option value='RS' >Servi\u00eb<\/option><option value='SC' >Seychellen<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='MF' >Sint Maarten<\/option><option value='SH' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='SI' >Sloveni\u00eb<\/option><option value='SK' >Slowakije<\/option><option value='SD' >Soedan<\/option><option value='SO' >Somali\u00eb<\/option><option value='ES' >Spanje<\/option><option value='SJ' >Spitsbergen en Jan Mayen<\/option><option value='LK' >Sri Lanka<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadzjikistan<\/option><option value='TW' >Taiwan<\/option><option value='TZ' >Tanzania, de Verenigde Republiek van<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad en Tobago<\/option><option value='TD' >Tsjaad<\/option><option value='CZ' >Tsjechi\u00eb<\/option><option value='TN' >Tunesi\u00eb<\/option><option value='TR' >Turkije<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks- en Caicoseilanden<\/option><option value='TV' >Tuvalu<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vaticaanstad<\/option><option value='VE' >Venezuela<\/option><option value='GB' >Verenigd Koninkrijk<\/option><option value='AE' >Verenigde Arabische Emiraten<\/option><option value='US' >Verenigde Staten<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis en Futuna<\/option><option value='EH' >Westelijke Sahara<\/option><option value='BY' >Wit-Rusland<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='SS' >Zuid Soedan<\/option><option value='ZA' >Zuid-Afrika<\/option><option value='SE' >Zweden<\/option><option value='CH' >Zwitserland<\/option><\/select>\n                                        <label for='input_11_7_6' id='input_11_7_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_11_8\" class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_8'><span class='gform-field-label__text'>E-mailadres boekhouding (elektronische facturatie)<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_11_8' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_11_23\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_23'><span class='gform-field-label__text'>PO-nummer<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_11_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_33\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Gala FLEET Manager of the Year<\/h3><div class='gsection_description' id='gfield_description_11_33'>Boek afzonderlijke plaatsen, \u00e9\u00e9n of meer tafels, of een combinatie van beide. Alle prijzen excl. btw.<\/div><\/div><div id=\"field_11_26\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_11_26 gfield_product_11_26 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_26_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Afzonderlijke plaatsen (\u20ac 395 p.p.)<\/span> <span class=\"screen-reader-text\">Aantal<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_26.1' value='Afzonderlijke plaatsen (\u20ac 395 p.p.)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_26' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_26'>395,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_26.2' id='ginput_base_price_11_26' class='gform_hidden' value='395,00 &#8364;'\/>\n\t\t\t\t\t <label for='ginput_quantity_11_26_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Aantal<\/label> <input type='number' name='input_26.3' value='' id='input_11_26_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Aantal Afzonderlijke plaatsen (\u20ac 395 p.p.)\" aria-describedby=\"ginput_product_price_11_26 gfield_description_11_26\" \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_11_26'>Maximaal 9. Vanaf 10 personen is een tafel voordeliger.<\/div><\/div><div id=\"field_11_30\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_11_30 gfield_product_11_30 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_30_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Tafel voor 10 personen (\u20ac 3.795)<\/span> <span class=\"screen-reader-text\">Aantal<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_30.1' value='Tafel voor 10 personen (\u20ac 3.795)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_30' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_30'>3.795,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_30.2' id='ginput_base_price_11_30' class='gform_hidden' value='3.795,00 &#8364;'\/>\n\t\t\t\t\t <label for='ginput_quantity_11_30_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Aantal<\/label> <input type='number' name='input_30.3' value='' id='input_11_30_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Aantal Tafel voor 10 personen (\u20ac 3.795)\" aria-describedby=\"ginput_product_price_11_30 gfield_description_11_30\" \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_11_30'>Aantal tafels.<\/div><\/div><div id=\"field_11_31\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_11_31 gfield_product_11_31 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_31_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Tafel voor 11 personen (\u20ac 4.175)<\/span> <span class=\"screen-reader-text\">Aantal<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_31.1' value='Tafel voor 11 personen (\u20ac 4.175)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_31' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_31'>4.175,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_31.2' id='ginput_base_price_11_31' class='gform_hidden' value='4.175,00 &#8364;'\/>\n\t\t\t\t\t <label for='ginput_quantity_11_31_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Aantal<\/label> <input type='number' name='input_31.3' value='' id='input_11_31_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Aantal Tafel voor 11 personen (\u20ac 4.175)\" aria-describedby=\"ginput_product_price_11_31 gfield_description_11_31\" \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_11_31'>Aantal tafels.<\/div><\/div><div id=\"field_11_32\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_11_32 gfield_product_11_32 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_32_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Tafel voor 12 personen (\u20ac 4.554)<\/span> <span class=\"screen-reader-text\">Aantal<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_32.1' value='Tafel voor 12 personen (\u20ac 4.554)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_32' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_32'>4.554,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_32.2' id='ginput_base_price_11_32' class='gform_hidden' value='4.554,00 &#8364;'\/>\n\t\t\t\t\t <label for='ginput_quantity_11_32_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Aantal<\/label> <input type='number' name='input_32.3' value='' id='input_11_32_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Aantal Tafel voor 12 personen (\u20ac 4.554)\" aria-describedby=\"ginput_product_price_11_32 gfield_description_11_32\" \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_11_32'>Aantal tafels.<\/div><\/div><div id=\"field_11_27\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Forum MOBILITOPIA (optioneel)<\/h3><div class='gsection_description' id='gfield_description_11_27'>Van 14 tot 18 uur, inclusief drankje tijdens de pauze. Toegang \u20ac 145 per persoon, of \u20ac 100 per persoon in combinatie met een plaats op het gala.<\/div><\/div><div id=\"field_11_28\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_11_28 gfield_product_11_28 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_28_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Forum \u2013 in combinatie met een galaplaats (\u20ac 100 p.p.)<\/span> <span class=\"screen-reader-text\">Aantal<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_28.1' value='Forum \u2013 in combinatie met een galaplaats (\u20ac 100 p.p.)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_28' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_28'>100,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_28.2' id='ginput_base_price_11_28' class='gform_hidden' value='100,00 &#8364;'\/>\n\t\t\t\t\t <label for='ginput_quantity_11_28_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Aantal<\/label> <input type='number' name='input_28.3' value='' id='input_11_28_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Aantal Forum \u2013 in combinatie met een galaplaats (\u20ac 100 p.p.)\" aria-describedby=\"ginput_product_price_11_28 gfield_description_11_28\" \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_11_28'>Aantal gala-deelnemers dat ook het forum bijwoont (maximaal het totale aantal geboekte galaplaatsen).<\/div><\/div><div id=\"field_11_29\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_11_29 gfield_product_11_29 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_29_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Forum \u2013 enkel forum (\u20ac 145 p.p.)<\/span> <span class=\"screen-reader-text\">Aantal<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_29.1' value='Forum \u2013 enkel forum (\u20ac 145 p.p.)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_29' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_29'>145,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_29.2' id='ginput_base_price_11_29' class='gform_hidden' value='145,00 &#8364;'\/>\n\t\t\t\t\t <label for='ginput_quantity_11_29_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Aantal<\/label> <input type='number' name='input_29.3' value='' id='input_11_29_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Aantal Forum \u2013 enkel forum (\u20ac 145 p.p.)\" aria-describedby=\"ginput_product_price_11_29 gfield_description_11_29\" \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_11_29'>Aantal personen dat enkel het forum bijwoont, zonder galaplaats.<\/div><\/div><div id=\"field_11_21\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><hr><\/div><div id=\"field_11_24\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-half gfield_price gfield_price_11_24 gfield_product_11_24 gfield_contains_required gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_11_24_1'><span class='gform-field-label__text'>BTW (21%)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_24.1' value='BTW (21%)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_11_24' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_11_24'>0,00 &#8364;<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_24.2' id='ginput_base_price_11_24' class='gform_hidden ginput_calculated_price' value='0,00 \u20ac'\/>\n\t\t\t\t\t<input type='hidden' name='input_24.3' value='1' class='ginput_quantity_11_24 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_11_12\" class=\"gfield gfield--type-total gfield--width-half gfield_price gfield_price_11_ gfield_total gfield_total_11_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_11_12'><span class='gform-field-label__text'>Totaal (incl. btw)<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_12' id='input_11_12' value='0,00 &#8364;' class='gform-text-input-reset ginput_total ginput_total_11' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_11_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Bevestiging<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_14'><div class='gchoice gchoice_11_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='JA, ik bevestig bovenstaande boeking voor 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Een factuur wordt mij aansluitend toegestuurd.'  id='choice_11_14_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_14_1' id='label_11_14_1' class='gform-field-label gform-field-label--type-inline'>JA, ik bevestig bovenstaande boeking voor de FLEET Manager of the Year 2027 en\/of het Forum MOBILITOPIA en schrijf het totaalbedrag over op rekeningnummer BE85 0682 2138 1006 met vermelding van mijn bedrijfsnaam en \u2018FLEET Manager 2027\u2019. 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