<div style="display:none" class="fm-form-container fm-theme1"><div id="fm-pages15" class="fm-pages wdform_page_navigation " show_title="" show_numbers="1" type="none"></div><form name="form15" action="/en/wp-json/wp/v2/pages/225663" method="post" id="form15" class="fm-form form15  " enctype="multipart/form-data"><input type="hidden" id="fm_page_id15" value="225663" name="fm_page_id15" /><input type="hidden" id="fm_current_post_type15" value="page" name="fm_current_post_type15" /><input type="hidden" id="counter15" value="52" name="counter15" /><input type="hidden" id="Itemid15" value="" name="Itemid15" /><input type="hidden" id="fm_shake15" value="1" name="fm_shake15" /><input type="text" class="fm-hide" id="fm_empty_field_validation15" value="" name="fm_empty_field_validation15" data-value="bd736efb144d599cf463541431fbf5c4" /><input type="hidden" id="fm_ajax_url15" data-ajax_url="https://dekoplopers.nl/wp-admin/admin-ajax.php?action=fm_submit_form&current_id=15&formType=embedded" /><input type="hidden" id="fm_ajax_redirect_url15" data-ajax_redirect_url="0" /><input type="hidden" id="fm_form_nonce15" name="fm_form_nonce15" value="fde8e570dd" /><input type="hidden" name="_wp_http_referer" value="/en/wp-json/wp/v2/pages/225663" /><div class="wdform-page-and-images fm-form-builder"><div id="15form_view1" class="wdform_page" page_title="Untitled page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="false"><div class="wdform_section"><div class="wdform_column"><div wdid="38" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><p>Om rijen bij de inschrijfbalie te voorkomen, vragen we je om het inschrijfgeld over te maken. Het inschrijfgeld voor de 5 km en 10 km bedraagt € 3,-.<br>Het inschrijfgeld voor de kinderloop is €1,-  (svp bedrag  aanpassen in betaalverzoek)<br>We hebben 3 mogelijkheden daarvoor, alvast bedankt!</p></div></div></div><div class="wdform_column"><div wdid="3" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><p>1) Maak het over<br>op rekening <b>NL95 INGB 0003 1783 58﻿</b><br>ten name van <b>Atletiekvereniging De Koplopers</b><br>onder vermelding van <b>Kopjesloop <Maand>, achternaam en afstand</b></p></div></div></div><div class="wdform_column"><div wdid="42" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><p>2) Of gebruik een directe link: <br><a href="https://www.ing.nl/payreq/m/?trxid=R0zKyYDBOD0SISx1UZTcEEv0lqcA1hT7">https://www.ing.nl/payreq/m/?trxid=R0zKyYDBOD0SISx1UZTcEEv0lqcA1hT7﻿</a><br></p></div></div></div><div class="wdform_column"><div wdid="43" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><p>3) Of scan de QR-code met een algemene QR-app (niet met je bankieren-app):<br><a href="https://www.ing.nl/payreq/m/?trxid=R0zKyYDBOD0SISx1UZTcEEv0lqcA1hT7" data-mce-href="https://www.ing.nl/payreq/m/?trxid=R0zKyYDBOD0SISx1UZTcEEv0lqcA1hT7"><img src="https://dekoplopers.nl/wp-content/uploads/kopjesloop/Kopjesloop 14 juni 2026.png" alt="ING Betaalverzoek" width="200" height="200" data-mce-src="https://dekoplopers.nl/wp-content/uploads/kopjesloop/Kopjesloop 14 juni 2026.png"></a></p></div></div></div><div class="wdform_column"><div wdid="44" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><div class="wdform-section-break-div" style="min-width: 300px; border-top:1px solid"></div></div></div></div><div class="wdform_column"><div wdid="45" class="wdform_row"><div type="type_editor" class="wdform-field"><p>Vul alle velden hieronder in en druk tot slot op de knop 'Verzenden'. De met een * gemarkeerde velden dienen verplicht ingevuld te worden.</p></div></div></div><div class="wdform_column"><div wdid="46" class="wdform_row"><div type="type_radio" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio" ><div class="wdform-label-section wd-width-100  wd-flex-wrap wd-flex-row">
    <label  class="wdform-label">Ik heb het inschrijfgeld overgemaakt:</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-100" ><div class="wd-flex wd-flex-row"><input type="hidden" name="wdform_46_element15" value="" /><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_46_element150" name="wdform_46_element15" value="Ja" onclick="set_default(&quot;wdform_46&quot;,&quot;0&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_46_element150"><span></span>Ja</label></div><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_46_element151" name="wdform_46_element15" value="Nee" onclick="set_default(&quot;wdform_46&quot;,&quot;1&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_46_element151"><span></span>Nee</label></div></div></div></div></div></div><div class="wdform_column"><div wdid="4" class="wdform_row"><div type="type_name" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_name" ><div class="wdform-label-section wd-width-100  wd-flex-row">
    <label  for="wdform_4_element_first15" class="wdform-label">Naam</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex  wd-flex-row wd-width-100" ><div class="wd-flex wd-flex-column wd-width-50"><input type="text" class="wd-width-100" id="wdform_4_element_first15" name="wdform_4_element_first15" data-value="" value="" title="" placeholder=""  /><label class="mini_label" for="wdform_4_element_first15">Voornaam</label></div><div class="wd-flex wd-flex-column wd-name-separator"></div><div class="wd-flex wd-flex-column wd-width-50"><input type="text" class="wd-width-100" id="wdform_4_element_last15" name="wdform_4_element_last15" data-value="" value="" title="" placeholder=""  /><label class="mini_label" for="wdform_4_element_last15">Achternaam</label></div></div></div></div></div><div class="wdform_column"><div wdid="5" class="wdform_row"><div type="type_date_fields" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_date_fields" ><div class="wdform-label-section wd-width-100 wdform_date_fields wd-flex-row">
    <label  for="wdform_5_day15" class="wdform-label">Geboortedatum</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex wdform_date_fields wd-flex-row wd-width-100" ><div class="wd-flex wd-flex-row wd-width-100 wd-align-items"><div class="wd-flex wd-flex-column"><select id="wdform_5_day15" name="wdform_5_day15" class="wdform_select_day" style="width: 60px;" ><option value=""></option><option value="01" >01</option><option value="02" >02</option><option value="03" >03</option><option value="04" >04</option><option value="05" >05</option><option value="06" >06</option><option value="07" >07</option><option value="08" >08</option><option value="09" >09</option><option value="10" >10</option><option value="11" >11</option><option value="12" >12</option><option value="13" >13</option><option value="14" >14</option><option value="15" >15</option><option value="16" >16</option><option value="17" >17</option><option value="18" >18</option><option value="19" >19</option><option value="20" >20</option><option value="21" >21</option><option value="22" >22</option><option value="23" >23</option><option value="24" >24</option><option value="25" >25</option><option value="26" >26</option><option value="27" >27</option><option value="28" >28</option><option value="29" >29</option><option value="30" >30</option><option value="31" >31</option></select><label for="wdform_5_day15" class="mini_label">dag</label></div><span class="wdform_separator">&nbsp;/&nbsp;</span><div class="wd-flex wd-flex-column"><select id="wdform_5_month15" name="wdform_5_month15" class="wdform_select_month" style="width: 100px;" ><option value=""></option><option value="01"   >January</option><option value="02" >February</option><option value="03" >March</option><option value="04"  >April</option><option value="05"  >May</option><option value="06"  >June</option><option value="07"  >July</option><option value="08"  >August</option><option value="09"  >September</option><option value="10"  >October</option><option value="11" >November</option><option value="12"  >December</option></select><label for="wdform_5_month15" class="mini_label">maand</label></div><span class="wdform_separator">&nbsp;/&nbsp;</span><div class="wd-flex wd-flex-column"><select id="wdform_5_year15" name="wdform_5_year15"  from="1901" to="2023" class="wdform_select_year" style="width: 80px;" ><option value=""></option><option value="2023" >2023</option><option value="2022" >2022</option><option value="2021" >2021</option><option value="2020" >2020</option><option value="2019" >2019</option><option value="2018" >2018</option><option value="2017" >2017</option><option value="2016" >2016</option><option value="2015" >2015</option><option value="2014" >2014</option><option value="2013" >2013</option><option value="2012" >2012</option><option value="2011" >2011</option><option value="2010" >2010</option><option value="2009" >2009</option><option value="2008" >2008</option><option value="2007" >2007</option><option value="2006" >2006</option><option value="2005" >2005</option><option value="2004" >2004</option><option value="2003" >2003</option><option value="2002" >2002</option><option value="2001" >2001</option><option value="2000" >2000</option><option value="1999" >1999</option><option value="1998" >1998</option><option value="1997" >1997</option><option value="1996" >1996</option><option value="1995" >1995</option><option value="1994" >1994</option><option value="1993" >1993</option><option value="1992" >1992</option><option value="1991" >1991</option><option value="1990" >1990</option><option value="1989" >1989</option><option value="1988" >1988</option><option value="1987" >1987</option><option value="1986" >1986</option><option value="1985" >1985</option><option value="1984" >1984</option><option value="1983" >1983</option><option value="1982" >1982</option><option value="1981" >1981</option><option value="1980" >1980</option><option value="1979" >1979</option><option value="1978" >1978</option><option value="1977" >1977</option><option value="1976" >1976</option><option value="1975" >1975</option><option value="1974" >1974</option><option value="1973" >1973</option><option value="1972" >1972</option><option value="1971" >1971</option><option value="1970" >1970</option><option value="1969" >1969</option><option value="1968" >1968</option><option value="1967" >1967</option><option value="1966" >1966</option><option value="1965" >1965</option><option value="1964" >1964</option><option value="1963" >1963</option><option value="1962" >1962</option><option value="1961" >1961</option><option value="1960" >1960</option><option value="1959" >1959</option><option value="1958" >1958</option><option value="1957" >1957</option><option value="1956" >1956</option><option value="1955" >1955</option><option value="1954" >1954</option><option value="1953" >1953</option><option value="1952" >1952</option><option value="1951" >1951</option><option value="1950" >1950</option><option value="1949" >1949</option><option value="1948" >1948</option><option value="1947" >1947</option><option value="1946" >1946</option><option value="1945" >1945</option><option value="1944" >1944</option><option value="1943" >1943</option><option value="1942" >1942</option><option value="1941" >1941</option><option value="1940" >1940</option><option value="1939" >1939</option><option value="1938" >1938</option><option value="1937" >1937</option><option value="1936" >1936</option><option value="1935" >1935</option><option value="1934" >1934</option><option value="1933" >1933</option><option value="1932" >1932</option><option value="1931" >1931</option><option value="1930" >1930</option><option value="1929" >1929</option><option value="1928" >1928</option><option value="1927" >1927</option><option value="1926" >1926</option><option value="1925" >1925</option><option value="1924" >1924</option><option value="1923" >1923</option><option value="1922" >1922</option><option value="1921" >1921</option><option value="1920" >1920</option><option value="1919" >1919</option><option value="1918" >1918</option><option value="1917" >1917</option><option value="1916" >1916</option><option value="1915" >1915</option><option value="1914" >1914</option><option value="1913" >1913</option><option value="1912" >1912</option><option value="1911" >1911</option><option value="1910" >1910</option><option value="1909" >1909</option><option value="1908" >1908</option><option value="1907" >1907</option><option value="1906" >1906</option><option value="1905" >1905</option><option value="1904" >1904</option><option value="1903" >1903</option><option value="1902" >1902</option><option value="1901" >1901</option></select><label for="wdform_5_year15" class="mini_label">jaar</label></div></div></div></div></div></div><div class="wdform_column"><div wdid="6" class="wdform_row"><div type="type_radio" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio" ><div class="wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column">
    <label  class="wdform-label">Geslacht</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100" ><div class="wd-flex wd-flex-column"><input type="hidden" name="wdform_6_element15" value="" /><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_6_element150" name="wdform_6_element15" value="Man" onclick="set_default(&quot;wdform_6&quot;,&quot;0&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_6_element150"><span></span>Man</label></div><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_6_element151" name="wdform_6_element15" value="Vrouw" onclick="set_default(&quot;wdform_6&quot;,&quot;1&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_6_element151"><span></span>Vrouw</label></div></div></div></div></div></div><div class="wdform_column"><div wdid="7" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_address" class="wdform-field wd-width-100 wd-flex wd-flex-row fm-type_address" ><div class="wdform-label-section wd-width-30 wd-hidden wdform_address wd-flex-column">
    <label  for="wdform_7_street115" class="wdform-label">Adres</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex wdform_address wd-flex-column wd-width-100" ><span class="wd-width-100 wd-flex wd-flex-row wd-flex-wrap wd-justify-content"><span class="wd-width-49 wd-address" id="wdform_7_address_2">
                <input class="wd-width-100 wdform_7_address_2" type="text" id="wdform_7_city15" name="wdform_9_city15" value=""  />
                <label for="wdform_7_city15" class="mini_label">Plaats</label></span></span></div></div></div></div><div class="wdform_column"><div wdid="14" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_submitter_mail" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_submitter_mail" ><div class="wdform-label-section wd-width-100  wd-flex-row">
    <label  for="wdform_14_element15" class="wdform-label">Email</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex  wd-flex-row wd-width-100" ><input type="text" class="wd-width-100" id="wdform_14_element15" name="wdform_14_element15" data-value="" value="" title="" placeholder=""   onchange="wd_check_email('14', '15', 'This is not a valid email address.')" /></div></div></div></div><div class="wdform_column"><div wdid="17" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_text" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text" ><div class="wdform-label-section wd-width-100  wd-flex-row wd-align-items-center">
    <label  for="wdform_17_element15" class="wdform-label">Vereninging</label></div><div class="wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100" ><input type="text"
                           class="wd-width-100"
                           id="wdform_17_element15"
                           name="wdform_17_element15"
                           value=""
                           data-value=""
                           title=""
                           placeholder=""
                           
                            /></div></div></div></div><div class="wdform_column"><div wdid="47" class="wdform_row"><div type="type_radio" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio" ><div class="wdform-label-section wd-width-100  wd-flex-wrap wd-flex-row">
    <label  class="wdform-label">Afstand</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-100" ><div class="wd-flex wd-flex-row"><input type="hidden" name="wdform_47_element15" value="" /><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_47_element150" name="wdform_47_element15" value="5 km" onclick="set_default(&quot;wdform_47&quot;,&quot;0&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_47_element150"><span></span>5 km</label></div><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_47_element151" name="wdform_47_element15" value="10 km" onclick="set_default(&quot;wdform_47&quot;,&quot;1&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_47_element151"><span></span>10 km</label></div><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_47_element152" name="wdform_47_element15" value="1 km" onclick="set_default(&quot;wdform_47&quot;,&quot;2&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_47_element152"><span></span>1 km</label></div></div></div></div></div></div><div class="wdform_column"><div wdid="51" class="wdform_row"><div type="type_own_select" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select" ><div class="wdform-label-section wd-width-100 wdform_select wd-flex-row">
    <label  for="wdform_51_element15" class="wdform-label">Ik wil me inschrijven voor de kopjesloop van</label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100" ><select class="wd-width-100" id="wdform_51_element15" name="wdform_51_element15" ><option value="14 juni" selected="selected">14 juni</option></select></div></div></div></div><div class="wdform_column"><div wdid="20" class="wdform_row"><div type="type_editor" class="wdform-field"><div class="wdform-section-break-div" style="min-width: 300px; border-top:1px solid"></div></div></div></div><div class="wdform_column"><div wdid="29" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_textarea" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea" ><div class="wdform-label-section wd-width-100 ">
    <label  for="wdform_29_element15" class="wdform-label">Toelichting/opmerking</label></div><div class="wdform-element-section wd-flex  wd-width-100" style="max-width: 250px;"><textarea class="wd-width-100"
                      id="wdform_29_element15"
                      name="wdform_29_element15"
                      placeholder=""
                      data-value=""
                      maxlength=""
                      style="height: 100px;"
                      ></textarea></div></div></div></div><div class="wdform_column"><div wdid="34" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><div class="wdform-section-break-div" style="min-width: 300px; border-top:1px solid"></div></div></div></div><div class="wdform_column"><div wdid="31" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_editor" class="wdform-field"><b>Algemene Verordening Persoonsgegevens (AVG / GDPR)</b>

AV De Koplopers: <b><a href="../privacy-policy/#lid" target="_blank" rel="noopener">Privacy Policy</a></b>

Atletiekunie: <b><a href="https://www.atletiekunie.nl/privacy-statement" target="_blank" rel="noopener">Privacy Statement</a></b></div></div></div><div class="wdform_column"><div wdid="32" class="wdform_row" style="position: relative; left: 0px; top: 0px;"><div type="type_radio" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio" ><div class="wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column">
    <label  class="wdform-label">Ik ga akkoord met de verwerking van persoonsgegevens door de vereniging zoals vastgelegd in de <a href="../privacy-policy/#lid" target="_blank" rel="noopener">Privacy Policy</a> en door de bond zoals vastgelegd in het <a href="https://www.atletiekunie.nl/privacy-statement" target="_blank" rel="noopener">Privacy Statement</a></label><span class="wdform-required">*</span></div><div class="wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100" ><div class="wd-flex wd-flex-column"><input type="hidden" name="wdform_32_element15" value="" /><div class="radio-div wd-choice wd-flex wd-flex-row"><input type="radio"  id="wdform_32_element150" name="wdform_32_element15" value="Ja" onclick="set_default(&quot;wdform_32&quot;,&quot;0&quot;,&quot;15&quot;); "   /><label class="wd-align-items-center wd-flex wd-flex-row" for="wdform_32_element150"><span></span>Ja</label></div></div></div></div></div></div><div class="wdform_column"><div wdid="33" class="wdform_row"><div type="type_radio" class="wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio" ><div class="wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column">
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