{"id":3234,"date":"2017-07-06T23:01:11","date_gmt":"2017-07-06T21:01:11","guid":{"rendered":"https:\/\/www.dekoplopers.nl\/?page_id=3234"},"modified":"2025-12-13T22:00:28","modified_gmt":"2025-12-13T21:00:28","slug":"inschrijfformulier-reanimatiecursus","status":"publish","type":"page","link":"https:\/\/dekoplopers.nl\/en\/home\/trainingen-cursussen\/inschrijfformulier-reanimatiecursus\/","title":{"rendered":"Inschrijfformulier Reanimatiecursus"},"content":{"rendered":"<div style=\"display:none\" class=\"fm-form-container fm-theme0\"><div id=\"fm-pages18\" class=\"fm-pages wdform_page_navigation\" show_title=\"\" show_numbers=\"1\" type=\"none\"><\/div><form name=\"form18\" action=\"\/en\/wp-json\/wp\/v2\/pages\/3234\" method=\"post\" id=\"form18\" class=\"fm-form form18\" enctype=\"multipart\/form-data\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/3234\"><input type=\"hidden\" id=\"fm_page_id18\" value=\"3234\" name=\"fm_page_id18\" \/><input type=\"hidden\" id=\"fm_current_post_type18\" value=\"page\" name=\"fm_current_post_type18\" \/><input type=\"hidden\" id=\"counter18\" value=\"52\" name=\"counter18\" \/><input type=\"hidden\" id=\"Itemid18\" value=\"\" name=\"Itemid18\" \/><input type=\"hidden\" id=\"fm_shake18\" value=\"1\" name=\"fm_shake18\" \/><input type=\"text\" class=\"fm-hide\" id=\"fm_empty_field_validation18\" value=\"\" name=\"fm_empty_field_validation18\" data-value=\"bd736efb144d599cf463541431fbf5c4\" \/><input type=\"hidden\" id=\"fm_ajax_url18\" data-ajax_url=\"https:\/\/dekoplopers.nl\/wp-admin\/admin-ajax.php?action=fm_submit_form&current_id=18&formType=embedded\" \/><input type=\"hidden\" id=\"fm_ajax_redirect_url18\" data-ajax_redirect_url=\"0\" \/><input type=\"hidden\" id=\"fm_form_nonce18\" name=\"fm_form_nonce18\" value=\"f632f7a9f3\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/3234\" \/><div class=\"wdform-page-and-images fm-form-builder\"><div id=\"18form_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=\"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=\"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_first18\" 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_first18\" name=\"wdform_4_element_first18\" data-value=\"\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_4_element_first18\">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_last18\" name=\"wdform_4_element_last18\" data-value=\"\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_4_element_last18\">Achternaam<\/label><\/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_street118\" 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_city18\" name=\"wdform_9_city18\" value=\"\"  \/>                <label for=\"wdform_7_city18\" class=\"mini_label\">Woonplaats<\/label><\/span><\/span><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"50\" class=\"wdform_row\"><div type=\"type_phone_new\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_phone_new\" ><div class=\"wdform-label-section wd-width-100\">    <label  for=\"wdform_50_element18\" class=\"wdform-label\">Telefoon<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><input type=\"text\"                       class=\"wd-width-100\"                       id=\"wdform_50_element18\"                       name=\"wdform_50_element18\"                       value=\"\"                       data-value=\"\"                       placeholder=\"\"  \/><\/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_element18\" 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_element18\" name=\"wdform_14_element18\" data-value=\"\" value=\"\" title=\"\" placeholder=\"\"   onchange=\"wd_check_email('14', '18', 'This is not a valid email address.')\" \/><\/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-column\">    <label  class=\"wdform-label\">Cursus<\/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_47_element18\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_47_element180\" name=\"wdform_47_element18\" value=\"beginnerscursus (dinsdag 20 januari 2026)\" onclick=\"set_default(&quot;wdform_47&quot;,&quot;0&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_47_element180\"><span><\/span>beginnerscursus (dinsdag 20 januari 2026)<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_47_element181\" name=\"wdform_47_element18\" value=\"herhalingscursus (dinsdag 27 januari 2026)\" onclick=\"set_default(&quot;wdform_47&quot;,&quot;1&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_47_element181\"><span><\/span>herhalingscursus (dinsdag 27 januari 2026)<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"20\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><p>N.B.: Naam en woonplaats worden afgedrukt op het certificaat.<br data-mce-bogus=\"1\"><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"51\" 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_element18\" 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_element18\"                      name=\"wdform_29_element18\"                      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_element18\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_32_element180\" name=\"wdform_32_element18\" value=\"Ja\" onclick=\"set_default(&quot;wdform_32&quot;,&quot;0&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_32_element180\"><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\">    <label  class=\"wdform-label\">Ik ga akkoord met de publicatie van beeldmateriaal van de cursus<\/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_33_element18\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_33_element180\" name=\"wdform_33_element18\" value=\"Ja\" onclick=\"set_default(&quot;wdform_33&quot;,&quot;0&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_33_element180\"><span><\/span>Ja<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_33_element181\" name=\"wdform_33_element18\" value=\"Nee\" onclick=\"set_default(&quot;wdform_33&quot;,&quot;1&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_33_element181\"><span><\/span>Nee<\/label><\/div><\/div><\/div><\/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=\"38\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><p>We vragen je om het cursusgeld vooraf over te maken. Het inschrijfgeld de cursus bedraagt \u20ac37,95. Voor leden draagt de club 10,0. Hoofdtrainers en trainers van IHG zijn vrijgesteld van bijdrage.<br>Mocht de cursus onverhoopt niet door kunnen gaan zal het inschrijfgeld worden teruggestort.<br><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 <strong>Reanimatiecursus 2026<\/strong><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"41\" 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><\/p><p><a data-mce-href=\"https:\/\/www.ing.nl\/payreq\/m\/?trxid=QjDML2HFZ1IcLgJvoPOKk5n3vU7fR67u\" href=\"https:\/\/www.ing.nl\/payreq\/m\/?trxid=QjDML2HFZ1IcLgJvoPOKk5n3vU7fR67u\" data-mce-selected=\"inline-boundary\">https:\/\/www.ing.nl\/payreq\/m\/?trxid=QjDML2HFZ1IcLgJvoPOKk5n3vU7fR67u<\/a><\/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): <a href=\"https:\/\/www.ing.nl\/payreq\/m\/?trxid=QjDML2HFZ1IcLgJvoPOKk5n3vU7fR67u\" data-mce-href=\"https:\/\/www.ing.nl\/payreq\/m\/?trxid=QjDML2HFZ1IcLgJvoPOKk5n3vU7fR67u\" data-mce-selected=\"inline-boundary\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/dekoplopers.nl\/wp-content\/uploads\/reanimatiecursus\/qrcode_reanimatiecursus2025.jpeg\" alt=\"ING Betaalverzoek\" width=\"200\" height=\"200\" data-mce-src=\"https:\/\/dekoplopers.nl\/wp-content\/uploads\/reanimatiecursus\/qrcode_reanimatiecursus2025.jpeg\"><\/a><\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"46\" 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-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_element18\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element180\" name=\"wdform_46_element18\" value=\"Ja\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;0&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element180\"><span><\/span>Ja<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element181\" name=\"wdform_46_element18\" value=\"Nee\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;1&quot;,&quot;18&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element181\"><span><\/span>Nee<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"37\" class=\"wdform_row\"><div type=\"type_recaptcha\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_recaptcha\" ><div class=\"wdform-label-section wd-width-30 wd-hidden wd-flex-row\">    <label  class=\"wdform-label\">reCAPTCHA<\/label><\/div><div class=\"wdform-element-section wd-flex wd-flex-row wd-width-100\" ><input type=\"hidden\" name=\"recaptcha_response18\" class=\"g-recaptcha\" data-size=\"v3\" id=\"recaptchaV3Response_1837\" data-id=\"37\" data-form-id=\"18\" data-badge=\"inline\" data-sitekey=\"6LcJQHQkAAAAAKrgtlj42NpBa9PvdFMaK-kDA4JX\"><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"1\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_submit_reset\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_submit_reset\" ><div class=\"wdform-element-section wd-flex  wd-flex-row wd-justify-content-left wd-width-100\" ><button  type=\"button\" class=\"button-submit\" onclick=\"fm_submit_form('18');\"  data-ajax=\"1\"><span class=\"fm-submit-loading spinner fm-ico-spinner\"><\/span>Submit<\/button><button  type=\"button\" class=\"button-reset\" onclick=\"fm_reset_form(18);\" >Wissen<\/button><\/div><\/div><\/div><\/div><\/div><div valign=\"top\" class=\"wdform_footer wd-width-100\"><div class=\"wd-width-100\"><div class=\"wd-width-100 wd-table\" style=\"padding-top:10px;\"><div class=\"wd-table-group\"><div id=\"18page_nav1\" class=\"wd-table-row\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_preload\"><\/div><input type=\"hidden\" name=\"fm-current-page\" value=\"https:\/\/dekoplopers.nl\/en\/wp-json\/wp\/v2\/pages\/3234\" \/><input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":5,"featured_media":0,"parent":228509,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"1080","footnotes":""},"class_list":["post-3234","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inschrijfformulier Reanimatiecursus - Atletiek Vereniging De Koplopers<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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