&nbsp;<!--webbot BOT="GeneratedScript" PREVIEW=" " startspan --><script Language="JavaScript"><!--
function FrontPage_Form1_Validator(theForm)
{

  if (theForm.Achternaam.value == "")
  {
    alert("Please enter a value for the \"\"Achternaam\"\" field.");
    theForm.Achternaam.focus();
    return (false);
  }

  if (theForm.Achternaam.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"\"Achternaam\"\" field.");
    theForm.Achternaam.focus();
    return (false);
  }

  if (theForm.Voornaam.value == "")
  {
    alert("Please enter a value for the \"\"Voornaam\"\" field.");
    theForm.Voornaam.focus();
    return (false);
  }

  if (theForm.Voornaam.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"\"Voornaam\"\" field.");
    theForm.Voornaam.focus();
    return (false);
  }

  if (theForm.Adres.value == "")
  {
    alert("Please enter a value for the \"\"Adres\"\" field.");
    theForm.Adres.focus();
    return (false);
  }

  if (theForm.Adres.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"\"Adres\"\" field.");
    theForm.Adres.focus();
    return (false);
  }

  if (theForm.Huisnummer.value == "")
  {
    alert("Please enter a value for the \"\"Huisnummer\"\" field.");
    theForm.Huisnummer.focus();
    return (false);
  }

  if (theForm.Huisnummer.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"\"Huisnummer\"\" field.");
    theForm.Huisnummer.focus();
    return (false);
  }

  var checkOK = "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzƒŠŒŽšœžŸÀÁÂÃÄÅÆÇÈÉÊËÌÍÎÏÐÑÒÓÔÕÖØÙÚÛÜÝÞßàáâãäåæçèéêëìíîïðñòóôõöøùúûüýþÿ0123456789- \t\r\n\f";
  var checkStr = theForm.Huisnummer.value;
  var allValid = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only letter, digit and whitespace characters in the \"\"Huisnummer\"\" field.");
    theForm.Huisnummer.focus();
    return (false);
  }

  if (theForm.Postcode.value == "")
  {
    alert("Please enter a value for the \"\" Postcode\" (0000AA)\" field.");
    theForm.Postcode.focus();
    return (false);
  }

  if (theForm.Postcode.value.length < 6)
  {
    alert("Please enter at least 6 characters in the \"\" Postcode\" (0000AA)\" field.");
    theForm.Postcode.focus();
    return (false);
  }

  if (theForm.Postcode.value.length > 6)
  {
    alert("Please enter at most 6 characters in the \"\" Postcode\" (0000AA)\" field.");
    theForm.Postcode.focus();
    return (false);
  }

  var checkOK = "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzƒŠŒŽšœžŸÀÁÂÃÄÅÆÇÈÉÊËÌÍÎÏÐÑÒÓÔÕÖØÙÚÛÜÝÞßàáâãäåæçèéêëìíîïðñòóôõöøùúûüýþÿ0123456789-";
  var checkStr = theForm.Postcode.value;
  var allValid = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only letter and digit characters in the \"\" Postcode\" (0000AA)\" field.");
    theForm.Postcode.focus();
    return (false);
  }

  if (theForm.Woonplaats.value == "")
  {
    alert("Please enter a value for the \"\"Woonplaats\"\" field.");
    theForm.Woonplaats.focus();
    return (false);
  }

  if (theForm.Woonplaats.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"\"Woonplaats\"\" field.");
    theForm.Woonplaats.focus();
    return (false);
  }

  if (theForm.Geboortedatum.value == "")
  {
    alert("Please enter a value for the \"\"Geboortedatum\" (00-00-0000)\" field.");
    theForm.Geboortedatum.focus();
    return (false);
  }

  if (theForm.Geboortedatum.value.length < 10)
  {
    alert("Please enter at least 10 characters in the \"\"Geboortedatum\" (00-00-0000)\" field.");
    theForm.Geboortedatum.focus();
    return (false);
  }

  if (theForm.Geboortedatum.value.length > 10)
  {
    alert("Please enter at most 10 characters in the \"\"Geboortedatum\" (00-00-0000)\" field.");
    theForm.Geboortedatum.focus();
    return (false);
  }

  var checkOK = "0123456789--";
  var checkStr = theForm.Geboortedatum.value;
  var allValid = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only digit and \"-\" characters in the \"\"Geboortedatum\" (00-00-0000)\" field.");
    theForm.Geboortedatum.focus();
    return (false);
  }

  if (theForm.to.value == "")
  {
    alert("Please enter a value for the \"to\" field.");
    theForm.to.focus();
    return (false);
  }

  if (theForm.to.value.length < 5)
  {
    alert("Please enter at least 5 characters in the \"to\" field.");
    theForm.to.focus();
    return (false);
  }

  if (theForm.e-mail Ouder 2.value == "")
  {
    alert("Please enter a value for the \"e-mail Ouder 2\" field.");
    theForm.e-mail Ouder 2.focus();
    return (false);
  }

  if (theForm.e-mail Ouder 2.value.length < 5)
  {
    alert("Please enter at least 5 characters in the \"e-mail Ouder 2\" field.");
    theForm.e-mail Ouder 2.focus();
    return (false);
  }

  if (theForm.e-mail kind.value == "")
  {
    alert("Please enter a value for the \"e-mail kind\" field.");
    theForm.e-mail kind.focus();
    return (false);
  }

  if (theForm.e-mail kind.value.length < 5)
  {
    alert("Please enter at least 5 characters in the \"e-mail kind\" field.");
    theForm.e-mail kind.focus();
    return (false);
  }

  if (theForm.Bankrekeningnummer.value == "")
  {
    alert("Please enter a value for the \"\"Bankrekeningnummer\"\" field.");
    theForm.Bankrekeningnummer.focus();
    return (false);
  }

  if (theForm.Bankrekeningnummer.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"\"Bankrekeningnummer\"\" field.");
    theForm.Bankrekeningnummer.focus();
    return (false);
  }

  if (theForm.Bankrekeningnummer.value.length > 9)
  {
    alert("Please enter at most 9 characters in the \"\"Bankrekeningnummer\"\" field.");
    theForm.Bankrekeningnummer.focus();
    return (false);
  }

  var checkOK = "0123456789-";
  var checkStr = theForm.Bankrekeningnummer.value;
  var allValid = true;
  var decPoints = 0;
  var allNum = "";
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"\"Bankrekeningnummer\"\" field.");
    theForm.Bankrekeningnummer.focus();
    return (false);
  }
  return (true);
}
//--></script><!--webbot BOT="GeneratedScript" endspan --><form action="http://www.xs4all.nl/cgi-bin/mail-a-form" method="post" onsubmit="return FrontPage_Form1_Validator(this)" name="FrontPage_Form1">
    <INPUT TYPE="hidden" NAME="subject" VALUE="Inschrijfformulier ARV Achilleskamp 2010">

    <input type="hidden" name="to" value="Jeugdkamp@arvachilles.nl"/>
  
 <!--  <input type="hidden" name="nextpage" value="http://www.xs4all.nl/~marschoo/ARVAchilles/bedankt.html"> -->
   
    <table id="table2" style="BORDER-COLLAPSE: collapse" cellspacing="0" cellpadding="0" width="100%" border="0">
        <tbody>
            <tr>
                <td bgcolor="#60c8ff">
                <p align="center"><b><span lang="nl"><font face="Arial" color="#2369aa" size="3">Inschrijfformulier</font></span><font face="Arial" color="#2369aa" size="3"> 
                Achilleskamp, vrijdag 22 tm zondag 24 oktober 2010</font></b></p>
                </td>
            </tr>
            <tr>
                <td>
                Graag alle gegevens in vullen.&nbsp;Alleen volledig ingevulde formulieren worden
                  geaccepteerd.</td>
            </tr>
        </tbody>
    </table>
    <div align="left">
    <table id="table3" style="text-align: left; margin-left: 0px" cellspacing="0" cellpadding="0" width="698" align="left" border="1">
        <tbody>
            <tr>
                <td align="right" width="178">Achternaam: </td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation" S-Display-Name="&quot;Achternaam&quot;"
                  B-Value-Required="TRUE" I-Minimum-Length="2" --><input tabindex="2" size="52" name="Achternaam"/>*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Voornaam:</td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation" S-Display-Name="&quot;Voornaam&quot;"
                  B-Value-Required="TRUE" I-Minimum-Length="2" --><input tabindex="3" size="52" name="Voornaam"/>*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Adres:</td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation" S-Display-Name="&quot;Adres&quot;"
                  B-Value-Required="TRUE" I-Minimum-Length="2" --><input tabindex="4" size="52" name="Adres"/>*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Huisnummer:</td>
                <td valign="top" width="514"><!--webbot bot="Validation"
                  s-display-name="&quot;Huisnummer&quot;" s-data-type="String"
                  b-allow-letters="TRUE" b-allow-digits="TRUE"
                  b-allow-whitespace="TRUE" b-value-required="TRUE"
                  i-minimum-length="1" --><input tabindex="5" size="52" name="Huisnummer"/>*</td>
            </tr>
            <tr>
                <td align="right" width="178">Postcode:</td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation"
                  s-display-name="&quot; Postcode&quot; (0000AA)"
                  s-data-type="String" b-allow-letters="TRUE"
                  b-allow-digits="TRUE" b-value-required="TRUE"
                  i-minimum-length="6" i-maximum-length="6" --><input title="Your Google Toolbar can fill this in for you. Select AutoFill" style="BACKGROUND-COLOR: #ffffa0" tabindex="6" maxlength="6" size="52" name="Postcode"/>*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Woonplaats:</td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation" S-Display-Name="&quot;Woonplaats&quot;"
                  B-Value-Required="TRUE" I-Minimum-Length="2" --><input tabindex="7" size="52" name="Woonplaats"/>*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Geboortedatum:</td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation"
                  s-display-name="&quot;Geboortedatum&quot; (00-00-0000)"
                  s-data-type="String" b-allow-digits="TRUE"
                  s-allow-other-chars="-" b-value-required="TRUE"
                  i-minimum-length="10" i-maximum-length="10" --><input tabindex="8" maxlength="10" size="52" name="Geboortedatum"/>*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Jongen / Meisje:</td>
                <td valign="top" width="514"><select name="Geslacht" size="1" tabindex="9">
                <option selected>Jongen</option>
                <option>Meisje</option>
                  </select><font face="Arial" size="3">*</font></td>
            </tr>
            <tr>
                <td align="right" width="178">E-mailadres Ouder/Verzorger:</td>
                <td valign="top" width="514"><!--webbot bot="Validation"
                  B-Value-Required="TRUE" I-Minimum-Length="5" --><input Type="text" name="to" size="52" tabindex="10"><font face="Arial" size="3">*&nbsp;</font></td>
            </tr>
            <tr>
                <td align="right" width="178">E-mailadres Ouder/Verzorger 2:</td>
                <td valign="top" width="514"><!--webbot bot="Validation"
                  B-Value-Required="TRUE" I-Minimum-Length="5" --><input Type="text" name="e-mail Ouder 2" size="52" tabindex="11" value="nvt">Optioneel</td>
            </tr>
            <tr>
                <td align="right" width="178">E-mailadres kind:</td>
                <td valign="top" width="514"><!--webbot bot="Validation"
                  B-Value-Required="TRUE" I-Minimum-Length="5" --><input Type="text" name="e-mail kind" size="52" tabindex="12" value="nvt">Optioneel</td>
            </tr>
            <tr>
                <td align="right" width="178">Telefoonnummer:<br>
              </td>
                <td valign="top" width="514"><font face="Arial" size="3"><input tabindex="15" size="52" name="Telefoonnummer"/>*<br>
                  </font><font color="#FF0000">Waarop ouder ook bereikbaar is
                  gedurende kamp</font></td>
            </tr>
            <tr>
                <td align="right" width="178">Telefoonnummer 2:<br>
                </td>
                <td valign="top" width="514"><font face="Arial" size="3"><input tabindex="16" size="52" name="Telefoonnummer 2" value="nvt"/></font>Optioneel</td>
            </tr>
            <tr>
                <td align="right" width="178">Bankrekeningnummer:</td>
                <td valign="top" width="514"><font face="Arial" size="3"><!--webbot
                  bot="Validation"
                  s-display-name="&quot;Bankrekeningnummer&quot;"
                  s-data-type="Integer" s-number-separators="x"
                  b-value-required="TRUE" i-minimum-length="1"
                  i-maximum-length="9" --><input tabindex="20" maxlength="9" size="52" name="Bankrekeningnummer"/>*</font></td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" width="178">Lidmaatschap:</td>
                <td width="514"><select name="Lidmaatschap" size="1" tabindex="21">
                    <option>Jeugd recreanten 2 of 3</option>
                <option>A-Pupil 2e jaars</option>
                <option>D-Junior</option>
                    <option>C-Junior</option>
                  </select><font face="Arial" size="3">* </font></td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" bgcolor="#60c8ff" colspan="2" width="694">
                <p style="TEXT-ALIGN: left"><b><font color="#2369aa">Vrijwilliger
                Van Oers Marathon Brabant d.d. 31-okt-2010</font></b></p>
                </td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" width="692" colspan="2">
                  <p align="left">Indien je als vrijwilliger meehelpt bij de Van
                  Oers Marathon Brabant op zondag 31 oktober 2010, dan krijg je
                  10 Euro van het inschrijfgeld terug<span style="FONT-SIZE: 11pt; COLOR: #1f497d; FONT-FAMILY: 'Calibri','sans-serif'"></o:p>
                  </span></td>
            </tr>
            <tr>
                <td align="right" width="178">Uw keuze:</td>
                <td valign="top" width="514"><select name="Vrijwilliger tijdens Marathon Brabant" size="1" tabindex="22">
                <option selected>Ik geef me niet op als vrijwilliger voor
                Marathon Brabant</option>
                <option>Ik geef me op als vrijwilliger voor Marathon Brabant</option>
                  </select><font face="Arial" size="3">*</font></td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" bgcolor="#60c8ff" colspan="2" width="694">
                <p style="TEXT-ALIGN: left"><b><font color="#2369aa">Akkoord
                Inschrijving en machtiging voor automatisch incasso</font></b></p>
                </td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" width="692" colspan="2">
                  <p align="left"><span style="font-size: 11pt; color: #1f497d; font-family: Calibri, sans-serif">Ondergetekende verleent hierbij de uitdrukkelijke machtiging aan de penningmeester van ARV Achilles te Etten-Leur om van zijn of haar op het online aanmeldformulier ingevulde giro- of bankrekening af te schrijven de verschuldigde inschrijfkosten voor
                  het Achilleskamp t.w. van 42,50 Euro per persoon<br>
                  <br>
                  Ondergetekende verklaart de ingevoerde gegevens volledig en naar waarheid te hebben ingevuld en tevens op de hoogte te zijn van en akkoord te gaan met de gestelde voorwaarden, zoals betaling via automatische
                  incasso*</span><span style="FONT-SIZE: 11pt; COLOR: #1f497d; FONT-FAMILY: 'Calibri','sans-serif'"></o:p>
                  </span></td>
                 
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" width="178">Machtiging:</td>
                <td width="514">
                  <font face="Arial"><input tabindex="30" type="radio" name="SchriftelijkeMachtiging" value="Ondergetekende verleent hierbij de uitdrukkelijke machtiging aan de penningmeester van ARV Achilles te Etten-Leur om van zijn of haar op het online aanmeldformulier ingevulde giro- of bankrekening af te schrijven de verschuldigde inschrijfkosten voor het Achilleskamp t.w. van 42,50 Euro per persoon" checked/ checked></font>Hierbij
                  ga ik akkoord met de regeling zoals hierboven vermeld*
                </td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" width="178">&nbsp;</td>
                <td width="514">
                  <p align="right"><font size="2">*)&nbsp; Verplichte velden.<br/>
                  </font></p>
                </td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" width="178">Bijzonderheden&nbsp;<br>
                  Medicijngebruik&nbsp;<br>
                  Opmerking:</td>
                <td width="514"><font face="Arial" size="3"><textarea tabindex="50" name="Bijzonderheden" rows="10" cols="47">

</textarea></font></td>
            </tr>
            <tr>
                <td style="TEXT-ALIGN: right" valign="top" colspan="2" width="694">
                <p style="TEXT-ALIGN: left"><font face="Arial" size="3"><input type="reset" name="reset" value="Wissen"/>&nbsp;&nbsp;&nbsp;
                <input tabindex="21" type="submit" value="Versturen"/></font></p>
                </td>
            </tr>
        </tbody>
    </table>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    </div>
    <p><!-- Hieronder kunt u een verborgen onderwerp voor het e-mailbericht meesturen --><input type="hidden" name="subject" value="aanmelding nieuw lid"/> <!-- Hieronder staan de knoppen om het bericht te wissen en/of te versturen -->&nbsp; </p>
</form>
<table>
<td width="30"></td>
&nbsp;