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<script src="/jquery-1.9.1.min.js" type="text/javascript"></script>
<div id="aanmelden_content" >
<p>Vul hieronder uw gegevens in er druk op <strong>'Versturen'</strong>.<br>
We nemen uw aanvraag dan zo spoedig mogelijk in behandeling.</p>
<div id="formresult"><br></div>
<form action="" id="aanmeldform1" name="aanmeldform1" >
<div style='width:49%;float:left;min-width:300px;'>
<div style='clear:both;'>
<div class='col1'>Naam:</div>
<div class='col2' id="naamcheck"><img src='images/verplicht.png' width='16'/></div>
<div class='col3'><input name="naam" id="naam" maxlength="50" /></div>
</div>
<div style='clear:both;'>
<div class='col1'>Postcode:</div>
<div class='col2' id="postcodecheck"><img src='images/verplicht.png' width='16'/></div>
<div class='col3'><input name="postcode" id="postcode" maxlength="7" /></div>
</div>
<div style='clear:both;'>
<div class='col1'>Telefoon:</div>
<div class='col2' id="telefoonnummercheck"><img src='images/verplicht.png' width='16'/></div>
<div class='col3'><input name="telefoonnummer" id="telefoonnummer" maxlength="15"/></div>
</div>
</div>
<div style='width:49%;float:left;min-width:300px;'>
<div style='clear:both;'>
<div class='col1'>Geboortedatum:</div>
<div class='col2' id="geboortedatumcheck"><img src='images/verplicht.png' width='16'/></div>
<div class='col3'><input placeholder="dd-mm-jjjj" name="geboortedatum" id="geboortedatum" maxlength="10" /></div>
</div>
<div style='clear:both;'>
<div class='col1'>Huisnummer:</div>
<div class='col2' id="huisnummercheck"><img src='images/verplicht.png' width='16'/></div>
<div class='col3'><input name="huisnummer" id="huisnummer" maxlength="9"/></div>
</div>
<div style='clear:both;'>
<div class='col1'>Email:</div>
<div class='col2' id="emailcheck"><img src='images/verplicht.png' width='16'/></div>
<div class='col3'><input name="email" id="email" maxlength="50"/></div>
</div>
</div>
<div style='clear:both;'>
Opmerking:<br><textarea name="opmerking" id="opmerking" cols="60" rows="5"></textarea>
</div>
<a href='#' onClick="verstuurHerhaalRecept()" class="versturen_button">Versturen</a>
</form>
<div id="terugbellen_content"></div>
<div id="responseDiv"></div>
</div>
<script type="text/javascript">
jQuery(window).on('load', function() {
initPages();
});;
</script>
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