{"id":80,"date":"2025-12-30T21:21:16","date_gmt":"2025-12-30T20:21:16","guid":{"rendered":"https:\/\/www.medischsportcentrum.nl\/?page_id=80"},"modified":"2026-03-02T22:57:37","modified_gmt":"2026-03-02T21:57:37","slug":"inschrijven","status":"publish","type":"page","link":"https:\/\/www.medischsportcentrum.nl\/index.php\/inschrijven\/","title":{"rendered":"Inschrijven"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:27px;--awb-margin-bottom:0px;--awb-background-image:linear-gradient(67deg, var(--awb-color3) 0%,var(--awb-color2) 100%);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-center fusion-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-one\" style=\"--awb-margin-bottom:20px;--awb-font-size:36px;\"><h1 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;font-size:1em;\"><div style=\"text-align: center;\">Direct inschrijven<\/div><\/h1><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-sizes-bottom:30px;--awb-border-color:var(--awb-color1);--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-bottom:0px;--awb-background-color:var(--awb-color1);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1 fusion-text-no-margin\" style=\"--awb-margin-bottom:0px;\"><p class=\"p1\">Ben je overtuigd en wil je graag sporten bij Medisch Sportcentrum de Brigantijn? Vul dan hieronder jouw contactgegevens in en wij nemen contact met je op voor een intakegesprek.<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-no-small-visibility\" style=\"--awb-border-sizes-bottom:30px;--awb-border-color:var(--awb-color1);--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-bottom:0px;--awb-background-color:var(--awb-color1);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:16.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:11.52%;--awb-spacing-left-medium:11.52%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.88%;--awb-width-medium:66.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:2.88%;--awb-spacing-left-medium:2.88%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form fusion-form-builder fusion-form-form-wrapper fusion-form-83\" style=\"--awb-tooltip-text-color:#ffffff;--awb-tooltip-background-color:#333333;--awb-form-bg-color:var(--awb-color2);--awb-form-placeholder-color:var(--awb-color1);--awb-form-text-color:var(--awb-color4);--awb-form-label-color:var(--awb-color4);--awb-form-border-radius:9px;\" data-form-id=\"83\" data-config=\"{&quot;form_id&quot;:&quot;83&quot;,&quot;form_post_id&quot;:&quot;83&quot;,&quot;post_id&quot;:80,&quot;form_type&quot;:&quot;ajax&quot;,&quot;confirmation_type&quot;:[&quot;redirect&quot;],&quot;redirect_url&quot;:&quot;https:\\\/\\\/www.medischsportcentrum.nl\\\/index.php\\\/bedankt\\\/&quot;,&quot;redirect_timeout&quot;:&quot;0&quot;,&quot;field_labels&quot;:{&quot;keuzepakket&quot;:&quot;Maak keuze voor een pakket&quot;,&quot;looptijd&quot;:&quot;Kies je gewenste looptijd&quot;,&quot;voornaam&quot;:&quot;Voornaam&quot;,&quot;tussenvoegsel&quot;:&quot;Tussenvoegsel&quot;,&quot;achternaam&quot;:&quot;Achternaam&quot;,&quot;geslacht&quot;:&quot;Geslacht&quot;,&quot;geboortedatum&quot;:&quot;Geboortedatum&quot;,&quot;straatnaam&quot;:&quot;Straatnaam&quot;,&quot;huisnummer&quot;:&quot;Huisnr.&quot;,&quot;toevoeging&quot;:&quot;Toevoeging&quot;,&quot;postcode&quot;:&quot;Postcode&quot;,&quot;woonplaats&quot;:&quot;Woonplaats&quot;,&quot;e-mailadres&quot;:&quot;E-mailadres&quot;,&quot;telefoonnummer&quot;:&quot;Telefoonnummer&quot;,&quot;contactpersoon_in_geval_van_nood&quot;:&quot;Contactpersoon in geval van nood&quot;,&quot;telefoonnummer_contactpersoon&quot;:&quot;Telefoonnummer contactpersoon&quot;,&quot;iban_rekeningnummer&quot;:&quot;IBAN Rekeningnummer&quot;,&quot;naam_rekeninghouder&quot;:&quot;Naam rekeninghouder&quot;,&quot;verwerking_persoonsgegevens&quot;:&quot;Persoonsgegevens&quot;,&quot;incasso&quot;:&quot;Incasso&quot;,&quot;voorwaarden2&quot;:&quot;Voorwaarden&quot;},&quot;field_logics&quot;:{&quot;keuzepakket&quot;:&quot;&quot;,&quot;looptijd&quot;:&quot;[]&quot;,&quot;voornaam&quot;:&quot;&quot;,&quot;tussenvoegsel&quot;:&quot;&quot;,&quot;achternaam&quot;:&quot;&quot;,&quot;geslacht&quot;:&quot;&quot;,&quot;geboortedatum&quot;:&quot;&quot;,&quot;straatnaam&quot;:&quot;&quot;,&quot;huisnummer&quot;:&quot;&quot;,&quot;toevoeging&quot;:&quot;&quot;,&quot;postcode&quot;:&quot;&quot;,&quot;woonplaats&quot;:&quot;&quot;,&quot;e-mailadres&quot;:&quot;&quot;,&quot;telefoonnummer&quot;:&quot;&quot;,&quot;contactpersoon_in_geval_van_nood&quot;:&quot;&quot;,&quot;telefoonnummer_contactpersoon&quot;:&quot;&quot;,&quot;iban_rekeningnummer&quot;:&quot;&quot;,&quot;naam_rekeninghouder&quot;:&quot;&quot;,&quot;verwerking_persoonsgegevens&quot;:&quot;&quot;,&quot;incasso&quot;:&quot;&quot;,&quot;voorwaarden2&quot;:&quot;&quot;,&quot;submit_1&quot;:&quot;&quot;},&quot;field_types&quot;:{&quot;keuzepakket&quot;:&quot;radio&quot;,&quot;looptijd&quot;:&quot;radio&quot;,&quot;voornaam&quot;:&quot;text&quot;,&quot;tussenvoegsel&quot;:&quot;text&quot;,&quot;achternaam&quot;:&quot;text&quot;,&quot;geslacht&quot;:&quot;radio&quot;,&quot;geboortedatum&quot;:&quot;date&quot;,&quot;straatnaam&quot;:&quot;text&quot;,&quot;huisnummer&quot;:&quot;text&quot;,&quot;toevoeging&quot;:&quot;text&quot;,&quot;postcode&quot;:&quot;text&quot;,&quot;woonplaats&quot;:&quot;text&quot;,&quot;e-mailadres&quot;:&quot;email&quot;,&quot;telefoonnummer&quot;:&quot;phone_number&quot;,&quot;contactpersoon_in_geval_van_nood&quot;:&quot;text&quot;,&quot;telefoonnummer_contactpersoon&quot;:&quot;phone_number&quot;,&quot;iban_rekeningnummer&quot;:&quot;text&quot;,&quot;naam_rekeninghouder&quot;:&quot;text&quot;,&quot;verwerking_persoonsgegevens&quot;:&quot;checkbox&quot;,&quot;incasso&quot;:&quot;checkbox&quot;,&quot;voorwaarden2&quot;:&quot;checkbox&quot;,&quot;submit_1&quot;:&quot;submit&quot;},&quot;nonce_method&quot;:&quot;ajax&quot;,&quot;form_views&quot;:&quot;&quot;,&quot;form_views_counting&quot;:&quot;&quot;}\"><form action=\"https:\/\/www.medischsportcentrum.nl\/index.php\/inschrijven\/\" method=\"post\" class=\"fusion-form fusion-form-83\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Maak keuze voor een pakket <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-radio\"><input data-empty-notice=\"Kies je pakket\" tabindex=\"\" id=\"radio-keuzepakket-1-0\" type=\"radio\" value=\"Basis\" name=\"keuzepakket\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-keuzepakket-1-0\">Basis<\/label><\/div><div class=\"fusion-form-radio\"><input data-empty-notice=\"Kies je pakket\" tabindex=\"\" id=\"radio-keuzepakket-1-1\" type=\"radio\" value=\"Vitaal\" name=\"keuzepakket\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-keuzepakket-1-1\">Vitaal<\/label><\/div><div class=\"fusion-form-radio\"><input data-empty-notice=\"Kies je pakket\" tabindex=\"\" id=\"radio-keuzepakket-1-2\" type=\"radio\" value=\"Optimaal\" name=\"keuzepakket\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-keuzepakket-1-2\">Optimaal<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Kies je gewenste looptijd <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-radio option-inline\"><input data-empty-notice=\"Kies je looptijd\" tabindex=\"\" id=\"radio-looptijd-2-0\" type=\"radio\" value=\"6 maanden\" name=\"looptijd\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-looptijd-2-0\">6 maanden<\/label><\/div><div class=\"fusion-form-radio option-inline\"><input data-empty-notice=\"Kies je looptijd\" tabindex=\"\" id=\"radio-looptijd-2-1\" type=\"radio\" value=\"12 maanden\" name=\"looptijd\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-looptijd-2-1\">12 maanden<\/label><\/div><div class=\"fusion-form-radio option-inline\"><input data-empty-notice=\"Kies je looptijd\" tabindex=\"\" id=\"radio-looptijd-2-2\" type=\"radio\" value=\"24 maanden\" name=\"looptijd\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-looptijd-2-2\">24 maanden<\/label><\/div><\/fieldset><\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Persoonlijke informatie<\/h3><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"voornaam\">Voornaam <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user-alt fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"voornaam\" id=\"voornaam\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-0 fusion_builder_column_inner_1_4 1_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:25%;--awb-margin-top-large:0px;--awb-spacing-right-large:7.68%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:7.68%;--awb-width-medium:25%;--awb-order-medium:0;--awb-spacing-right-medium:7.68%;--awb-spacing-left-medium:7.68%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"tussenvoegsel\">Tussenvoegsel<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user-alt fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"tussenvoegsel\" id=\"tussenvoegsel\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-1 fusion_builder_column_inner_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.56%;--awb-width-medium:75%;--awb-order-medium:0;--awb-spacing-right-medium:2.56%;--awb-spacing-left-medium:2.56%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"achternaam\">Achternaam <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user-alt fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"achternaam\" id=\"achternaam\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-2 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Geslacht <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-geslacht-3-0\" type=\"radio\" value=\"Man\" name=\"geslacht\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-geslacht-3-0\">Man<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-geslacht-3-1\" type=\"radio\" value=\"Vrouw\" name=\"geslacht\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-geslacht-3-1\">Vrouw<\/label><\/div><\/fieldset><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-3 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><label for=\"geboortedatum\">Geboortedatum <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-input-with-icon\"><i class=\"fa-birthday-cake fas\"><\/i><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d F Y\" tabindex=\"\" id=\"geboortedatum\" name=\"geboortedatum\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-4 fusion_builder_column_inner_3_5 3_5 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:60%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.2%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.2%;--awb-width-medium:60%;--awb-order-medium:0;--awb-spacing-right-medium:3.2%;--awb-spacing-left-medium:3.2%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"straatnaam\">Straatnaam <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"straatnaam\" id=\"straatnaam\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-5 fusion_builder_column_inner_1_5 1_5 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:20%;--awb-margin-top-large:0px;--awb-spacing-right-large:9.6%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:9.6%;--awb-width-medium:20%;--awb-order-medium:0;--awb-spacing-right-medium:9.6%;--awb-spacing-left-medium:9.6%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"huisnummer\">Huisnr. <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"huisnummer\" id=\"huisnummer\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-6 fusion_builder_column_inner_1_5 1_5 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:20%;--awb-margin-top-large:0px;--awb-spacing-right-large:9.6%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:9.6%;--awb-width-medium:20%;--awb-order-medium:0;--awb-spacing-right-medium:9.6%;--awb-spacing-left-medium:9.6%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"toevoeging\">Toevoeging<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"toevoeging\" id=\"toevoeging\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-7 fusion_builder_column_inner_1_4 1_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:25%;--awb-margin-top-large:0px;--awb-spacing-right-large:7.68%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:7.68%;--awb-width-medium:25%;--awb-order-medium:0;--awb-spacing-right-medium:7.68%;--awb-spacing-left-medium:7.68%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"postcode\">Postcode <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"postcode\" id=\"postcode\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-8 fusion_builder_column_inner_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.56%;--awb-width-medium:75%;--awb-order-medium:0;--awb-spacing-right-medium:2.56%;--awb-spacing-left-medium:2.56%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"woonplaats\">Woonplaats <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-building fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"woonplaats\" id=\"woonplaats\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Contactinformatie<\/h3><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"e-mailadres\">E-mailadres <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-envelope fas\"><\/i><input type=\"email\" autocomplete=\"off\" name=\"e-mailadres\" id=\"e-mailadres\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"telefoonnummer\">Telefoonnummer <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"telefoonnummer\" id=\"telefoonnummer\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"contactpersoon_in_geval_van_nood\">Contactpersoon in geval van nood <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-address-card fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"contactpersoon_in_geval_van_nood\" id=\"contactpersoon_in_geval_van_nood\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"telefoonnummer_contactpersoon\">Telefoonnummer contactpersoon <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-address-card fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"telefoonnummer_contactpersoon\" id=\"telefoonnummer_contactpersoon\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Betaalgegevens<\/h3><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"iban_rekeningnummer\">IBAN Rekeningnummer<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"iban_rekeningnummer\" id=\"iban_rekeningnummer\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"naam_rekeninghouder\">Naam rekeninghouder<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"naam_rekeninghouder\" id=\"naam_rekeninghouder\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-title title fusion-title-5 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Toestemming<\/h3><\/div><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset data-awb-fieldset-min-required=\"1\" data-awb-fieldset-max-required=\"0\" data-awb-fieldset-error=\"Please select all checkboxes from this field.\"><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Persoonsgegevens <abbr class=\"fusion-form-element-required\" title=\"Please select all checkboxes from this field.\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-verwerking_persoonsgegevens-1-0\" type=\"checkbox\" value=\"Ik geef toestemming voor het verwerken van mijn persoonsgegevens door Medisch Sportcentrum de Brigantijn, ten behoeve van het beantwoorden van mijn aanvraag en het aangaan en uitvoeren van een overeenkomst.\" name=\"verwerking_persoonsgegevens[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-verwerking_persoonsgegevens-1-0\">Ik geef toestemming voor het verwerken van mijn persoonsgegevens door Medisch Sportcentrum de Brigantijn, ten behoeve van het beantwoorden van mijn aanvraag en het aangaan en uitvoeren van een overeenkomst.<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset data-awb-fieldset-min-required=\"1\" data-awb-fieldset-max-required=\"0\" data-awb-fieldset-error=\"Please select all checkboxes from this field.\"><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Incasso <abbr class=\"fusion-form-element-required\" title=\"Please select all checkboxes from this field.\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-incasso-2-0\" type=\"checkbox\" value=\"Ik machtig Medisch Sportcentrum de Brigantijn om de verschuldigde abonnementsbedragen via automatische incasso van mijn rekening af te schrijven. Ik heb kennisgenomen van het abonnement en de bijbehorende voorwaarden.\" name=\"incasso[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-incasso-2-0\">Ik machtig Medisch Sportcentrum de Brigantijn om de verschuldigde abonnementsbedragen via automatische incasso van mijn rekening af te schrijven. Ik heb kennisgenomen van het abonnement en de bijbehorende voorwaarden.<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset data-awb-fieldset-min-required=\"1\" data-awb-fieldset-max-required=\"0\" data-awb-fieldset-error=\"Please select all checkboxes from this field.\"><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Voorwaarden <abbr class=\"fusion-form-element-required\" title=\"Please select all checkboxes from this field.\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-voorwaarden2-3-0\" type=\"checkbox\" value=\"Ik ga akkoord met de Algemene Voorwaarden en het Huisreglement\" name=\"voorwaarden2[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-voorwaarden2-3-0\">Ik ga akkoord met de Algemene Voorwaarden en het Huisreglement<\/label><\/div><\/fieldset><\/div><div class=\"fusion-text fusion-text-2\" style=\"--awb-text-color:#667f74;\"><p>Bekijk hier de\u00a0<a href=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/02\/20260228-Algemene-voorwaarden.pdf\" target=\"_blank\" rel=\"noopener\">Algemene Voorwaarden<\/a> en het <a href=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/MSC-de-Brigantijn-huisreglement.pdf\" target=\"_blank\" rel=\"noopener\">Huisreglement<\/a><\/p>\n<\/div>\n<div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div ><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"83\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Verstuur het formulier<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"fusion_privacy_store_ip_ua\" value=\"false\"><input type=\"hidden\" name=\"fusion_privacy_expiration_interval\" value=\"48\"><input type=\"hidden\" name=\"privacy_expiration_action\" value=\"anonymize\"><\/form><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:16.666666666667%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:11.52%;--awb-spacing-left-medium:11.52%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-no-medium-visibility fusion-no-large-visibility\" style=\"--awb-border-sizes-bottom:30px;--awb-border-color:var(--awb-color1);--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-bottom:0px;--awb-background-color:var(--awb-color1);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form fusion-form-builder fusion-form-form-wrapper fusion-form-83\" style=\"--awb-tooltip-text-color:#ffffff;--awb-tooltip-background-color:#333333;--awb-form-bg-color:var(--awb-color2);--awb-form-placeholder-color:var(--awb-color1);--awb-form-text-color:var(--awb-color4);--awb-form-label-color:var(--awb-color4);--awb-form-border-radius:9px;\" data-form-id=\"83\" data-config=\"{&quot;form_id&quot;:&quot;83&quot;,&quot;form_post_id&quot;:&quot;83&quot;,&quot;post_id&quot;:80,&quot;form_type&quot;:&quot;ajax&quot;,&quot;confirmation_type&quot;:[&quot;redirect&quot;],&quot;redirect_url&quot;:&quot;https:\\\/\\\/www.medischsportcentrum.nl\\\/index.php\\\/bedankt\\\/&quot;,&quot;redirect_timeout&quot;:&quot;0&quot;,&quot;field_labels&quot;:{&quot;keuzepakket&quot;:&quot;Maak keuze voor een pakket&quot;,&quot;looptijd&quot;:&quot;Kies je gewenste looptijd&quot;,&quot;voornaam&quot;:&quot;Voornaam&quot;,&quot;tussenvoegsel&quot;:&quot;Tussenvoegsel&quot;,&quot;achternaam&quot;:&quot;Achternaam&quot;,&quot;geslacht&quot;:&quot;Geslacht&quot;,&quot;geboortedatum&quot;:&quot;Geboortedatum&quot;,&quot;straatnaam&quot;:&quot;Straatnaam&quot;,&quot;huisnummer&quot;:&quot;Huisnr.&quot;,&quot;toevoeging&quot;:&quot;Toevoeging&quot;,&quot;postcode&quot;:&quot;Postcode&quot;,&quot;woonplaats&quot;:&quot;Woonplaats&quot;,&quot;e-mailadres&quot;:&quot;E-mailadres&quot;,&quot;telefoonnummer&quot;:&quot;Telefoonnummer&quot;,&quot;contactpersoon_in_geval_van_nood&quot;:&quot;Contactpersoon in geval van nood&quot;,&quot;telefoonnummer_contactpersoon&quot;:&quot;Telefoonnummer contactpersoon&quot;,&quot;iban_rekeningnummer&quot;:&quot;IBAN Rekeningnummer&quot;,&quot;naam_rekeninghouder&quot;:&quot;Naam rekeninghouder&quot;,&quot;verwerking_persoonsgegevens&quot;:&quot;Persoonsgegevens&quot;,&quot;incasso&quot;:&quot;Incasso&quot;,&quot;voorwaarden2&quot;:&quot;Voorwaarden&quot;},&quot;field_logics&quot;:{&quot;keuzepakket&quot;:&quot;&quot;,&quot;looptijd&quot;:&quot;[]&quot;,&quot;voornaam&quot;:&quot;&quot;,&quot;tussenvoegsel&quot;:&quot;&quot;,&quot;achternaam&quot;:&quot;&quot;,&quot;geslacht&quot;:&quot;&quot;,&quot;geboortedatum&quot;:&quot;&quot;,&quot;straatnaam&quot;:&quot;&quot;,&quot;huisnummer&quot;:&quot;&quot;,&quot;toevoeging&quot;:&quot;&quot;,&quot;postcode&quot;:&quot;&quot;,&quot;woonplaats&quot;:&quot;&quot;,&quot;e-mailadres&quot;:&quot;&quot;,&quot;telefoonnummer&quot;:&quot;&quot;,&quot;contactpersoon_in_geval_van_nood&quot;:&quot;&quot;,&quot;telefoonnummer_contactpersoon&quot;:&quot;&quot;,&quot;iban_rekeningnummer&quot;:&quot;&quot;,&quot;naam_rekeninghouder&quot;:&quot;&quot;,&quot;verwerking_persoonsgegevens&quot;:&quot;&quot;,&quot;incasso&quot;:&quot;&quot;,&quot;voorwaarden2&quot;:&quot;&quot;,&quot;submit_2&quot;:&quot;&quot;},&quot;field_types&quot;:{&quot;keuzepakket&quot;:&quot;radio&quot;,&quot;looptijd&quot;:&quot;radio&quot;,&quot;voornaam&quot;:&quot;text&quot;,&quot;tussenvoegsel&quot;:&quot;text&quot;,&quot;achternaam&quot;:&quot;text&quot;,&quot;geslacht&quot;:&quot;radio&quot;,&quot;geboortedatum&quot;:&quot;date&quot;,&quot;straatnaam&quot;:&quot;text&quot;,&quot;huisnummer&quot;:&quot;text&quot;,&quot;toevoeging&quot;:&quot;text&quot;,&quot;postcode&quot;:&quot;text&quot;,&quot;woonplaats&quot;:&quot;text&quot;,&quot;e-mailadres&quot;:&quot;email&quot;,&quot;telefoonnummer&quot;:&quot;phone_number&quot;,&quot;contactpersoon_in_geval_van_nood&quot;:&quot;text&quot;,&quot;telefoonnummer_contactpersoon&quot;:&quot;phone_number&quot;,&quot;iban_rekeningnummer&quot;:&quot;text&quot;,&quot;naam_rekeninghouder&quot;:&quot;text&quot;,&quot;verwerking_persoonsgegevens&quot;:&quot;checkbox&quot;,&quot;incasso&quot;:&quot;checkbox&quot;,&quot;voorwaarden2&quot;:&quot;checkbox&quot;,&quot;submit_2&quot;:&quot;submit&quot;},&quot;nonce_method&quot;:&quot;ajax&quot;,&quot;form_views&quot;:&quot;&quot;,&quot;form_views_counting&quot;:&quot;&quot;}\"><form action=\"https:\/\/www.medischsportcentrum.nl\/index.php\/inschrijven\/\" method=\"post\" class=\"fusion-form fusion-form-83\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Maak keuze voor een pakket <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-radio\"><input data-empty-notice=\"Kies je pakket\" tabindex=\"\" id=\"radio-keuzepakket-4-0\" type=\"radio\" value=\"Basis\" name=\"keuzepakket\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-keuzepakket-4-0\">Basis<\/label><\/div><div class=\"fusion-form-radio\"><input data-empty-notice=\"Kies je pakket\" tabindex=\"\" id=\"radio-keuzepakket-4-1\" type=\"radio\" value=\"Vitaal\" name=\"keuzepakket\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-keuzepakket-4-1\">Vitaal<\/label><\/div><div class=\"fusion-form-radio\"><input data-empty-notice=\"Kies je pakket\" tabindex=\"\" id=\"radio-keuzepakket-4-2\" type=\"radio\" value=\"Optimaal\" name=\"keuzepakket\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-keuzepakket-4-2\">Optimaal<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Kies je gewenste looptijd <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-radio option-inline\"><input data-empty-notice=\"Kies je looptijd\" tabindex=\"\" id=\"radio-looptijd-5-0\" type=\"radio\" value=\"6 maanden\" name=\"looptijd\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-looptijd-5-0\">6 maanden<\/label><\/div><div class=\"fusion-form-radio option-inline\"><input data-empty-notice=\"Kies je looptijd\" tabindex=\"\" id=\"radio-looptijd-5-1\" type=\"radio\" value=\"12 maanden\" name=\"looptijd\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-looptijd-5-1\">12 maanden<\/label><\/div><div class=\"fusion-form-radio option-inline\"><input data-empty-notice=\"Kies je looptijd\" tabindex=\"\" id=\"radio-looptijd-5-2\" type=\"radio\" value=\"24 maanden\" name=\"looptijd\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-looptijd-5-2\">24 maanden<\/label><\/div><\/fieldset><\/div><div class=\"fusion-title title fusion-title-6 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Persoonlijke informatie<\/h3><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"voornaam\">Voornaam <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user-alt fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"voornaam\" id=\"voornaam\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-9 fusion_builder_column_inner_1_4 1_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:25%;--awb-margin-top-large:0px;--awb-spacing-right-large:7.68%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:7.68%;--awb-width-medium:25%;--awb-order-medium:0;--awb-spacing-right-medium:7.68%;--awb-spacing-left-medium:7.68%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"tussenvoegsel\">Tussenvoegsel<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user-alt fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"tussenvoegsel\" id=\"tussenvoegsel\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-10 fusion_builder_column_inner_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.56%;--awb-width-medium:75%;--awb-order-medium:0;--awb-spacing-right-medium:2.56%;--awb-spacing-left-medium:2.56%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"achternaam\">Achternaam <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user-alt fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"achternaam\" id=\"achternaam\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-11 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Geslacht <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-geslacht-6-0\" type=\"radio\" value=\"Man\" name=\"geslacht\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-geslacht-6-0\">Man<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-geslacht-6-1\" type=\"radio\" value=\"Vrouw\" name=\"geslacht\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-geslacht-6-1\">Vrouw<\/label><\/div><\/fieldset><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-12 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><label for=\"geboortedatum\">Geboortedatum <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-input-with-icon\"><i class=\"fa-birthday-cake fas\"><\/i><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d F Y\" tabindex=\"\" id=\"geboortedatum\" name=\"geboortedatum\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-13 fusion_builder_column_inner_3_5 3_5 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:60%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.2%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.2%;--awb-width-medium:60%;--awb-order-medium:0;--awb-spacing-right-medium:3.2%;--awb-spacing-left-medium:3.2%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"straatnaam\">Straatnaam <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"straatnaam\" id=\"straatnaam\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-14 fusion_builder_column_inner_1_5 1_5 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:20%;--awb-margin-top-large:0px;--awb-spacing-right-large:9.6%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:9.6%;--awb-width-medium:20%;--awb-order-medium:0;--awb-spacing-right-medium:9.6%;--awb-spacing-left-medium:9.6%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"huisnummer\">Huisnr. <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"huisnummer\" id=\"huisnummer\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-15 fusion_builder_column_inner_1_5 1_5 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:20%;--awb-margin-top-large:0px;--awb-spacing-right-large:9.6%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:9.6%;--awb-width-medium:20%;--awb-order-medium:0;--awb-spacing-right-medium:9.6%;--awb-spacing-left-medium:9.6%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"toevoeging\">Toevoeging<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"toevoeging\" id=\"toevoeging\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-16 fusion_builder_column_inner_1_4 1_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:25%;--awb-margin-top-large:0px;--awb-spacing-right-large:7.68%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:7.68%;--awb-width-medium:25%;--awb-order-medium:0;--awb-spacing-right-medium:7.68%;--awb-spacing-left-medium:7.68%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"postcode\">Postcode <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-home fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"postcode\" id=\"postcode\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-17 fusion_builder_column_inner_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.56%;--awb-width-medium:75%;--awb-order-medium:0;--awb-spacing-right-medium:2.56%;--awb-spacing-left-medium:2.56%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"woonplaats\">Woonplaats <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-building fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"woonplaats\" id=\"woonplaats\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Contactinformatie<\/h3><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"e-mailadres\">E-mailadres <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-envelope fas\"><\/i><input type=\"email\" autocomplete=\"off\" name=\"e-mailadres\" id=\"e-mailadres\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"telefoonnummer\">Telefoonnummer <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"telefoonnummer\" id=\"telefoonnummer\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"contactpersoon_in_geval_van_nood\">Contactpersoon in geval van nood <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-address-card fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"contactpersoon_in_geval_van_nood\" id=\"contactpersoon_in_geval_van_nood\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"telefoonnummer_contactpersoon\">Telefoonnummer contactpersoon <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-address-card fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"telefoonnummer_contactpersoon\" id=\"telefoonnummer_contactpersoon\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-title title fusion-title-8 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Betaalgegevens<\/h3><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"iban_rekeningnummer\">IBAN Rekeningnummer<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"iban_rekeningnummer\" id=\"iban_rekeningnummer\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div class=\"fusion-form-label-wrapper\"><label for=\"naam_rekeninghouder\">Naam rekeninghouder<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"naam_rekeninghouder\" id=\"naam_rekeninghouder\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-title title fusion-title-9 fusion-sep-none fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Toestemming<\/h3><\/div><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset data-awb-fieldset-min-required=\"1\" data-awb-fieldset-max-required=\"0\" data-awb-fieldset-error=\"Please select all checkboxes from this field.\"><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Persoonsgegevens <abbr class=\"fusion-form-element-required\" title=\"Please select all checkboxes from this field.\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-verwerking_persoonsgegevens-4-0\" type=\"checkbox\" value=\"Ik geef toestemming voor het verwerken van mijn persoonsgegevens door Medisch Sportcentrum de Brigantijn, ten behoeve van het beantwoorden van mijn aanvraag en het aangaan en uitvoeren van een overeenkomst.\" name=\"verwerking_persoonsgegevens[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-verwerking_persoonsgegevens-4-0\">Ik geef toestemming voor het verwerken van mijn persoonsgegevens door Medisch Sportcentrum de Brigantijn, ten behoeve van het beantwoorden van mijn aanvraag en het aangaan en uitvoeren van een overeenkomst.<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset data-awb-fieldset-min-required=\"1\" data-awb-fieldset-max-required=\"0\" data-awb-fieldset-error=\"Please select all checkboxes from this field.\"><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Incasso <abbr class=\"fusion-form-element-required\" title=\"Please select all checkboxes from this field.\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-incasso-5-0\" type=\"checkbox\" value=\"Ik machtig Medisch Sportcentrum de Brigantijn om de verschuldigde abonnementsbedragen via automatische incasso van mijn rekening af te schrijven. Ik heb kennisgenomen van het abonnement en de bijbehorende voorwaarden.\" name=\"incasso[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-incasso-5-0\">Ik machtig Medisch Sportcentrum de Brigantijn om de verschuldigde abonnementsbedragen via automatische incasso van mijn rekening af te schrijven. Ik heb kennisgenomen van het abonnement en de bijbehorende voorwaarden.<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><fieldset data-awb-fieldset-min-required=\"1\" data-awb-fieldset-max-required=\"0\" data-awb-fieldset-error=\"Please select all checkboxes from this field.\"><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Voorwaarden <abbr class=\"fusion-form-element-required\" title=\"Please select all checkboxes from this field.\">*<\/abbr><\/span><\/legend><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-voorwaarden2-6-0\" type=\"checkbox\" value=\"Ik ga akkoord met de Algemene Voorwaarden en het Huisreglement\" name=\"voorwaarden2[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-voorwaarden2-6-0\">Ik ga akkoord met de Algemene Voorwaarden en het Huisreglement<\/label><\/div><\/fieldset><\/div><div class=\"fusion-text fusion-text-3\" style=\"--awb-text-color:#667f74;\"><p>Bekijk hier de\u00a0<a href=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/02\/20260228-Algemene-voorwaarden.pdf\" target=\"_blank\" rel=\"noopener\">Algemene Voorwaarden<\/a> en het <a href=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/MSC-de-Brigantijn-huisreglement.pdf\" target=\"_blank\" rel=\"noopener\">Huisreglement<\/a><\/p>\n<\/div>\n<div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"83\"><div ><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-2 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"83\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Verstuur het formulier<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-9 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"fusion_privacy_store_ip_ua\" value=\"false\"><input type=\"hidden\" name=\"fusion_privacy_expiration_interval\" value=\"48\"><input type=\"hidden\" name=\"privacy_expiration_action\" value=\"anonymize\"><\/form><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-background-color:var(--awb-color7);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-end fusion-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-10 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-image-element \" style=\"--awb-margin-top:30px;--awb-max-width:250px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><img decoding=\"async\" width=\"922\" height=\"454\" title=\"Logo MSC Diap@2x\" src=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/Logo-MSC-Diap@2x-2.png\" alt class=\"img-responsive wp-image-119\" srcset=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/Logo-MSC-Diap@2x-2-200x98.png 200w, https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/Logo-MSC-Diap@2x-2-400x197.png 400w, https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/Logo-MSC-Diap@2x-2-600x295.png 600w, https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/Logo-MSC-Diap@2x-2-800x394.png 800w, https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/01\/Logo-MSC-Diap@2x-2.png 922w\" sizes=\"(max-width: 640px) 100vw, 600px\" \/><\/span><\/div><div class=\"fusion-title title fusion-title-10 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-text-color:var(--awb-color1);--awb-font-size:18px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;font-size:1em;\">Brigantijnlaan 423, 2496 ZT Den Haag<br \/>\nTelefoon: 06 21 44 94 81<br \/>\ninfo@medischsportcentrum.nl<\/h3><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-11 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-4 link-white\" style=\"--awb-text-color:var(--awb-color1);\"><p style=\"text-align: right;\"><a href=\"https:\/\/www.medischsportcentrum.nl\/wp-content\/uploads\/2026\/02\/20260228-Privacyverklaring.pdf\" target=\"_blank\" rel=\"noopener\">Privacyverklaring<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-80","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/pages\/80","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/comments?post=80"}],"version-history":[{"count":8,"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/pages\/80\/revisions"}],"predecessor-version":[{"id":188,"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/pages\/80\/revisions\/188"}],"wp:attachment":[{"href":"https:\/\/www.medischsportcentrum.nl\/index.php\/wp-json\/wp\/v2\/media?parent=80"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}