{"id":2286,"date":"2019-09-13T16:14:32","date_gmt":"2019-09-13T14:14:32","guid":{"rendered":"https:\/\/archief.detour.be\/?page_id=2286"},"modified":"2024-10-20T22:05:51","modified_gmt":"2024-10-20T20:05:51","slug":"inschrijving","status":"publish","type":"page","link":"https:\/\/archief.detour.be\/fr\/inschrijving\/","title":{"rendered":"Inscription"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_5' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Inschrijving reis<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/fr\/wp-json\/wp\/v2\/pages\/2286' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_5_60\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_60'><span class='gform-field-label__text'>X\/Twitter<\/span><\/label><div class='gfield_description' id='gfield_description_5_60'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_60' id='input_5_60' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_5_43\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2>Inschrijving voor motorreis:  <span id=\"recupTitel_01\">\u2018Sloveni\u00eb 8 nachten\/9 dagen\u2019<\/span><\/h2>\n<em>een apart inschrijvingsformulier invullen per piloot en eventuele duo<\/em>\n<\/li><li id=\"field_5_36\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_36'><span class='gform-field-label__text'>gekozen reis<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_5_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_45\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_45'><span class='gform-field-label__text'>link naar reisinformatie<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_5_45' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Reis \u2018<span id=\"recupTitel_02\">Sloveni\u00eb 8 nachten\/9 dagen<\/span>\u2019 \u2013 klik <a href\"\" target=\"blank\" id=\"linkReis\">hier<\/a> voor de volledige reisinfo.<br\/>\n<ul>\n<li>Prijs Piloot: \u20ac <span id=\"prijsPiloot\">xxxx,xx <\/span> \/ Duo: \u20ac <span id=\"prijsDuo\">xxxx,xx<\/span> <\/li>\n<!--<li>Supplement juli\/augustus en verlengde WE: \u20ac <span id=\"prijsSupplement\">xxxx,xx<\/span>   p.p.<\/li>-->\n<li>Toeslag 1-persoonskamer: \u20ac <span id=\"prijsKamer\">xxxx,xx<\/span> <\/li>\n<!--<li>Gevraagd voorschot: \u20ac <span id=\"prijsVoorschot\">xxxx,xx<\/span> p.p. <\/li>-->\n<\/ul>\n\n<\/li><li id=\"field_5_37\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_37'><span class='gform-field-label__text'>standaardprijs piloot<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='8' data-text-counter-template='{current} of {max} max characters'><input name='input_37' id='input_5_37' type='text' value='' class='medium' maxlength='8' aria-describedby=\"gfield_description_5_37\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_37'>standaardtarief zonder:\neventuele vroegboekkorting, korting voor korter verblijf of geen motortransport\/vlucht of supplementen, zoals oversizemotor,  \u00e9\u00e9npersoonskamer of verzekeringen.  \nDe bestelbon achteraf zal de eventuele kortingen of supplementen vermelden en het juiste eindtotaal berekenen.<\/div><\/li><li id=\"field_5_38\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_38'><span class='gform-field-label__text'>standaardprijs duo<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='8' data-text-counter-template='{current} of {max} max characters'><input name='input_38' id='input_5_38' type='text' value='' class='medium' maxlength='8' aria-describedby=\"gfield_description_5_38\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_38'>standaardtarief zonder:\neventuele vroegboekkorting, korting voor korter verblijf of geen motortransport\/vlucht of supplementen, zoals \u00e9\u00e9npersoonskamer of verzekeringen.  \nDe bestelbon achteraf zal de eventuele kortingen of supplementen vermelden en het juiste eindtotaal berekenen.<\/div><\/li><li id=\"field_5_39\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_39'><span class='gform-field-label__text'>prijs supplement<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_5_39' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_42\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_42'><span class='gform-field-label__text'>opleg 1-persoonskamer (indien van toepassing)<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='8' data-text-counter-template='{current} of {max} max characters'><input name='input_42' id='input_5_42' type='text' value='' class='medium' maxlength='8'     aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_57\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Bovenvermelde tarieven zijn de standaardtarieven.  Het exacte eindtotaal wordt pas berekend in de bestelbon die na aanvaarding van de inschrijving wordt opgestuurd via email.<\/li><li id=\"field_5_40\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_40'><span class='gform-field-label__text'>aantal dagen reis, voor zover niet ingekort door klant<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_5_40' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>NAAM en Voornaam<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_1'>NAAM (in drukletters) en 1ste Voornaam (exact zoals op het  identiteitsdocument vermeld)<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_1'>\n                            \n                            <span id='input_5_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_5_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_1_3' class='gform-field-label gform-field-label--type-sub '>NAAM (in drukletters)<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_5_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_1_6' class='gform-field-label gform-field-label--type-sub '>1ste Voornaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_5_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_5'><span class='gform-field-label__text'>E-mailadres<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_5_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_5_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Maak hier je keuze van service<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_58'>Bevestig hier of je motortransport wenst (D\u00e9tour de Luxe) of dat je zelf wenst te rijden aar de reisbestemming (D\u00e9tour Comfort)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_58'>\n\t\t\t<li class='gchoice gchoice_5_58_0'>\n\t\t\t\t<input name='input_58' type='radio' value='Ik kies voor de formule &#039;D\u00e9tour de Luxe&#039; met motortransport en zoveel meer....'  id='choice_5_58_0'    \/>\n\t\t\t\t<label for='choice_5_58_0' id='label_5_58_0' class='gform-field-label gform-field-label--type-inline'>Ik kies voor de formule 'D\u00e9tour de Luxe' met motortransport en zoveel meer....<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_58_1'>\n\t\t\t\t<input name='input_58' type='radio' value='Ik wens zelf te rijden naar de reisbestemming en ontvang graag de hiervoor voorziene korting'  id='choice_5_58_1'    \/>\n\t\t\t\t<label for='choice_5_58_1' id='label_5_58_1' class='gform-field-label gform-field-label--type-inline'>Ik wens zelf te rijden naar de reisbestemming en ontvang graag de hiervoor voorziene korting<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Heb je al met D\u00e9tour gereisd?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_14'>\u00e9\u00e9n van de drie opties aanduiden.  Is er een wijziging van co\u00f6rdinaten (adres, telefoon...), kies voor 'nieuwe klant'.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_14'>\n\t\t\t<li class='gchoice gchoice_5_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='nee, ik ben een nieuwe klant'  id='choice_5_14_0'    \/>\n\t\t\t\t<label for='choice_5_14_0' id='label_5_14_0' class='gform-field-label gform-field-label--type-inline'>nee, ik ben een nieuwe klant<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='ja, ik ben een bestaande klant en reis met dezelfde motor als laatste reis'  id='choice_5_14_1'    \/>\n\t\t\t\t<label for='choice_5_14_1' id='label_5_14_1' class='gform-field-label gform-field-label--type-inline'>ja, ik ben een bestaande klant en reis met dezelfde motor als laatste reis<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_14_2'>\n\t\t\t\t<input name='input_14' type='radio' value='ja, ik ben een bestaande klant maar reis met een andere motor'  id='choice_5_14_2'    \/>\n\t\t\t\t<label for='choice_5_14_2' id='label_5_14_2' class='gform-field-label gform-field-label--type-inline'>ja, ik ben een bestaande klant maar reis met een andere motor<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_4'><span class='gform-field-label__text'>GSM<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_5_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_5_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_12'><span class='gform-field-label__text'>Merk + type van uw motorfiets<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_5_12' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_13'><span class='gform-field-label__text'>Nummerplaat<\/span><\/label><div class='gfield_description' id='gfield_description_5_13'>zonder spaties en verbindingstekens: bvb. MBCB925<\/div><div class='ginput_container ginput_container_text'><input name='input_13' id='input_5_13' type='text' value='' class='medium'  aria-describedby=\"gfield_description_5_13\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_51'><span class='gform-field-label__text'>Jaartal 1ste inschrijving motor<\/span><\/label><div class='gfield_description' id='gfield_description_5_51'>Is nodig voor de aangifte gratis inbegrepen verzekering motortransport : enkel jaartal vermelden<\/div><div class='ginput_container ginput_container_text' data-text-counter-max='4' data-text-counter-template='{current} of {max} max characters'><input name='input_51' id='input_5_51' type='text' value='' class='medium' maxlength='4' aria-describedby=\"gfield_description_5_51\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_50'><span class='gform-field-label__text'>Nieuwwaarde van de motor inclusief BTW<\/span><\/label><div class='gfield_description' id='gfield_description_5_50'>Ken je de nieuwwaarde niet, dan zoeken we die zelf op.  Oorspronkelijke nieuwwaarde (indien gekend) van de motor inclusief BTW.  Tot max. \u20ac 30.000 nieuwwaarde is de transportverzekering gratis inbegrepen (daarboven = 0,3 % supplement).  A.u.b. niet meer vermelden dan de effectieve nieuwwaarde.  Enkel invullen als je kiest voor formule met motortransport. <\/div><div class='ginput_container ginput_container_text' data-text-counter-max='10' data-text-counter-template='{current} of {max} max characters'><input name='input_50' id='input_5_50' type='text' value='' class='medium' maxlength='10' aria-describedby=\"gfield_description_5_50\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Kun je de BTW recupereren op de motorkosten?<\/span><\/label><div class='gfield_description' id='gfield_description_5_54'>Sommige zelfstandigen kunnen de BTW geheel of gedeeltelijk recupereren op de motorkosten en dat hoeft niet mee verzekerd te worden bij het motortransport.  Enkel in te vullen als je kiest voor de formule met motortransport.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_54'>\n\t\t\t<li class='gchoice gchoice_5_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='Nee, ik kan geen BTW recupereren op de motor'  id='choice_5_54_0'    \/>\n\t\t\t\t<label for='choice_5_54_0' id='label_5_54_0' class='gform-field-label gform-field-label--type-inline'>Nee, ik kan geen BTW recupereren op de motor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='Ja, ik kan de BTW recupereren op de motor'  id='choice_5_54_1'    \/>\n\t\t\t\t<label for='choice_5_54_1' id='label_5_54_1' class='gform-field-label gform-field-label--type-inline'>Ja, ik kan de BTW recupereren op de motor<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_10\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adres<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_5_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_10_1_container' >\n                                        <input type='text' name='input_10.1' id='input_5_10_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_10_1' id='input_5_10_1_label' class='gform-field-label gform-field-label--type-sub '>Straat + nummer<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_10_3_container' >\n                                    <input type='text' name='input_10.3' id='input_5_10_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_10_3' id='input_5_10_3_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_10.4' id='input_5_10_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_5_10_5_container' >\n                                    <input type='text' name='input_10.5' id='input_5_10_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_10_5' id='input_5_10_5_label' class='gform-field-label gform-field-label--type-sub '>Stad<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_5_10_6_container' >\n                                        <select name='input_10.6' id='input_5_10_6'   aria-required='false'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_5_10_6' id='input_5_10_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_5_11\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Geboortedatum<\/span><\/label><div id='input_5_11' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_5_11_2_container'><label for='input_5_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Dag<\/label><select name='input_11[]' id='input_5_11_2'   aria-required='false'  ><option value=''>Dag<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_5_11_1_container'><label for='input_5_11_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Maand<\/label><select name='input_11[]' id='input_5_11_1'   aria-required='false'  ><option value=''>Maand<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_5_11_3_container'><label for='input_5_11_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jaar<\/label><select name='input_11[]' id='input_5_11_3'   aria-required='false'  ><option value=''>Jaar<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_5_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Duo?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_15'>\n\t\t\t<li class='gchoice gchoice_5_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='ik rij solo'  id='choice_5_15_0'    \/>\n\t\t\t\t<label for='choice_5_15_0' id='label_5_15_0' class='gform-field-label gform-field-label--type-inline'>ik rij solo<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='ik boek ook voor mijn duopassagier'  id='choice_5_15_1'    \/>\n\t\t\t\t<label for='choice_5_15_1' id='label_5_15_1' class='gform-field-label gform-field-label--type-inline'>ik boek ook voor mijn duopassagier<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_16\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>NAAM en voornaam van de duopassagier<\/span><\/label><div class='gfield_description' id='gfield_description_5_16'>NAAM (in drukletters) en 1ste voornaam, exact zoals op het identiteitsdocument vermeld is.<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_16'>\n                            \n                            <span id='input_5_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_5_16_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_16_3' class='gform-field-label gform-field-label--type-sub '>NAAM (in drukletters)<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_5_16_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_16_6' class='gform-field-label gform-field-label--type-sub '>1ste Voornaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_5_18\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_18'><span class='gform-field-label__text'>E-mailadres van de duopassagier<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_18' id='input_5_18' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_5_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_17'><span class='gform-field-label__text'>GSM van de duopassagier<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_5_17' type='tel' value='' class='medium'    aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_5_55\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Geboortedatum duopassagier<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_5_55' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_5_55_2_container'><label for='input_5_55_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Dag<\/label><select name='input_55[]' id='input_5_55_2'   aria-required='true'  ><option value=''>Dag<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_5_55_1_container'><label for='input_5_55_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Maand<\/label><select name='input_55[]' id='input_5_55_1'   aria-required='true'  ><option value=''>Maand<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_5_55_3_container'><label for='input_5_55_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jaar<\/label><select name='input_55[]' id='input_5_55_3'   aria-required='true'  ><option value=''>Jaar<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_5_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_19'><span class='gform-field-label__text'>opmerking<\/span><\/label><div class='gfield_description' id='gfield_description_5_19'>Dit kan zijn met wie je wenst de kamer te delen, de gevraagde  inkorting van de reis, het nummer van de reisvoucher die je wenst te gebruiken of enig andere opmerking omtrent deze reservatie.\n<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_5_19' class='textarea medium'  aria-describedby=\"gfield_description_5_19\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_5_59\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_59'><span class='gform-field-label__text'>speciaal dieet of voedselintolerantie<\/span><\/label><div class='gfield_description' id='gfield_description_5_59'>Ben je vegetari\u00ebr of heb je last van bepaalde voedselintoleranties dan kan je dit hier vermelden. Ook als je absoluut geen vlees of vis lust, mag je het hier vermelden.  In de mate van het mogelijke zoeken we in samenspraak met het hotel een oplossing.\n<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_59' id='input_5_59' class='textarea medium'  aria-describedby=\"gfield_description_5_59\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_5_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>1-persoonskamer gewenst?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_20'>\n\t\t\t<li class='gchoice gchoice_5_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='ja'  id='choice_5_20_0'    \/>\n\t\t\t\t<label for='choice_5_20_0' id='label_5_20_0' class='gform-field-label gform-field-label--type-inline'>ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='nee'  id='choice_5_20_1'    \/>\n\t\t\t\t<label for='choice_5_20_1' id='label_5_20_1' class='gform-field-label gform-field-label--type-inline'>nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_21\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_21'><span class='gform-field-label__text'>Gewenste vertrekdatum<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_5_21'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_21'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_21' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_21' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_21' aria-label='Gewenste vertrekdatum: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is de vertrekdatum flexibel?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_22'>\n\t\t\t<li class='gchoice gchoice_5_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='ja'  id='choice_5_22_0'    \/>\n\t\t\t\t<label for='choice_5_22_0' id='label_5_22_0' class='gform-field-label gform-field-label--type-inline'>ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='nee'  id='choice_5_22_1'    \/>\n\t\t\t\t<label for='choice_5_22_1' id='label_5_22_1' class='gform-field-label gform-field-label--type-inline'>nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_23\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_23'><span class='gform-field-label__text'>Vroegste vertrekdatum<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_5_23'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_23'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_23' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_23' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_23' aria-label='Vroegste vertrekdatum: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_24\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_24'><span class='gform-field-label__text'>Laatste vertrekdatum<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_5_24'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_24'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_24' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_24' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_24' aria-label='Laatste vertrekdatum: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_25\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  >Voor alle reizen die doorgaan vanaf 2022 is een annulatieverzekering en reisbijstand voor de motor en piloot\/duo verplicht.  Deze kan hierna ook via ons afgesloten worden.  Informatie omtrent deze verzekeringen, zie onze <a href=\"\/onze-faq\/#verzekeringen\" target=\"blank\">FAQ Verzekering<\/a> (link opent in een nieuw tabblad).<\/li><li id=\"field_5_9\" class=\"gfield gfield--type-select gfield--input-type-select populate-posts field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_9'><span class='gform-field-label__text'>Verborgen: U wenst zich in te schrijven voor:<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_5_9' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Selecteer uw reis<\/option><option value='6928' >Het magische Marokko (01 -15 april 2025)<\/option><option value='7481' >Levante - el camino del Cid (05 - 12 mei 2025)<\/option><option value='7501' >El Priorat - de verborgen parel van Cataloni\u00eb (22 - 29\/05\/2025)<\/option><option value='4313' >Van de wijnhuizen in La Rioja tot de bergtoppen van de Picos de Europa (08\/06 - 16\/06\/2025)<\/option><option value='7496' >Noorwegen - rondreis langs fjorden en gletsjers (27\/06 tot 06\/07 2025)<\/option><option value='7490' >Sloveni\u00eb en Julische Alpen (20\/08 tot 27\/08\/2025)<\/option><option value='7997' >Valencia Motorparadijs (28\/09 tot 05\/10\/2025)<\/option><option value='8271' >Het magische Marokko (06 - 20 april 2026)<\/option><\/select><\/div><\/li><li id=\"field_5_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Verzekering reisannulatie<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_26'>We verwachten dat elke deelnemer beschikt over een degelijke annulatieverzekering. \nOnze polis bieden wij aan voor slechts 2,90 % supplement op de reissom (polis via Ethias).  Heb je een eigen (gratis) polis via je creditcard, kijk de voorwaarden na a.u.b. !<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_26'>\n\t\t\t<li class='gchoice gchoice_5_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='ja, ik wens jullie verzekering reisannulatie te nemen want ik heb zelf geen annulatieverzekering'  id='choice_5_26_0'    \/>\n\t\t\t\t<label for='choice_5_26_0' id='label_5_26_0' class='gform-field-label gform-field-label--type-inline'>ja, ik wens jullie verzekering reisannulatie te nemen want ik heb zelf geen annulatieverzekering<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='nee, ik wens geen annulatieverzekering via jullie polis bij Ethias te nemen.'  id='choice_5_26_1'    \/>\n\t\t\t\t<label for='choice_5_26_1' id='label_5_26_1' class='gform-field-label gform-field-label--type-inline'>nee, ik wens geen annulatieverzekering via jullie polis bij Ethias te nemen.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Reisbijstand personen voor piloot \u00e0 2 \u20ac\/dag<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_31'>Een reisbijstandverzekering personen kan je ook via ons afsluiten voor \u20ac 2\/persoon\/dag (polis Ethias Privilege). Deze polis biedt in principe wereldwijde dekking qua bijstand aan personen (behoudens landen in oorlog enz.) . Voorlopig enkel voor wie gedomicilieerd is in Belgi\u00eb.  Dit is de minimale basis waaraan de reisbijstand motor aan toegevoegd kan worden.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_31'>\n\t\t\t<li class='gchoice gchoice_5_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='ja, ik wens jullie reisbijstandpolis Ethias Privilege'  id='choice_5_31_0'    \/>\n\t\t\t\t<label for='choice_5_31_0' id='label_5_31_0' class='gform-field-label gform-field-label--type-inline'>ja, ik wens jullie reisbijstandpolis Ethias Privilege<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='nee, ik wens geen reisbijstand personen via jullie polis te nemen'  id='choice_5_31_1'    \/>\n\t\t\t\t<label for='choice_5_31_1' id='label_5_31_1' class='gform-field-label gform-field-label--type-inline'>nee, ik wens geen reisbijstand personen via jullie polis te nemen<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Reisbijstand personen voor duopassagier \u00e0 2 \u20ac\/dag<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_30'>\n\t\t\t<li class='gchoice gchoice_5_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='ja, de reisbijstandpolis personen  Ethias Privilege voor de duo'  id='choice_5_30_0'    \/>\n\t\t\t\t<label for='choice_5_30_0' id='label_5_30_0' class='gform-field-label gform-field-label--type-inline'>ja, de reisbijstandpolis personen  Ethias Privilege voor de duo<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='nee, ik wens geen reisbijstand personen voor de duo via jullie polis'  id='choice_5_30_1'    \/>\n\t\t\t\t<label for='choice_5_30_1' id='label_5_30_1' class='gform-field-label gform-field-label--type-inline'>nee, ik wens geen reisbijstand personen voor de duo via jullie polis<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Reisbijstand motor \u00e0 4 \u20ac\/dag<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_28'>We verwachten van jou dat je beschikt over een  reisbijstandverzekering (minstens voor de motor). \nDeze kun je ook via ons afsluiten voor \u20ac 4\/motor\/dag (polis Ethias Privilege). Deze polis dekt enkel geografisch Europa en voorlopig enkel voor personen gedomicilieerd in Belgi\u00eb.   Dit mag gerust een eigen polis zijn, maar kijk dan a.u.b. ook de voorwaarden na !\nVoor de reis buiten Europa (Marokko), kan dit via je eigen polis reisbijstand motor als deze daar dekking biedt.  Of je vraagt van ons een doorverwijzing\/voorstel van reisbijstand motor geldig in Marokko.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_28'>\n\t\t\t<li class='gchoice gchoice_5_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='ja, ik wens reisbijstand via jullie polis Ethias Privilege (en neem ook de personenbijstand erbij)'  id='choice_5_28_0'    \/>\n\t\t\t\t<label for='choice_5_28_0' id='label_5_28_0' class='gform-field-label gform-field-label--type-inline'>ja, ik wens reisbijstand via jullie polis Ethias Privilege (en neem ook de personenbijstand erbij)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='ja, een voorstel van reisbijstand a.u.b. met dekking in Marokko'  id='choice_5_28_1'    \/>\n\t\t\t\t<label for='choice_5_28_1' id='label_5_28_1' class='gform-field-label gform-field-label--type-inline'>ja, een voorstel van reisbijstand a.u.b. met dekking in Marokko<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_28_2'>\n\t\t\t\t<input name='input_28' type='radio' value='nee, ik neem geen reisbijstand motor via jullie polis. Ik ben voldoende verzekerd.'  id='choice_5_28_2'    \/>\n\t\t\t\t<label for='choice_5_28_2' id='label_5_28_2' class='gform-field-label gform-field-label--type-inline'>nee, ik neem geen reisbijstand motor via jullie polis. Ik ben voldoende verzekerd.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Afkoop vrijstelling transportverzekering<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_52'>De polis verzekering motortransport voorziet een vrijstelling van \u20ac 375 per schadegeval\/motor.  Deze vrijstelling kan wegvallen.  (\u20ac 19 per motor supplement)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_52'>\n\t\t\t<li class='gchoice gchoice_5_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='Ja, verlaging vrijstelling transportverzekering \u00e0 \u20ac 19 supplement'  id='choice_5_52_0'    \/>\n\t\t\t\t<label for='choice_5_52_0' id='label_5_52_0' class='gform-field-label gform-field-label--type-inline'>Ja, verlaging vrijstelling transportverzekering \u00e0 \u20ac 19 supplement<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='Nee, de vrijstelling van \u20ac 375 is OK voor mij'  id='choice_5_52_1'    \/>\n\t\t\t\t<label for='choice_5_52_1' id='label_5_52_1' class='gform-field-label gform-field-label--type-inline'>Nee, de vrijstelling van \u20ac 375 is OK voor mij<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Algemene voorwaarden<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_32'>\n\t\t\t<li class='gchoice gchoice_5_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='Ik aanvaard de &lt;a href=&quot;\/algemene-en-bijzondere-voorwaarden\/&quot; target=&quot;blank&quot;&gt;algemene en bijzondere reisvoorwaarden&lt;\/a&gt; van Motorreis.com &amp; D\u00e9tour'  id='choice_5_32_0'    \/>\n\t\t\t\t<label for='choice_5_32_0' id='label_5_32_0' class='gform-field-label gform-field-label--type-inline'>Ik aanvaard de <a href=\"\/algemene-en-bijzondere-voorwaarden\/\" target=\"blank\">algemene en bijzondere reisvoorwaarden<\/a> van Motorreis.com &amp; D\u00e9tour<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Privacy beleid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_33'>\n\t\t\t<li class='gchoice gchoice_5_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='Ik heb kennis genomen van de &lt;a href=&quot;\/privacy-policy\/&quot; target=&quot;blank&quot;&gt;Privacy Policy&lt;\/a&gt; en het informatiedocument &lt;a href=&quot;\/wp-content\/uploads\/2018\/08\/Algemene-reisvoorwaarden-pakketreisovereenkomsten-voor-reizen-verkocht-vanaf-1-juli-2018.pdf&quot; target=&quot;blank&quot;&gt;Pakketreizen&lt;\/a&gt;.'  id='choice_5_33_0'    \/>\n\t\t\t\t<label for='choice_5_33_0' id='label_5_33_0' class='gform-field-label gform-field-label--type-inline'>Ik heb kennis genomen van de <a href=\"\/privacy-policy\/\" target=\"blank\">Privacy Policy<\/a> en het informatiedocument <a href=\"\/wp-content\/uploads\/2018\/08\/Algemene-reisvoorwaarden-pakketreisovereenkomsten-voor-reizen-verkocht-vanaf-1-juli-2018.pdf\" target=\"blank\">Pakketreizen<\/a>.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_56\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Inschrijven<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_5' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_5' id='gform_theme_5' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_5' id='gform_style_settings_5' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='5' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='pXAdcqpp+JpufYYlKuoKn9ZvUJPhQ7nQP4KeHWIdaRINLZfDOVkFF2MJPxT2axovBh7+n8Ub8U6CSVeWZqfyc7Oi+1dJCIHjRZJMcz1p7P9+iVY=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_5' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_5' id='gform_target_page_number_5' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_5' id='gform_source_page_number_5' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n<span class=\"et_bloom_bottom_trigger\"><\/span>","protected":false},"excerpt":{"rendered":"<div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_5' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Inscription au voyage<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/fr\/wp-json\/wp\/v2\/pages\/2286' data-formid='5' novalidate data-trp-original-action=\"\/fr\/wp-json\/wp\/v2\/pages\/2286\">\n                        <div class='gform-body gform_body'><ul id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_5_60\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_60'><span class='gform-field-label__text'>Commentaires<\/span><\/label><div class='gfield_description' id='gfield_description_5_60'>Ce champ est utilis\u00e9 \u00e0 des fins de validation et ne doit pas \u00eatre modifi\u00e9.<\/div><div class='ginput_container'><input name='input_60' id='input_5_60' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_5_43\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2>Inscription au voyage en moto :  <span id=\"recupTitel_01\">Slov\u00e9nie 8 nuits\/9 jours<\/span><\/h2>\n<em>remplir un formulaire d'inscription s\u00e9par\u00e9 par pilote et par duo \u00e9ventuel<\/em>\n<\/li><li id=\"field_5_36\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_36'><span class='gform-field-label__text'>voyage s\u00e9lectionn\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_5_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_45\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_45'><span class='gform-field-label__text'>lien vers les informations sur les voyages<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_5_45' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Voyage '<span id=\"recupTitel_02\">Slov\u00e9nie 8 nuits\/9 jours<\/span>' - cliquer <a href\"\" target=\"blank\" id=\"linkReis\">ici<\/a> pour des informations compl\u00e8tes sur le voyage.<br\/>\n<ul>\n<li>Prix pilote : \u20ac <span id=\"prijsPiloot\">xxxx,xx <\/span> \/ Duo : \u20ac <span id=\"prijsDuo\">xxxx,xx<\/span> <\/li>\n<!--<li>Supplement juli\/augustus en verlengde WE: \u20ac <span id=\"prijsSupplement\">xxxx,xx<\/span>   p.p.<\/li>-->\n<li>Suppl\u00e9ment chambre individuelle : \u20ac <span id=\"prijsKamer\">xxxx,xx<\/span> <\/li>\n<!--<li>Gevraagd voorschot: \u20ac <span id=\"prijsVoorschot\">xxxx,xx<\/span> p.p. <\/li>-->\n<\/ul>\n\n<\/li><li id=\"field_5_37\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_37'><span class='gform-field-label__text'>prix standard pilote<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='8' data-text-counter-template='{current} of {max} max characters'><input name='input_37' id='input_5_37' type='text' value='' class='medium' maxlength='8' aria-describedby=\"gfield_description_5_37\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_37'>tarif standard sans :\ntoute r\u00e9duction pour r\u00e9servation anticip\u00e9e, r\u00e9duction pour s\u00e9jour plus court ou pas de transport de moto\/vol ou de suppl\u00e9ments, tels que moto surdimensionn\u00e9e, chambre individuelle ou assurance.  \nLe formulaire de commande mentionnera ensuite les r\u00e9ductions ou les suppl\u00e9ments et calculera le total final correct.<\/div><\/li><li id=\"field_5_38\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_38'><span class='gform-field-label__text'>prix standard duo<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='8' data-text-counter-template='{current} of {max} max characters'><input name='input_38' id='input_5_38' type='text' value='' class='medium' maxlength='8' aria-describedby=\"gfield_description_5_38\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_38'>tarif standard sans :\ntoute r\u00e9duction pour r\u00e9servation anticip\u00e9e, r\u00e9duction pour un s\u00e9jour plus court ou sans transport motoris\u00e9\/vol ou suppl\u00e9ments, tels que chambre individuelle ou assurance.  \nLe formulaire de commande mentionnera ensuite les \u00e9ventuelles r\u00e9ductions ou suppl\u00e9ments et calculera le total final correct.<\/div><\/li><li id=\"field_5_39\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_39'><span class='gform-field-label__text'>suppl\u00e9ment de prix<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_5_39' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_42\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_42'><span class='gform-field-label__text'>suppl\u00e9ment pour chambre individuelle (le cas \u00e9ch\u00e9ant)<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='8' data-text-counter-template='{current} of {max} max characters'><input name='input_42' id='input_5_42' type='text' value='' class='medium' maxlength='8'     aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_57\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Les tarifs ci-dessus sont les tarifs standard.  Le montant total exact ne sera calcul\u00e9 que dans le bon de commande envoy\u00e9 par courrier \u00e9lectronique apr\u00e8s acceptation de l'inscription.<\/li><li id=\"field_5_40\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_40'><span class='gform-field-label__text'>le nombre de jours de voyage, s'il n'est pas raccourci par le client<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_5_40' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>NOM et pr\u00e9nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_1'>NOM (en caract\u00e8res d'imprimerie) et 1er pr\u00e9nom (exactement comme indiqu\u00e9 sur le document d'identit\u00e9)<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_1'>\n                            \n                            <span id='input_5_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_5_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_1_3' class='gform-field-label gform-field-label--type-sub'>NOM (en caract\u00e8res d'imprimerie)<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_5_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_1_6' class='gform-field-label gform-field-label--type-sub'>1er Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_5_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_5'><span class='gform-field-label__text'>Adresse \u00e9lectronique<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_5_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_5_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Faites votre choix de service ici<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_58'>Confirmez ici si vous souhaitez un transport en moto (D\u00e9tour de Luxe) ou si vous souhaitez vous rendre \u00e0 destination en voiture (D\u00e9tour Comfort).<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_58'>\n\t\t\t<li class='gchoice gchoice_5_58_0'>\n\t\t\t\t<input name='input_58' type='radio' value='Ik kies voor de formule &#039;D\u00e9tour de Luxe&#039; met motortransport en zoveel meer....'  id='choice_5_58_0'    \/>\n\t\t\t\t<label for='choice_5_58_0' id='label_5_58_0' class='gform-field-label gform-field-label--type-inline'>Je choisis la formule \"D\u00e9tour de Luxe\" avec transport en moto et bien plus encore....<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_58_1'>\n\t\t\t\t<input name='input_58' type='radio' value='Ik wens zelf te rijden naar de reisbestemming en ontvang graag de hiervoor voorziene korting'  id='choice_5_58_1'    \/>\n\t\t\t\t<label for='choice_5_58_1' id='label_5_58_1' class='gform-field-label gform-field-label--type-inline'>Je souhaite me rendre moi-m\u00eame \u00e0 la destination et b\u00e9n\u00e9ficier de la r\u00e9duction pr\u00e9vue \u00e0 cet effet.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Avez-vous d\u00e9j\u00e0 voyag\u00e9 avec D\u00e9tour ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_14'>indiquer l'une des trois options.  S'il y a un changement de coordonn\u00e9es (adresse, t\u00e9l\u00e9phone...), s\u00e9lectionnez \"nouveau client\".<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_14'>\n\t\t\t<li class='gchoice gchoice_5_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='nee, ik ben een nieuwe klant'  id='choice_5_14_0'    \/>\n\t\t\t\t<label for='choice_5_14_0' id='label_5_14_0' class='gform-field-label gform-field-label--type-inline'>non, je suis un nouveau client<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='ja, ik ben een bestaande klant en reis met dezelfde motor als laatste reis'  id='choice_5_14_1'    \/>\n\t\t\t\t<label for='choice_5_14_1' id='label_5_14_1' class='gform-field-label gform-field-label--type-inline'>Oui, je suis un client existant et je voyage avec le m\u00eame moteur que lors de mon dernier voyage.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_14_2'>\n\t\t\t\t<input name='input_14' type='radio' value='ja, ik ben een bestaande klant maar reis met een andere motor'  id='choice_5_14_2'    \/>\n\t\t\t\t<label for='choice_5_14_2' id='label_5_14_2' class='gform-field-label gform-field-label--type-inline'>oui, je suis un client existant mais je voyage avec un autre v\u00e9lo<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_4'><span class='gform-field-label__text'>GSM<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_5_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_5_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_12'><span class='gform-field-label__text'>Marque + type de votre moto<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_5_12' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_13'><span class='gform-field-label__text'>Plaque d'immatriculation<\/span><\/label><div class='gfield_description' id='gfield_description_5_13'>sans espace ni trait d'union : par exemple MBCB925<\/div><div class='ginput_container ginput_container_text'><input name='input_13' id='input_5_13' type='text' value='' class='medium'  aria-describedby=\"gfield_description_5_13\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_51'><span class='gform-field-label__text'>Ann\u00e9e 1\u00e8re immatriculation moteur<\/span><\/label><div class='gfield_description' id='gfield_description_5_51'>Est n\u00e9cessaire pour la d\u00e9claration d'assurance gratuite transport motoris\u00e9 : il suffit d'indiquer l'ann\u00e9e.<\/div><div class='ginput_container ginput_container_text' data-text-counter-max='4' data-text-counter-template='{current} of {max} max characters'><input name='input_51' id='input_5_51' type='text' value='' class='medium' maxlength='4' aria-describedby=\"gfield_description_5_51\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_50'><span class='gform-field-label__text'>Valeur du moteur neuf, TVA comprise<\/span><\/label><div class='gfield_description' id='gfield_description_5_50'>Si vous ne connaissez pas la valeur \u00e0 l'\u00e9tat neuf, nous la rechercherons nous-m\u00eames.  Valeur neuve originale (si elle est connue) de la moto, TVA comprise.  Jusqu'\u00e0 une valeur \u00e0 neuf maximale de 30 000 \u20ac, l'assurance transport est incluse gratuitement (au-del\u00e0 = suppl\u00e9ment de 0,3 %).  N'indiquez pas plus que la valeur \u00e0 neuf effective.  \u00c0 compl\u00e9ter uniquement si vous choisissez la formule avec transport de la moto. <\/div><div class='ginput_container ginput_container_text' data-text-counter-max='10' data-text-counter-template='{current} of {max} max characters'><input name='input_50' id='input_5_50' type='text' value='' class='medium' maxlength='10' aria-describedby=\"gfield_description_5_50\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_5_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Pouvez-vous r\u00e9cup\u00e9rer la TVA sur le co\u00fbt du moteur ?<\/span><\/label><div class='gfield_description' id='gfield_description_5_54'>Certains ind\u00e9pendants peuvent r\u00e9cup\u00e9rer tout ou partie de la TVA sur les frais de moto et celle-ci ne doit pas \u00eatre assur\u00e9e avec le transport de la moto.  A compl\u00e9ter uniquement si vous choisissez la formule avec transport de la moto.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_54'>\n\t\t\t<li class='gchoice gchoice_5_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='Nee, ik kan geen BTW recupereren op de motor'  id='choice_5_54_0'    \/>\n\t\t\t\t<label for='choice_5_54_0' id='label_5_54_0' class='gform-field-label gform-field-label--type-inline'>Non, je ne peux pas r\u00e9cup\u00e9rer la TVA sur le v\u00e9lo<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='Ja, ik kan de BTW recupereren op de motor'  id='choice_5_54_1'    \/>\n\t\t\t\t<label for='choice_5_54_1' id='label_5_54_1' class='gform-field-label gform-field-label--type-inline'>Oui, je peux r\u00e9cup\u00e9rer la TVA sur le v\u00e9lo<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_10\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_5_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_10_1_container' >\n                                        <input type='text' name='input_10.1' id='input_5_10_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_10_1' id='input_5_10_1_label' class='gform-field-label gform-field-label--type-sub'>Rue + num\u00e9ro<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_10_3_container' >\n                                    <input type='text' name='input_10.3' id='input_5_10_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_10_3' id='input_5_10_3_label' class='gform-field-label gform-field-label--type-sub'>Code postal<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_10.4' id='input_5_10_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_5_10_5_container' >\n                                    <input type='text' name='input_10.5' id='input_5_10_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_10_5' id='input_5_10_5_label' class='gform-field-label gform-field-label--type-sub'>Ville<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_5_10_6_container' >\n                                        <select name='input_10.6' id='input_5_10_6'   aria-required='false'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00celes \u00c5land<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='AS' >Samoa am\u00e9ricaines<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua et Barbuda<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerba\u00efdjan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahre\u00efn<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbade<\/option><option value='BY' >B\u00e9larus<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BJ' >B\u00e9nin<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie et Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='BR' >Br\u00e9sil<\/option><option value='IO' >Territoire britannique de l'oc\u00e9an Indien<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='KY' >\u00celes Ca\u00efmans<\/option><option value='CF' >R\u00e9publique centrafricaine<\/option><option value='TD' >Tchad<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CX' >L'\u00eele de No\u00ebl<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value='CK' >\u00celes Cook<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Chypre<\/option><option value='CZ' >Tch\u00e9coslovaquie<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='DO' >R\u00e9publique dominicaine<\/option><option value='EC' >\u00c9quateur<\/option><option value='EG' >\u00c9gypte<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='ER' >Erythr\u00e9e<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >\u00c9thiopie<\/option><option value='FK' >\u00celes Malouines<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GF' >Guyane fran\u00e7aise<\/option><option value='PF' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='TF' >Terres australes fran\u00e7aises<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GE' >G\u00e9orgie<\/option><option value='DE' >Allemagne<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GL' >Groenland<\/option><option value='GD' >Grenade<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernesey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GY' >Guyane<\/option><option value='HT' >Ha\u00efti<\/option><option value='HM' >\u00cele Heard et \u00eeles McDonald<\/option><option value='VA' >Saint-Si\u00e8ge<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='IS' >Islande<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IR' >L'Iran<\/option><option value='IQ' >L'Irak<\/option><option value='IE' >Irlande<\/option><option value='IM' >\u00cele de Man<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Cor\u00e9e, R\u00e9publique populaire d\u00e9mocratique de&#039;Cor\u00e9e, R\u00e9publique populaire d\u00e9mocratique de<\/option><option value='KR' >Cor\u00e9e, R\u00e9publique de<\/option><option value='KW' >Kowe\u00eft<\/option><option value='KG' >Kirghizistan<\/option><option value='LA' >R\u00e9publique d\u00e9mocratique populaire lao<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Lib\u00e9ria<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaisie<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MH' >\u00celes Marshall<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritanie<\/option><option value='MU' >Maurice<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='ME' >Mont\u00e9n\u00e9gro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Maroc<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NP' >N\u00e9pal<\/option><option value='NL' >Pays-Bas<\/option><option value='NC' >Nouvelle-Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niue<\/option><option value='NF' >\u00cele Norfolk<\/option><option value='MK' >Mac\u00e9doine du Nord<\/option><option value='MP' >Mariannes du Nord (\u00celes)<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, \u00c9tat de<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='PE' >P\u00e9rou<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Pologne<\/option><option value='PT' >Portugal<\/option><option value='PR' >Porto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Roumanie<\/option><option value='RU' >F\u00e9d\u00e9ration de Russie<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='KN' >Saint-Kitts-et-Nevis<\/option><option value='LC' >Sainte-Lucie<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint-Pierre et Miquelon<\/option><option value='VC' >Saint-Vincent-et-les-Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >Saint-Marin<\/option><option value='ST' >Sao Tom\u00e9 et Principe<\/option><option value='SA' >Arabie Saoudite<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SX' >Saint Martin<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SB' >\u00celes Salomon<\/option><option value='SO' >Somalie<\/option><option value='ZA' >Afrique du Sud<\/option><option value='GS' >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value='SS' >Sud Soudan<\/option><option value='ES' >Espagne<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Soudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard et Jan Mayen<\/option><option value='SE' >Su\u00e8de<\/option><option value='CH' >Suisse<\/option><option value='SY' >R\u00e9publique arabe syrienne<\/option><option value='TW' >Ta\u00efwan<\/option><option value='TJ' >Tadjikistan<\/option><option value='TZ' >Tanzanie, R\u00e9publique unie de<\/option><option value='TH' >Tha\u00eflande<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9-et-Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TC' >\u00celes Turks et Caicos<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Ouganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >\u00c9mirats arabes unis<\/option><option value='GB' >Royaume-Uni<\/option><option value='US' >\u00c9tats-Unis<\/option><option value='UY' >Uruguay<\/option><option value='UM' >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><option value='UZ' >Ouzb\u00e9kistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><option value='VI' >\u00celes Vierges, \u00c9tats-Unis<\/option><option value='WF' >Wallis et Futuna<\/option><option value='EH' >Sahara occidental<\/option><option value='YE' >Y\u00e9men<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_5_10_6' id='input_5_10_6_label' class='gform-field-label gform-field-label--type-sub'>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_5_11\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Date de naissance<\/span><\/label><div id='input_5_11' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_5_11_2_container'><label for='input_5_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Au revoir<\/label><select name='input_11[]' id='input_5_11_2'   aria-required='false'  ><option value=''>Au revoir<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_5_11_1_container'><label for='input_5_11_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_11[]' id='input_5_11_1'   aria-required='false'  ><option value=''>Mois<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_5_11_3_container'><label for='input_5_11_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_11[]' id='input_5_11_3'   aria-required='false'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_5_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Duo ?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_15'>\n\t\t\t<li class='gchoice gchoice_5_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='ik rij solo'  id='choice_5_15_0'    \/>\n\t\t\t\t<label for='choice_5_15_0' id='label_5_15_0' class='gform-field-label gform-field-label--type-inline'>Je conduis seul<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='ik boek ook voor mijn duopassagier'  id='choice_5_15_1'    \/>\n\t\t\t\t<label for='choice_5_15_1' id='label_5_15_1' class='gform-field-label gform-field-label--type-inline'>Je r\u00e9serve \u00e9galement pour mon passager<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_16\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>NOM et pr\u00e9nom du passager<\/span><\/label><div class='gfield_description' id='gfield_description_5_16'>NOM (en caract\u00e8res d'imprimerie) et 1er pr\u00e9nom, tels qu'ils figurent sur le document d'identit\u00e9.<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_16'>\n                            \n                            <span id='input_5_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_5_16_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_16_3' class='gform-field-label gform-field-label--type-sub'>NOM (en caract\u00e8res d'imprimerie)<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_5_16_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_16_6' class='gform-field-label gform-field-label--type-sub'>1er Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_5_18\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_18'><span class='gform-field-label__text'>Adresse \u00e9lectronique du passager<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_18' id='input_5_18' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_5_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_17'><span class='gform-field-label__text'>T\u00e9l\u00e9phone portable pour deux passagers<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_5_17' type='tel' value='' class='medium'    aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_5_55\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Date de naissance du passager<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_5_55' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_5_55_2_container'><label for='input_5_55_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Au revoir<\/label><select name='input_55[]' id='input_5_55_2'   aria-required='true'  ><option value=''>Au revoir<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_5_55_1_container'><label for='input_5_55_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_55[]' id='input_5_55_1'   aria-required='true'  ><option value=''>Mois<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_5_55_3_container'><label for='input_5_55_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_55[]' id='input_5_55_3'   aria-required='true'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_5_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_19'><span class='gform-field-label__text'>note<\/span><\/label><div class='gfield_description' id='gfield_description_5_19'>Il peut s'agir de la personne avec laquelle vous souhaitez partager la chambre, du raccourcissement souhait\u00e9 du voyage, du num\u00e9ro du bon de voyage que vous souhaitez utiliser ou de tout autre commentaire concernant cette r\u00e9servation.\n<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_5_19' class='textarea medium'  aria-describedby=\"gfield_description_5_19\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_5_59\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_59'><span class='gform-field-label__text'>r\u00e9gime alimentaire particulier ou intol\u00e9rance alimentaire<\/span><\/label><div class='gfield_description' id='gfield_description_5_59'>Si vous \u00eates v\u00e9g\u00e9tarien ou si vous souffrez de certaines intol\u00e9rances alimentaires, vous pouvez le mentionner ici. Si vous n'aimez absolument pas la viande ou le poisson, vous pouvez \u00e9galement le mentionner ici.  Dans la mesure du possible, nous trouverons une solution en concertation avec l'h\u00f4tel.\n<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_59' id='input_5_59' class='textarea medium'  aria-describedby=\"gfield_description_5_59\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_5_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Chambre individuelle souhait\u00e9e ?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_20'>\n\t\t\t<li class='gchoice gchoice_5_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='ja'  id='choice_5_20_0'    \/>\n\t\t\t\t<label for='choice_5_20_0' id='label_5_20_0' class='gform-field-label gform-field-label--type-inline'>oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='nee'  id='choice_5_20_1'    \/>\n\t\t\t\t<label for='choice_5_20_1' id='label_5_20_1' class='gform-field-label gform-field-label--type-inline'>non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_21\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_21'><span class='gform-field-label__text'>Date de d\u00e9part souhait\u00e9e<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_5_21'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_21'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_21' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_21' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_21' aria-label='Gewenste vertrekdatum: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>La date de d\u00e9part est-elle flexible ?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_22'>\n\t\t\t<li class='gchoice gchoice_5_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='ja'  id='choice_5_22_0'    \/>\n\t\t\t\t<label for='choice_5_22_0' id='label_5_22_0' class='gform-field-label gform-field-label--type-inline'>oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='nee'  id='choice_5_22_1'    \/>\n\t\t\t\t<label for='choice_5_22_1' id='label_5_22_1' class='gform-field-label gform-field-label--type-inline'>non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_23\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_23'><span class='gform-field-label__text'>Date de d\u00e9part la plus proche<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_5_23'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_23'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_23' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_23' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_23' aria-label='Vroegste vertrekdatum: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_24\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_24'><span class='gform-field-label__text'>Derni\u00e8re date de d\u00e9part<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_5_24'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_24'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_5_24' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_5_24' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_5_24' aria-label='Laatste vertrekdatum: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_5_25\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  >Pour tous les voyages se poursuivant \u00e0 partir de 2022, l'assurance annulation et l'assistance voyage pour la moto et le pilote\/duo sont obligatoires.  Ces assurances peuvent \u00e9galement \u00eatre souscrites par notre interm\u00e9diaire ci-apr\u00e8s.  Pour plus d'informations sur ces assurances, voir notre <a href=\"\/fr\/onze-faq\/#verzekeringen\" target=\"blank\">FAQ Assurance<\/a> (le lien s'ouvre dans un nouvel onglet).<\/li><li id=\"field_5_9\" class=\"gfield gfield--type-select gfield--input-type-select populate-posts field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_5_9'><span class='gform-field-label__text'>Cach\u00e9 : Vous souhaitez vous inscrire \u00e0 :<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_5_9' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>S\u00e9lectionnez votre voyage<\/option><option value='6928' >Maroc magique (01 -15 avril 2025)<\/option><option value='7481' >Levante - el camino del Cid (05 - 12 mai 2025)<\/option><option value='7501' >El Priorat - le joyau cach\u00e9 de la Catalogne (22 - 29\/05\/2025)<\/option><option value='4313' >Des caves de La Rioja aux sommets des Pics d'Europe (08\/06 - 16\/06\/2025)<\/option><option value='7496' >Norv\u00e8ge - voyage aller-retour le long des fjords et des glaciers (27\/06 au 06\/07 2025)<\/option><option value='7490' >Slov\u00e9nie et Alpes juliennes (20\/08 au 27\/08\/2025)<\/option><option value='7997' >Valence Motorbike Paradise (28\/09 au 05\/10\/2025)<\/option><option value='8271' >Maroc magique (06 - 20 avril 2026)<\/option><\/select><\/div><\/li><li id=\"field_5_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Assurance annulation de voyage<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_26'>Nous attendons de chaque participant qu'il ait une assurance annulation d\u00e9cente.\nNous proposons notre police pour seulement 2,90 % de suppl\u00e9ment sur le montant du voyage (police via Ethias).  Si vous avez votre propre police (gratuite) via votre carte de cr\u00e9dit, veuillez v\u00e9rifier les conditions !<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_26'>\n\t\t\t<li class='gchoice gchoice_5_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='ja, ik wens jullie verzekering reisannulatie te nemen want ik heb zelf geen annulatieverzekering'  id='choice_5_26_0'    \/>\n\t\t\t\t<label for='choice_5_26_0' id='label_5_26_0' class='gform-field-label gform-field-label--type-inline'>oui, je souhaite souscrire \u00e0 votre assurance annulation de voyage car je n'ai pas d'assurance annulation moi-m\u00eame<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='nee, ik wens geen annulatieverzekering via jullie polis bij Ethias te nemen.'  id='choice_5_26_1'    \/>\n\t\t\t\t<label for='choice_5_26_1' id='label_5_26_1' class='gform-field-label gform-field-label--type-inline'>non, je ne souhaite pas souscrire une assurance annulation par le biais de votre police aupr\u00e8s d'Ethias.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Assistance voyage pour le pilote \u00e0 2 \u20ac\/jour<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_31'>Vous pouvez \u00e9galement souscrire aupr\u00e8s de nous une assurance assistance voyage pour les personnes au prix de 2 \u20ac\/personne\/jour (police Ethias Privilege). En principe, cette police offre une couverture d'assistance aux personnes dans le monde entier (sauf pour les pays en guerre, etc.). Pour l'instant, uniquement pour les personnes domicili\u00e9es en Belgique.  Il s'agit de la base minimale \u00e0 laquelle la moto d'assistance voyage peut \u00eatre ajout\u00e9e.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_31'>\n\t\t\t<li class='gchoice gchoice_5_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='ja, ik wens jullie reisbijstandpolis Ethias Privilege'  id='choice_5_31_0'    \/>\n\t\t\t\t<label for='choice_5_31_0' id='label_5_31_0' class='gform-field-label gform-field-label--type-inline'>oui, je souhaite b\u00e9n\u00e9ficier de votre politique d'assistance voyage Ethias Privilege<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='nee, ik wens geen reisbijstand personen via jullie polis te nemen'  id='choice_5_31_1'    \/>\n\t\t\t\t<label for='choice_5_31_1' id='label_5_31_1' class='gform-field-label gform-field-label--type-inline'>non, je ne souhaite pas prendre des personnes d'assistance voyage par le biais de votre police<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Assistance voyage pour le passager \u00e0 2 \u20ac\/jour<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_30'>\n\t\t\t<li class='gchoice gchoice_5_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='ja, de reisbijstandpolis personen  Ethias Privilege voor de duo'  id='choice_5_30_0'    \/>\n\t\t\t\t<label for='choice_5_30_0' id='label_5_30_0' class='gform-field-label gform-field-label--type-inline'>oui, la police d'assistance voyage personnes Ethias Privilege pour le duo<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='nee, ik wens geen reisbijstand personen voor de duo via jullie polis'  id='choice_5_30_1'    \/>\n\t\t\t\t<label for='choice_5_30_1' id='label_5_30_1' class='gform-field-label gform-field-label--type-inline'>non, je ne souhaite pas de personnes d'assistance voyage pour le duo par le biais de votre police<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Assistance aux d\u00e9placements en moto \u00e0 4 \u20ac\/jour<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_28'>Nous attendons de vous que vous ayez une assurance assistance voyage (au moins pour la moto).\nVous pouvez \u00e9galement la contracter par notre interm\u00e9diaire pour 4 \u20ac\/moto\/jour (police Ethias Privilege). Cette police ne couvre que l'Europe g\u00e9ographique et, pour l'instant, uniquement les personnes domicili\u00e9es en Belgique.   Il peut s'agir de votre propre police, mais v\u00e9rifiez les conditions !\nPour le voyage en dehors de l'Europe (Maroc), cela peut se faire via votre propre police d'assistance voyage pour les motos si elle offre une couverture \u00e0 cet endroit.  Ou vous pouvez nous demander une r\u00e9f\u00e9rence\/proposition d'assistance voyage moto valable au Maroc.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_28'>\n\t\t\t<li class='gchoice gchoice_5_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='ja, ik wens reisbijstand via jullie polis Ethias Privilege (en neem ook de personenbijstand erbij)'  id='choice_5_28_0'    \/>\n\t\t\t\t<label for='choice_5_28_0' id='label_5_28_0' class='gform-field-label gform-field-label--type-inline'>oui, je souhaite b\u00e9n\u00e9ficier d'une assistance voyage par le biais de votre police Ethias Privilege (et \u00e9galement d'une assistance personnelle)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='ja, een voorstel van reisbijstand a.u.b. met dekking in Marokko'  id='choice_5_28_1'    \/>\n\t\t\t\t<label for='choice_5_28_1' id='label_5_28_1' class='gform-field-label gform-field-label--type-inline'>oui, une proposition d'assistance voyage s'il vous pla\u00eet avec une couverture au Maroc<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_28_2'>\n\t\t\t\t<input name='input_28' type='radio' value='nee, ik neem geen reisbijstand motor via jullie polis. Ik ben voldoende verzekerd.'  id='choice_5_28_2'    \/>\n\t\t\t\t<label for='choice_5_28_2' id='label_5_28_2' class='gform-field-label gform-field-label--type-inline'>non, je ne souscris pas \u00e0 l'assistance voyage moto par le biais de votre police. Je suis suffisamment assur\u00e9.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Dispense d'assurance transport<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_52'>La police d'assurance transport automobile pr\u00e9voit une exon\u00e9ration de 375 euros par sinistre\/moto.  Cette franchise peut \u00eatre supprim\u00e9e.  (suppl\u00e9ment de 19 \u20ac par moto)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_52'>\n\t\t\t<li class='gchoice gchoice_5_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='Ja, verlaging vrijstelling transportverzekering \u00e0 \u20ac 19 supplement'  id='choice_5_52_0'    \/>\n\t\t\t\t<label for='choice_5_52_0' id='label_5_52_0' class='gform-field-label gform-field-label--type-inline'>Oui, exon\u00e9ration de l'assurance transport pour la r\u00e9duction du suppl\u00e9ment de 19 euros<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_5_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='Nee, de vrijstelling van \u20ac 375 is OK voor mij'  id='choice_5_52_1'    \/>\n\t\t\t\t<label for='choice_5_52_1' id='label_5_52_1' class='gform-field-label gform-field-label--type-inline'>Non, l'exon\u00e9ration de 375 euros me convient.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Conditions g\u00e9n\u00e9rales d'utilisation<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_32'>\n\t\t\t<li class='gchoice gchoice_5_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='Ik aanvaard de &lt;a href=&quot;\/algemene-en-bijzondere-voorwaarden\/&quot; target=&quot;blank&quot;&gt;algemene en bijzondere reisvoorwaarden&lt;\/a&gt; van Motorreis.com &amp; D\u00e9tour'  id='choice_5_32_0'    \/>\n\t\t\t\t<label for='choice_5_32_0' id='label_5_32_0' class='gform-field-label gform-field-label--type-inline'>J'accepte la <a href=\"\/fr\/algemene-en-bijzondere-voorwaarden\/\" target=\"blank\">conditions g\u00e9n\u00e9rales et particuli\u00e8res de voyage<\/a> De Motorreis.com &amp; D\u00e9tour<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_5_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Politique de confidentialit\u00e9<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_5_33'>\n\t\t\t<li class='gchoice gchoice_5_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='Ik heb kennis genomen van de &lt;a href=&quot;\/privacy-policy\/&quot; 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