File: D:/HostingSpaces/PvdBoogaard/indoorski.nl/backup/oude-site/asp/reizen/mei-reis-form.asp
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<META HTTP-EQUIV="Content-Type" content="text/html; charset=iso-8859-1">
<title>Najaars reis</title>
<script language="JavaScript" src="mei-reis.js"></script>
<script language="javascript">
if(self.location==top.location)self.location="index.asp";
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<link href="../../css/forms.css" rel="stylesheet" type="text/css">
<link href="../../css/standaard.css" rel="stylesheet" type="text/css">
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<td height="25" class="Style01">Inschrijfformulier Meireis 2010 </td>
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<td background="../../image/container-lijn.PNG"><img src="../../image/container-lijn.PNG" width="11" height="9" /></td>
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<td>
<br>
<form name="checkform" action='../mail-scripts/mail-meireis.asp' method='post'>
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="23%" class="Style02">Naam:</td>
<td width="77%"><input name="naam" type="textbox" class="inputborder1" id="naam" size="30"></td>
</tr>
<tr>
<td class="Style02">Adres:</td>
<td><input name="adres" type="textbox" class="inputborder1" id="adres" size="30"></td>
</tr>
<tr>
<td class="Style02">Postcode:</td>
<td><input name="postcode" type="textbox" class="inputborder1" id="postcode" size="10"></td>
</tr>
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<td class="Style02">Woonplaats:</td>
<td><input name="woonplaats" type="textbox" class="inputborder1" id="woonplaats" size="30"></td>
</tr>
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<td class="Style02">Telefoonnummer:</td>
<td><input name="telnummer" type="textbox" class="inputborder1" id="telnummer" size="30"></td>
</tr>
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<td class="Style02">E-mailadres:</td>
<td><input name="emailadres" type="textbox" class="inputborder1" id="emailadres" size="30"></td>
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</table>
<br>
<table width="100%" border="0" cellspacing="0" cellpadding="0">
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<td width="23%" class="Style02">Appartement (Incl. skipas)</td>
<td width="4%"><input type="checkbox" name="hotel" value="ON" onClick="CheckValue()" checked></td>
<td width="23%" class="Style02">€ 395,-</td>
<td width="50%"> </td>
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<td class="Style02">Huur Ski / Snowboard </td>
<td><input type="checkbox" name="matriaal" value="ON" onClick="CheckValue()"></td>
<td class="Style02">€ 75,-</td>
<td> </td>
</tr>
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<td class="Style02">Huur Schoenen </td>
<td><input type="checkbox" name="schoenen" value="ON" onClick="CheckValue()"></td>
<td class="Style02">€ 25,00</td>
<td><div id="hidden1" STYLE="display:;">
<input name="SchoenMaat" type="textbox" class="inputborder2" size="5">
<span class="Style02">Schoenmaat</span></div></td>
</tr>
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<td height="2"> </td>
<td> </td>
<td> </td>
<td><input name="subtotaal" type="hidden" class="inputborder3" size="5"></td>
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<td><strong class="Style03">Annuleringsverzekering</strong></td>
<td> </td>
<td> </td>
<td> </td>
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<td class="Style05">5% van de reissom</td>
<td><input type="checkbox" name="annuleer" value="ON" onClick="CheckValue()"></td>
<td><span class="Style05">€</span>
<input name="annuleerbedrag" type="textbox" class="inputborder4" size="5"></td>
<td><div class="Style01" id="hidden2" style="display:;">
<input name="gebdatum" type="textbox" class="inputborder2" size="8">
<span class="Style05">Geb. Datum </span></div></td>
</tr>
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<td><b class="Style03">Reisverzekering</b></td>
<td> </td>
<td> </td>
<td> </td>
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<td class="Style05">A (eigen risico €75,-)</td>
<td><input type="checkbox" name="reisv1" value="ON" onClick="CheckValue()"></td>
<td class="Style05">€ 20,-</td>
<td> </td>
</tr>
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<td class="Style05">B (zonder eigen risico)</td>
<td><input type="checkbox" name="reisv2" value="ON" onClick="CheckValue()"></td>
<td class="Style05">€ 25,-</td>
<td> </td>
</tr>
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<td><b class="Style03">Ski / Snowboardles</b></td>
<td> </td>
<td> </td>
<td> </td>
</tr>
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<td><b class="Style05">Ski / Snowboardles</b></td>
<td><input type="checkbox" name="skiles" value="ON" onClick="CheckValue()"></td>
<td class="Style05">€ 95,- (5 dagdelen)</td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
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<td class="Style02"><b class="Style06">TOTAAL te betalen:</b></td>
<td> </td>
<td><span class="Style06">€</span>
<input name="totaal" type="textbox" class="inputborder3" size="5"></td>
<td><input name='Send' type='submit' class="form-button" value='Verzenden'>
<input name='Clear' type='reset' class="form-button" value='Wissen'>
</td>
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</table>
<table width="100%" border="0" cellspacing="0" cellpadding="0">
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<td align="center" class="Style04"><p><br>
Het bedrag kan worden overgemaakt op rekening nummer 40.58.06.868 t.n.v. Indoorski Den-Bosch.</p></td>
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</table>
<%=Request.Form("naam")%>
<%=Request.Form("adres")%>
<%=Request.Form("postcode")%>
<%=Request.Form("woonplaats")%>
<%=Request.Form("telnummer")%>
<%=Request.Form("emailadres")%>
<%=Request.Form("hotel")%>
<%=Request.Form("matriaal")%>
<%=Request.Form("schoenen")%>
<%=Request.Form("schoenmaat")%>
<%=Request.Form("subtotaal")%>
<%=Request.Form("annuleerbedrag")%>
<%=Request.Form("gebdatum")%>
<%=Request.Form("reisv1")%>
<%=Request.Form("reisv2")%>
<%=Request.Form("skiles")%>
<%=Request.Form("totaal")%>
</form></td></tr>
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