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<NOSCRIPT> <META HTTP-EQUIV="refresh" CONTENT="0; URL=/nojavascript/index.html"> </NOSCRIPT> <link rel="stylesheet" href="http://www.sport.be/css/v3/event_base.css" type="text/css"> <link rel="stylesheet" href="http://www.sport.be/css/2008/grinta.css" type="text/css"> <style> body { background-color:white; background-image: none; } </style> <SCRIPT LANGUAGE="JavaScript" SRC="http://www.sport.be/javascripts/popup.js"></SCRIPT> <script language="JavaScript" src="http://www.sport.be/javascripts/validation.js"></script> <SCRIPT language="JavaScript"> function funOnSubmit() { var strErro; strErro = "" ; strErro += funCheckBlank(); if (strErro == "") { return true; spnErrors.style.display = "none"; } else { var strErr = ""; spnErrors.style.display = ""; strErr += "_______________________________________\n\n"; strErr += strErro; strErr += "_______________________________________"; alert (strErr); window.location.href = "#top"; return false; } } function funCheckBlank() { var strErrors = ""; //------------------------ // basic checks //------------------------ strErrors += checkEmpty(frmRun.txtFirstName,"","~ Een voornaam is verplicht !\n","errorInput","text"); strErrors += checkEmpty(frmRun.txtLastName,"","~ Een familienaam is verplicht !\n","errorInput","text"); strErrors += checkEmpty(frmRun.txtStreet,"","~ Een straat is verplicht !\n","errorInput","text"); strErrors += checkEmpty(frmRun.txtStreetNumber,"","~ Een huisnummer is verplicht !\n","errorInput","text"); strErrors += checkEmpty(frmRun.txtPostalCode,"","~ Een postcode is verplicht !\n","errorInput","text"); strErrors += checkEmpty(frmRun.txtCity,"","~ Een plaats is verplicht !\n","errorInput","text"); strErrors += checkEmail(frmRun.txtEmail,"","~ E-mail adres is niet correct of niet ingevuld !\n","errorInput","text"); strErrors += checkBetweenNumbers(frmRun.txtBirthDateDay,1,31,"","~ Een geboortedatum is verplicht !\n","errorInput","text"); strErrors += checkBetweenNumbers(frmRun.txtBirthDateMonth,1,12,"","~ Een geboortedatum is verplicht !\n","errorInput","text"); strErrors += checkBetweenNumbers(frmRun.txtBirthDateYear,1900,2005,"","~ Een geboortedatum is verplicht !\n","errorInput","text"); //------------------------ // is run selected ? //------------------------ if ((!document.frmRun.rdAboType[0].checked) && (!document.frmRun.rdAboType[1].checked)) { strErrors += "~ Gelieve een abonnementtype te kiezen !\n"; } strErrors += checkRadio(frmRun.rdPayment,"","~ Gelieve een betalingswijze te selecteren !\n","errorInput","text"); //------------------------ // transfer checks if selected //------------------------ if (document.frmRun.rdPayment[1].checked) { strErrors += checkBelgianAccount(frmRun.txtTransferAccountNumber1,frmRun.txtTransferAccountNumber2,frmRun.txtTransferAccountNumber3,"","~ Dit rekeningnummer is niet correct !\n","errorInput","text"); } else { document.frmRun.txtTransferAccountNumber1.className = "text"; document.frmRun.txtTransferAccountNumber2.className = "text"; document.frmRun.txtTransferAccountNumber3.className = "text"; } //------------------------ // foreign transfer checks if selected //------------------------ if (document.frmRun.rdPayment[2].checked) { strErrors += checkEmpty(frmRun.txtForeignTransferAccountNumber,"","~ Gelieve uw rekeningnummer in te voeren !\n","errorInput","text"); } else { document.frmRun.txtForeignTransferAccountNumber.className = "text"; } return strErrors; } function clearBelgianTransfer() { document.frmRun.txtTransferAccountNumber1.value = "" ; document.frmRun.txtTransferAccountNumber2.value = "" ; document.frmRun.txtTransferAccountNumber3.value = "" ; } function clearForeignTransfer() { document.frmRun.txtForeignTransferAccountNumber.value = "" ; } function changePayment() { if (document.frmRun.rdPayment[0].checked) { //------------------------ // ONLINE PAYMENT //------------------------ clearBelgianTransfer(); clearForeignTransfer(); } if (document.frmRun.rdPayment[1].checked) { //------------------------ // belgian transfer //------------------------ clearForeignTransfer(); } if (document.frmRun.rdPayment[2].checked) { //------------------------ // foreign transfer //------------------------ clearBelgianTransfer(); } } function countPoints() { var total = 0; //------------------------ // Jaarabo //------------------------ if (document.frmRun.rdAboType[0].checked) { document.frmRun.txtJaarabonnement.value = 24 ; total = total + 24; } else { document.frmRun.txtJaarabonnement.value = "" ; } //------------------------ // Proefabo //------------------------ if (document.frmRun.rdAboType[1].checked) { document.frmRun.txtProefabonnement.value = 9.99 ; total = total + 9.99; } else { document.frmRun.txtProefabonnement.value = "" ; } document.frmRun.txtTotal2Pay.value = total ; } --> </SCRIPT> <form action="/grinta/nl/abonnement//post_nolayout.jsp#top" method="post" name="frmRun"> <div class = "title"><a href="#top"></a>Abonnement Grinta!</div> <div class = "content"> <SPAN id="spnErrors" class="little" style="DISPLAY: none;color:red"> <br>U moet alle verplichte velden invullen </SPAN> <TABLE class = "detail" cellspacing = 1 cellpadding = 3> <TR> <TD class="detailHeader" colspan = "2"> Persoonlijke gegevens </TD> </TR> <TR> <TD class="detailLabel"> Voornaam </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtFirstName" size = "30"><SPAN id="spnLastName" style="DISPLAY: none;color:red">!</SPAN> </TD> <TR> <TD class="detailLabel"> Naam </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtLastName" size = "30"><SPAN id="spnFirstName" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Straat </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtStreet" size = "30"><SPAN id="spnStreet" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Nummer </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtStreetNumber" size = "2"><SPAN id="spnStreetNumber" style="DISPLAY: none;color:red">!</SPAN> Bus <INPUT type = "text" class= "text" name = "txtBoxNumber" size = "2"> </TD> </TR> <TR> <TD class="detailLabel"> Postcode </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtPostalCode" size = "4"><SPAN id="spnPostalCode" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Gemeente </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtCity" size = "30"><SPAN id="spnCity" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Land </TD> <TD class="detailContent" > <select name='selCountry' class = 'text'> <option value ='1' selected>België</option><option value ='18'>Afghanistan</option><option value ='3'>Algerije</option><option value ='4'>Andorra</option><option value ='5'>Angola</option><option value ='6'>Antarctica</option><option value ='7'>Argentinië</option><option value ='8'>Armenië</option><option value ='9'>Aruba</option><option value ='10'>Australië</option><option value ='12'>Azerbaïdjan</option><option value ='13'>Bahamas</option><option value ='14'>Bahrain</option><option value ='15'>Bangladesh</option><option value ='16'>Barbados</option><option value ='19'>Belize</option><option value ='20'>Benin</option><option value ='21'>Bermuda</option><option value ='22'>Bolivië</option><option value ='23'>Bosnië-Herzegovina</option><option value ='24'>Botswana</option><option value ='25'>Brazilië</option><option value ='26'>Bulgarije</option><option value ='27'>Burkina Faso</option><option value ='28'>Burundi</option><option value ='29'>Cambodia</option><option value ='31'>Canada</option><option value ='32'>Cape Verde</option><option value ='33'>Chili</option><option value ='34'>China</option><option value ='35'>Colombia</option><option value ='36'>Congo</option><option value ='165'>Congo</option><option value ='37'>Costa Rica</option><option value ='40'>Cuba</option><option value ='41'>Cyprus</option><option value ='43'>Denemarken</option><option value ='44'>Dominikaanse republiek</option><option value ='2'>Duitsland</option><option value ='45'>Ecuador</option><option value ='46'>Egypte</option><option value ='47'>El Salvador</option><option value ='48'>Engeland</option><option value ='49'>Estland</option><option value ='50'>Ethiopiëi</option><option value ='51'>Fareur</option><option value ='52'>Fiji</option><option value ='120'>Filippijnen</option><option value ='53'>Finland</option><option value ='54'>Frankrijk</option><option value ='55'>Gabon</option><option value ='56'>Gambië</option><option value ='57'>Georgië</option><option value ='59'>Ghana</option><option value ='60'>Gibraltar</option><option value ='62'>Grenada</option><option value ='61'>Griekenland</option><option value ='63'>Guadeloupe</option><option value ='64'>Guatemala</option><option value ='65'>Guinea</option><option value ='66'>Haiti</option><option value ='67'>Honduras</option><option value ='68'>Hongarije</option><option value ='74'>Ierland</option><option value ='69'>Ijsland</option><option value ='70'>Indië</option><option value ='71'>Indonesië</option><option value ='73'>Irak</option><option value ='72'>Iran</option><option value ='75'>Israel</option><option value ='76'>Italië</option><option value ='38'>Ivoorkust</option><option value ='77'>Jamaica</option><option value ='78'>Japan</option><option value ='79'>Jordanië</option><option value ='30'>Kameroen</option><option value ='80'>Kazakhstan</option><option value ='81'>Kenia</option><option value ='83'>Koeweit</option><option value ='82'>Korea</option><option value ='39'>Kroatië</option><option value ='84'>Letland</option><option value ='85'>Libanon</option><option value ='86'>Liberia</option><option value ='87'>Liechtenstein</option><option value ='88'>Litouwen</option><option value ='89'>Luxemburg</option><option value ='90'>Macedonië</option><option value ='91'>Madagascar</option><option value ='92'>Malaisië</option><option value ='93'>Malediven</option><option value ='94'>Mali</option><option value ='95'>Malta</option><option value ='102'>Marokko</option><option value ='96'>Martinique</option><option value ='97'>Mauritanië</option><option value ='98'>Mauritius</option><option value ='99'>Mexico</option><option value ='100'>Moldavië</option><option value ='101'>Mongolië</option><option value ='103'>Mozambique</option><option value ='104'>Namibi</option><option value ='106'>Nederland</option><option value ='107'>Nederlandse Antillen</option><option value ='105'>Nepal</option><option value ='109'>Nicaragua</option><option value ='108'>Nieuw-Zeeland</option><option value ='110'>Niger</option><option value ='111'>Nigeria</option><option value ='112'>Noord Ierland</option><option value ='113'>Noorwegen</option><option value ='153'>Oeganda</option><option value ='154'>Oekraïne</option><option value ='158'>Oezbikistan</option><option value ='114'>Oman</option><option value ='11'>Oostenrijk</option><option value ='115'>Pakistan</option><option value ='116'>Panama</option><option value ='117'>Papua Nieuw Guinea</option><option value ='118'>Paraguay</option><option value ='119'>Peru</option><option value ='121'>Polen</option><option value ='122'>Portugal</option><option value ='123'>Puerto Rico</option><option value ='124'>Qatar</option><option value ='125'>Roemenië</option><option value ='126'>Rusland</option><option value ='127'>Rwanda</option><option value ='128'>Samoa</option><option value ='129'>San Marino</option><option value ='130'>Saudi Arabië</option><option value ='131'>Schotland</option><option value ='132'>Senegal</option><option value ='163'>Servië-Montenegro</option><option value ='133'>Sierra Leone</option><option value ='134'>Singapore</option><option value ='135'>Slovakije</option><option value ='136'>Slovenië</option><option value ='137'>Solomon eilanden</option><option value ='138'>Somalië</option><option value ='140'>Spanje</option><option value ='141'>Sri lanka</option><option value ='142'>Sudan</option><option value ='143'>Suriname</option><option value ='146'>Taiwan</option><option value ='147'>Tanzanië</option><option value ='148'>Thailand</option><option value ='149'>Togo</option><option value ='150'>Trinidad en Tobago</option><option value ='42'>Tsjechië</option><option value ='151'>Tunesië</option><option value ='152'>Turkije</option><option value ='157'>Uruguay</option><option value ='159'>Vaticaanstad</option><option value ='160'>Venezuela</option><option value ='155'>Verenigde Arabische Emiraten</option><option value ='156'>Verenigde Staten</option><option value ='161'>Vietnam</option><option value ='162'>Wales</option><option value ='17'>Wit-Rusland</option><option value ='164'>Yemen</option><option value ='166'>Zambia</option><option value ='167'>Zimbabwe</option><option value ='139'>Zuid-Afrika</option><option value ='144'>Zweden</option><option value ='145'>Zwitserland</option> </select> </TD> </TR> <TR> <TD class="detailLabel"> Taal </TD> <TD class="detailContent" > <!-- <INPUT type = "text" class= "text" name = "txtCountry" size = "30"><SPAN id="spnCountry" style="DISPLAY: none;color:red">!</SPAN> --> <select name='selLanguage' class = 'text'> <option value = '4'>Duits</option><option value = '3'>Engels</option><option value = '2'>Frans</option><option value = '5'>Italiaans</option><option value = '1' selected>Nederlands</option><option value = '6'>Spaans</option> </select> </TD> </TR> <TR> <TD class="detailLabel"> E-mail </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtEmail" size = "30"><SPAN id="spnEmail" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Telefoon </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtTelephone" size = "15"><SPAN id="spnTelephone" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Fax </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtFax" size = "15"><SPAN id="spnFax" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> GSM </TD> <TD class="detailContent" > <INPUT type = "text" class= "text" name = "txtMobile" size = "15"><SPAN id="spnMobile" style="DISPLAY: none;color:red">!</SPAN> </TD> </TR> <TR> <TD class="detailLabel"> Geslacht </TD> <TD class="detailContent" > <INPUT type="radio" value="M" checked name = "rdSexe">Man <INPUT type="radio" value="V" name = "rdSexe">Vrouw </TD> </TR> <TR> <TD class="detailLabel"> Geboortedatum </TD> <TD class="detailContent" > <input type = 'text' class = 'text' name = "txtBirthDateDay" size = "4" maxlength = "2" value = "dd">-<input type = 'text' class = 'text' name = "txtBirthDateMonth" size = "4" maxlength = "2" value = "mm">-<input type = 'text' class = 'text' name = "txtBirthDateYear" size = "6" maxlength = "4" value = "yyyy"> </TD> </TR> </TABLE> <br> <table class = "list"cellspacing = 1 cellpadding = 3> <tr> <td class = "listHeader" colspan = "3">Abonnement</td> </tr> <tr> <td class = "listContent"><INPUT type="radio" name = "rdAboType" value="533" onclick="countPoints();">Jaarabonnement Grinta! (6 nummers)</td> <td class = "listContent">24 €</td> <td class = "listContent"><input type = "text" name = "txtJaarabonnement" readonly class = "text" size = "3"></td> </tr> <tr> <td class = "listContentAlternating"><INPUT type="radio" name = "rdAboType" value="681" onclick="countPoints();">Kennismakingsabonnement Grinta! (3 nummers, inclusief GRATIS knooppuntenspecial)</td> <td class = "listContentAlternating">9.99 €</TD> <td class = "listContentAlternating"><input type = "text" name = "txtProefabonnement" readonly class = "text" size = "3"></td> </tr> <TR> <TD class="listFooter" colspan="2"><strong>Totaal te betalen</strong></TD> <TD class="listFooter"><INPUT type = "text" class = "text" size = 3 name = "txtTotal2Pay" value="0" READONLY></TD> </TR> </table> <br> <table class = "list" cellspacing = 1 cellpadding = 3> <tr> <td class = "listHeader" colspan = "2">Betalingsgegevens</td> </tr> <tr> <td class = "listContent" colspan = 2> <INPUT type = radio name = "rdPayment" value = "ONLINE" onclick = "changePayment()"> Ik betaal online via een beveiligde lijn en kies voor één van de volgende betalingsmethodes.<br><img src = http://www.sport.be/images/mysportbe/banken/visa.gif border = 0 hspace = 2><img src = http://www.sport.be/images/mysportbe/banken/mastercard.gif border = 0 hspace = 2><img src = http://www.sport.be/images/mysportbe/banken/kbconline.gif border = 0 hspace = 2><img src = http://www.sport.be/images/mysportbe/banken/cbconline.gif border = 0 hspace = 2><img src = http://www.sport.be/images/mysportbe/banken/dexianetbanking.gif border = 0 hspace = 2><img src = http://www.sport.be/images/mysportbe/banken/inghomepay.gif border = 0 hspace = 2> </td> </tr> <tr> <td class = "listContent" colspan = 2> <INPUT type = radio name = "rdPayment" value = "BELGIANACCOUNT" onclick = "changePayment()">Storting via rekeningnummer <SPAN id="spnTransfer" style="DISPLAY: none;color:red">!</SPAN> <br> <INPUT type = text size = 3 maxlength = 3 name = "txtTransferAccountNumber1" class = "text" > - <INPUT type = text size = 7 maxlength = 7 name = "txtTransferAccountNumber2" class = "text" > - <INPUT type = text size = 2 maxlength = 2 name = "txtTransferAccountNumber3" class = "text" > <span id="spnTransferAccountNumber" style="DISPLAY: none;color:red">!</span> <br><br>Je moet het juiste bedrag zelf overschrijven op N° 735-0187023-92 met vermelding van GRINTA10 </td> </tr> <tr> <td class = "listContent" colspan = 2> <INPUT type = radio name = "rdPayment" value = "FOREIGNACCOUNT" onclick = "changePayment()" >Storting via een buitenlands rekeningnummer <SPAN id="spnForeignTransfer" style="DISPLAY: none;color:red">!</SPAN><br> <INPUT type = text size = 25 name = "txtForeignTransferAccountNumber" class = "text" > <span id="spnForeignTransferAccountNumber" style="DISPLAY: none;color:red">!</span> <br><br>IBAN NR : BE12 7350 1870 2392 - BIC CODE KREDBEBB - BANKNAME: KBC N° 735-0187023-92 </td> </tr> </table> <input type = "submit" value = "Verstuur" onClick="return funOnSubmit(this.form)"> <br> <br> <span class = "legal"> "Alle informatie is bestemd voor Golazo media. Zij mag evenwel doorgegeven worden aan de partijen die contractueel verbonden zijn met Golazo media. De wet van 8 december 1992 i.v.m. de bescherming van de persoonlijke levenssfeer t.o.v. gegevensverwerking voorziet het toegangsrecht tot de gegevens en het verbeteren ervan." </span> </form> </div>
