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- <DOCTYPE HTML>
- <html>
- <head>
- <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script>
- <meta name="viewport" content="width=device-width, initial-scale=1">
- <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
- <link rel="stylesheet" href="https://www.w3schools.com/w3css/4/w3.css">
- <style>
- .hidden {
- display:none
- }
- select[font=select1], select {
- width: 20%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- select[font=select2], select {
- width: 23.5%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- select[font=select3], select {
- width: 20%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- select[font=MRselect1], select {
- width: 31%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- select[font=MRselect2], select {
- width: 31%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- select[font=MRselect3], select {
- width: 31%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- </style>
- <style>
- p.big {
- line-height: 1.7;
- }
- p.big2 {
- line-height: 0.1;
- }
- * {
- box-sizing: border-box;
- }
- .column {
- float: left;
- width: 49%;
- padding: 10px;
- }
- .row:after {
- content: "";
- display: table;
- clear: both;
- margin: auto;
- </style>
- <style>
- .container {
- display: block;
- position: relative;
- padding-left: 35px;
- margin-bottom: 12px;
- cursor: pointer;
- font-size: 15px;
- -webkit-user-select: none;
- -moz-user-select: none;
- -ms-user-select: none;
- user-select: none;
- }
- .container input {
- position: absolute;
- opacity: 0;
- cursor: pointer;
- }
- .checkmark {
- position: absolute;
- top: 0;
- left: 0;
- height: 15px;
- width: 15px;
- background-color: #619bf9;
- border-radius: 50%;
- }
- .container:hover input ~ .checkmark {
- background-color: #4286f4;
- }
- .container input:checked ~ .checkmark {
- background-color: #4286f4;
- }
- .checkmark:after {
- content: "";
- position: absolute;
- display: none;
- }
- .container input:checked ~ .checkmark:after {
- display: block;
- }
- .container .checkmark:after {
- top: 3.5px;
- left: 3.5px;
- width: 7px;
- height: 7px;
- border-radius: 50%;
- background: white;
- }
- </style>
- <style>
- input[font=date1], select {
- width: 100%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- input[type=text2], select {
- width: 100%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- input[type=text3], select {
- width: 42%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- input[type=tel], select {
- width: 100%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- input[type=email], select {
- width: 100%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- input[type=text], select {
- width: 100%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- input[type=submit] {
- width: 100%;
- background-color: #619bf9;
- color: white;
- padding: 14px 20px;
- margin: 8px 0;
- border: none;
- border-radius: 4px;
- cursor: pointer;
- }
- input[type=submit]:hover {
- background-color: #4286f4;
- }
- div {
- border-radius: 5px;
- background-color: #f2f2f2;
- padding: 20px;
- }
- input[font=40] {
- width: 100%;
- padding: 12px 20px;
- margin: 8px 0;
- display: inline-block;
- border: 1px solid #ccc;
- border-radius: 4px;
- box-sizing: border-box;
- }
- </style>
- </head>
- <body onload="onload()">
- <div>
- <p>
- <form action="https://formcarry.com/s/MO2xo3fYFXS" method="POST" accept-charset="UTF-8" onsubmit="modal(); return false;">
- <!---------------------------------------------------------------------------------------------------------------------------------------->
- <div id="id01" class="w3-modal">
- <div class="w3-modal-content">
- <div class="w3-container">
- <span onclick="document.getElementById('id01').style.display='none'" class="w3-button w3-display-topright">×</span>
- <p><center><h1><b>Bedankt!</b></h1></center></p>
- <p><center>Bedankt voor uw aanvraag, we reageren zo spoedig mogelijk terug.</center></p>
- <br>
- <br>
- <br>
- <br>
- <div class="w3-display-bottomleft"><font size="0.5" >
- - <a href="http://spanishgardencalpe.tk">
- Het Spanish Garden Calpe Team</a>
- <img src="1.png" width="42" height="42">
- & <a href="http://dhwebservices.nl">
- DHwebservices.nl</a>
- <img src="2.png" width="35" height="25">
- </font></div>
- </div>
- </div>
- </div>
- <!---------------------------------------------------------------------------------------------------------------------------------------->
- <label for="voornaam">Naam:</label>
- <input type="text3" id="voornaam" name="Voornaam" placeholder="Uw voornaam" required>
- <input type="text3" id="Uw achternaam" name="Achternaam" placeholder="Uw achternaam" required>
- <!---------------------------------------------------------------------------------------------------------------------------------------->
- <p>
- <script>
- function modal() {
- document.getElementById('id01').style.display='block'
- }
- </script>
- <label>Geboortedatum:</label>
- <font color="#f2f2f2">_</font>
- <select font="select3" name="geboortedag" id="dag">
- <option value="0">Dag</option>
- </select>
- <select font="select2" name="geboortemaand" id="maand2" onchange="VeranderenMaanden1(this);">
- <option value="leeg">Maand</option>
- <option value="januari">januari</option>
- <option value="februari">februari</option>
- <option value="maart">maart</option>
- <option value="april">april</option>
- <option value="mei">mei</option>
- <option value="juni">juni</option>
- <option value="juli">juli</option>
- <option value="augustus">augustus</option>
- <option value="september">september</option>
- <option value="oktober">oktober</option>
- <option value="november">november</option>
- <option value="december">december</option>
- </select>
- <select font="select1" onclick="disable1()" onchange="return JaarVeranderen(), MaandVeranderen()" id="selectBox" name="geboortejaar">
- <option id="leeg" value="leeg">Jaar</option>
- <option id="jaar1" value="1920">1920</option>
- <option id="jaar" value="1921">1921</option>
- <option id="jaar" value="1922">1922</option>
- <option id="jaar" value="1923">1923</option>
- <option id="jaar1" value="1924">1924</option>
- <option id="jaar" value="1925">1925</option>
- <option id="jaar" value="1926">1926</option>
- <option id="jaar" value="1927">1927</option>
- <option id="jaar1" value="1928">1928</option>
- <option id="jaar" value="1929">1929</option>
- <option id="jaar" value="1930">1930</option>
- <option id="jaar" value="1931">1931</option>
- <option id="jaar1" value="1932">1932</option>
- <option id="jaar" value="1933">1933</option>
- <option id="jaar" value="1934">1934</option>
- <option id="jaar" value="1935">1935</option>
- <option id="jaar1" value="1936">1936</option>
- <option id="jaar" value="1937">1937</option>
- <option id="jaar" value="1938">1938</option>
- <option id="jaar" value="1939">1939</option>
- <option id="jaar1" value="1940">1940</option>
- <option id="jaar" value="1941">1941</option>
- <option id="jaar" value="1942">1942</option>
- <option id="jaar" value="1943">1943</option>
- <option id="jaar1" value="1944">1944</option>
- <option id="jaar" value="1945">1945</option>
- <option id="jaar" value="1946">1946</option>
- <option id="jaar" value="1947">1947</option>
- <option id="jaar1" value="1948">1948</option>
- <option id="jaar" value="1949">1949</option>
- <option id="jaar" value="1950">1950</option>
- <option id="jaar" value="1951">1951</option>
- <option id="jaar1" value="1952">1952</option>
- <option id="jaar" value="1953">1953</option>
- <option id="jaar" value="1954">1954</option>
- <option id="jaar" value="1955">1955</option>
- <option id="jaar1" value="1956">1956</option>
- <option id="jaar" value="1957">1957</option>
- <option id="jaar" value="1958">1958</option>
- <option id="jaar" value="1959">1959</option>
- <option id="jaar1" value="1960">1960</option>
- <option id="jaar" value="1961">1961</option>
- <option id="jaar" value="1962">1962</option>
- <option id="jaar" value="1963">1963</option>
- <option id="jaar1" value="1964">1964</option>
- <option id="jaar" value="1965">1965</option>
- <option id="jaar" value="1966">1966</option>
- <option id="jaar" value="1967">1967</option>
- <option id="jaar1" value="1968">1968</option>
- <option id="jaar" value="1969">1969</option>
- <option id="jaar" value="1970">1970</option>
- <option id="jaar" value="1971">1971</option>
- <option id="jaar1" value="1972">1972</option>
- <option id="jaar" value="1973">1973</option>
- <option id="jaar" value="1974">1974</option>
- <option id="jaar" value="1975">1975</option>
- <option id="jaar1" value="1976">1976</option>
- <option id="jaar" value="1977">1977</option>
- <option id="jaar" value="1978">1978</option>
- <option id="jaar" value="1979">1979</option>
- <option id="jaar1" value="1980">1980</option>
- <option id="jaar" value="1981">1981</option>
- <option id="jaar" value="1982">1982</option>
- <option id="jaar" value="1983">1983</option>
- <option id="jaar1" value="1984">1984</option>
- <option id="jaar" value="1985">1985</option>
- <option id="jaar" value="1986">1986</option>
- <option id="jaar" value="1987">1987</option>
- <option id="jaar1" value="1988">1988</option>
- <option id="jaar" value="1989">1989</option>
- <option id="jaar" value="1990">1990</option>
- <option id="jaar" value="1991">1991</option>
- <option id="jaar1" value="1992">1992</option>
- <option id="jaar" value="1993">1993</option>
- <option id="jaar" value="1994">1994</option>
- <option id="jaar" value="1995">1995</option>
- <option id="jaar1" value="1996">1996</option>
- <option id="jaar" value="1997">1997</option>
- <option id="jaar" value="1998">1998</option>
- <option id="jaar" value="1999">1999</option>
- <option id="jaar1" value="2000">2000</option>
- <option id="jaar" value="2001">2001</option>
- <option id="jaar" value="2002">2002</option>
- <option id="jaar" value="2003">2003</option>
- <option id="jaar1" value="2004">2004</option>
- <option id="jaar" value="2005">2005</option>
- <option id="jaar" value="2006">2006</option>
- <option id="jaar" value="2007">2007</option>
- <option id="jaar1" value="2008">2008</option>
- <option id="jaar" value="2009">2009</option>
- <option id="jaar" value="1010">2010</option>
- </select>
- <script>
- function disable1() {
- document.getElementById("maand1").disabled = true;
- }
- function disable2() {
- document.getElementById("maand2").disabled = true;
- }
- function disable3() {
- document.getElementById("maand3").disabled = true;
- }
- function able1() {
- document.getElementById("maand1").disabled = false;
- }
- function able2() {
- document.getElementById("maand2").disabled = false;
- }
- function able3() {
- document.getElementById("maand3").disabled = false;
- }
- </script>
- <script>
- var maanden1 = new Array(4)
- maanden1["leeg"] = ["Dag"];
- maanden1["januari"] = ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- maanden1["februari"] = ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29"];
- maanden1["maart"] = ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- maanden1["april"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30"];
- maanden1["mei"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- maanden1["juni"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30"];
- maanden1["juli"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- maanden1["augustus"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- maanden1["september"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30"];
- maanden1["oktober"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- maanden1["november"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30"];
- maanden1["december"]= ["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "21", "22", "23", "24", "25", "26", "27", "28", "29", "30", "31"];
- function VeranderenMaanden1(selectObj) {
- var idx = selectObj.selectedIndex;
- var which = selectObj.options[idx].value;
- cList = maanden1[which];
- var cSelect = document.getElementById("dag");
- var len=cSelect.options.length;
- while (cSelect.options.length > 0) {
- cSelect.remove(0);
- }
- var newOption;
- for (var i=0; i<cList.length; i++) {
- newOption = document.createElement("option");
- newOption.value = cList[i];
- newOption.text=cList[i];
- try {
- cSelect.add(newOption);
- }
- catch (e) {
- cSelect.appendChild(newOption);
- }
- }
- }
- </script>
- </p>
- <!---------------------------------------------------------------------------------------------------------------------------------------->
- <p>
- <label for="email">E-mail:</label>
- <input type="email" id="email" name="E-mail" placeholder="Uw e-mail" required>
- <label for="email">Telefoonnummer:</label>
- <input type="tel" id="telefoonnummer" name="Telefoonnummer" placeholder="Uw telefoonnummer" required>
- </p>
- <p>
- <label for="aankomstdatum">Aankomstdatum:</label><font color="#f2f2f2">_</font>
- <input style="width: 70%;" type="date" font="date1" id="aankomstdatum" min="2018-07-01" name="Aankomstdatum" placeholder="Aankomstdatum" required>
- </p>
- <p>
- <label for="vertrekdatum">Vertrekdatum:</label><font color="#f2f2f2">_</font>
- <input style="width: 70%;" type="date" id="vertrekdatum" font="date1" min="2018-07-14" name="Vertrekdatum" placeholder="Vertrekdatum" required>
- </p>
- <!-------------------------------------------------------------------------------------------------------------------------------------------------------------->
- <div class="row">
- <div class="column" style="background-color:#f2f2f2">
- <h4><input id="myCheck" type="checkbox" name="1e medereiziger" onclick="myFunction()" value="Ja"><font color="#f2f2f2">_</font><b>1e Medereiziger:</b></h4>
- <p id="text" style="display:none">
- <br>
- <label for="Voornaam 1e medereiziger">Voornaam medereiziger:</label>
- <br>
- <br>
- <br>
- <p id="1text" style="display:none">
- <label for="Achternaam 1e medereiziger">Achternaam Medereiziger:</label>
- <br>
- <br>
- <br>
- <p id="2text" style="display:none">
- <label for="geboortedatum 1e medereiziger">Geboortedatum Medereiziger:</label>
- <br>
- </p>
- <script>
- function myFunction() {
- var checkBox = document.getElementById("myCheck");
- var text = document.getElementById("text");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("1text");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("2text");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("3text");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("4text");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("5text");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- }
- </script>
- <h4><input id="myCheck1" type="checkbox" name="2e Medereiziger" onchange="myFunction1()" value="Ja"><font color="#f2f2f2">_</font><b>2e Medereiziger:</b></h4>
- <p id="text1" style="display:none">
- <br>
- <label for="Voornaam 2e medereiziger">Voornaam medereiziger:</label>
- <br>
- <br>
- <br>
- <p id="1text1" style="display:none">
- <label for="Achternaam 2e medereiziger">Achternaam Medereiziger:</label>
- <br>
- <br>
- <br>
- <p id="2text1" style="display:none">
- <label for="geboortedatum 2e medereiziger">Geboortedatum Medereiziger:</label>
- <br>
- </p>
- <script>
- function myFunction1() {
- var checkBox = document.getElementById("myCheck1");
- var text = document.getElementById("text1");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("1text1");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("2text1");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("3text1");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("4text1");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- var text = document.getElementById("5text1");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- }
- </script>
- <h4><input id="myCheck2" type="checkbox" name="3e Medereiziger" onclick="myFunction2()" value="Ja"><font color="#f2f2f2">_</font><b>3e Medereiziger:</b></h4>
- <p id="text2" style="display:none">
- <br>
- <br>
- <label for="Voornaam 3e medereiziger">Voornaam medereiziger:</label>
- <br>
- <br>
- <br>
- <p id="1text2" style="display:none">
- <label for="Achternaam 3e medereiziger">Achternaam Medereiziger:</label>
- <br>
- <br>
- <br>
- <p id="2text2" style="display:none">
- <label for="geboortedatum 3e medereiziger">Geboortedatum Medereiziger:</label>
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- <p id="text3" style="display:none">
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- <p id="2text3" style="display:none">
- <label for="geboortedatum 4e medereiziger">Geboortedatum Medereiziger:</label>
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- function myFunction3() {
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- var text = document.getElementById("text3");
- if (checkBox.checked == true){
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- text.style.display = "block";
- } else {
- text.style.display = "none";
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- var text = document.getElementById("3text3");
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- text.style.display = "block";
- } else {
- text.style.display = "none";
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- var text = document.getElementById("4text3");
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- text.style.display = "block";
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- text.style.display = "none";
- }
- var text = document.getElementById("5text3");
- if (checkBox.checked == true){
- text.style.display = "block";
- } else {
- text.style.display = "none";
- }
- }
- </script>
- <h4><input id="myCheck4" type="checkbox" name="5e Medereiziger" onclick="myFunction4()" value="Ja"><font color="#f2f2f2">_</font><b>5e Medereiziger:</b></h4>
- <p id="text4" style="display:none">
- <br>
- <label for="Voornaam 5e medereiziger">Voornaam medereiziger:</label>
- <br>
- <br>
- <br>
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- <label for="Achternaam 5e medereiziger">Achternaam Medereiziger:</label>
- <br>
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- <p id="2text4" style="display:none">
- <label for="geboortedatum 5e medereiziger">Geboortedatum Medereiziger:</label>
- <script>
- function myFunction4() {
- var checkBox = document.getElementById("myCheck4");
- var text = document.getElementById("text4");
- if (checkBox.checked == true){
- text.style.display = "block";
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- text.style.display = "none";
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- text.style.display = "block";
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- text.style.display = "block";
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- }
- }
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- <!--------------------------------------------------------------------------------------------------------------------------------------->
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- <!--------------------------------------------------------------------------------------------------------------------------------------->
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- <p id="3text" style="display:none">
- <br>
- <br>
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- </p><p id="5text" style="display:none">
- <input type="text2" name="Geboortedatum 1e medereiziger" placeholder="DD-MM-JJJJ">
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- <p class="big">
- <font color="#f2f2f2">_</font><br>
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- <p id="3text1" style="display:none">
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- <input type="text2" id="Achternaam 2e medereiziger" name="Achternaam 2e medereiziger" placeholder="Achternaam">
- </p><p id="5text1" style="display:none">
- <input type="text2" name="Geboortedatum 2e medereiziger" placeholder="DD-MM-JJJJ">
- </p>
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- <input type="text2" id="Voornaam 3e medereiziger" name="Voornaam 3e medereiziger" placeholder="Voornaam">
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- <input type="text2" id="Achternaam 3e medereiziger" name="Achternaam 3e medereiziger" placeholder="Achternaam">
- </p><p id="5text2" style="display:none">
- <input type="text2" name="Geboortedatum 3e medereiziger" placeholder="DD-MM-JJJJ">
- </p>
- </div>
- <div class="column" style="background-color:#f2f2f2">
- <p id="3text3" style="display:none">
- <input type="text2" id="Voornaam 4e medereiziger" name="Voornaam 4e medereiziger" placeholder="Voornaam">
- </p><p id="4text3" style="display:none">
- <input type="text2" id="Achternaam 4e medereiziger" name="Achternaam 4e medereiziger" placeholder="Achternaam">
- </p><p id="5text3" style="display:none">
- <input type="text2" name="Geboortedatum 4e medereiziger" placeholder="DD-MM-JJJJ">
- </p>
- </div>
- <div class="column" style="background-color:#f2f2f2">
- <p id="3text4" style="display:none">
- <input type="text2" id="Voornaam 5e medereiziger" name="Voornaam 5e medereiziger" placeholder="Voornaam">
- </p><p id="4text4" style="display:none">
- <input type="text2" id="Achternaam 5e medereiziger" name="Achternaam 5e medereiziger" placeholder="Achternaam">
- </p><p id="5text4" style="display:none">
- <input type="text2" name="Geboortedatum 5e medereiziger" placeholder="DD-MM-JJJJ">
- </p>
- </div>
- <!--------------------------------------------------------------------------------------------------------------------------------------->
- </div>
- <!--------------------------------------------------------------------------------------------------------------------------------------->
- <input type="submit" value="Verzenden">
- </form>
- </div>
- </body>
- </html>
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