{"id":382,"date":"2017-01-02T23:05:41","date_gmt":"2017-01-02T22:05:41","guid":{"rendered":"https:\/\/debuylinsurance.com\/?page_id=382"},"modified":"2024-04-15T18:46:25","modified_gmt":"2024-04-15T16:46:25","slug":"offerte","status":"publish","type":"page","link":"https:\/\/debuylinsurance.com\/nl\/offerte\/","title":{"rendered":"Gratis offerte"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column width=&#8221;1\/4&#8243;][vc_single_image image=&#8221;212&#8243; img_size=&#8221;large&#8221;][\/vc_column][vc_column width=&#8221;3\/4&#8243;][vc_column_text css=&#8221;&#8221;]<div class=\"frm_forms  with_frm_style frm_style_debuyl\" id=\"frm_form_51_container\" data-token=\"b77159323b003ef41b5e07444e50e71d\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_en-quote23d68ac805dbd9c166c7b27\" data-token=\"b77159323b003ef41b5e07444e50e71d\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">NL Quote 2024-03<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"51\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_51\" id=\"frm_hide_fields_51\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"en-quote23d68ac805dbd9c166c7b27\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_51\" name=\"frm_submit_entry_51\" value=\"c514861a15\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nl\/wp-json\/wp\/v2\/pages\/382\" \/><div id=\"frm_field_1424_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Verzekeringsaanvraag<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1425_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label col-form-label form-label\">Aanvraag offerte verzekering voor\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1425-1424-0\">\t\t\t<label  for=\"field_z3zp6047299b02c92db7df138-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1425]\" id=\"field_z3zp6047299b02c92db7df138-0\" value=\"Paard\"\n\t\t data-sectionid=\"1424\"  data-frmval=\"Paard\" data-reqmsg=\"Aanvraag offerte verzekering voor cannot be blank.\" data-invmsg=\"Aanvraag offerte verzekering voor is ongeldig\"  checked=\"checked\" \/> Paard<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1425-1424-4\">\t\t\t<label  for=\"field_z3zp6047299b02c92db7df138-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1425]\" id=\"field_z3zp6047299b02c92db7df138-4\" value=\"Veulen\"\n\t\t data-sectionid=\"1424\"  data-frmval=\"Paard\" data-reqmsg=\"Aanvraag offerte verzekering voor cannot be blank.\" data-invmsg=\"Aanvraag offerte verzekering voor is ongeldig\"   \/> Veulen<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1425-1424-1\">\t\t\t<label  for=\"field_z3zp6047299b02c92db7df138-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1425]\" id=\"field_z3zp6047299b02c92db7df138-1\" value=\"Ongeboren veulen\"\n\t\t data-sectionid=\"1424\"  data-frmval=\"Paard\" data-reqmsg=\"Aanvraag offerte verzekering voor cannot be blank.\" data-invmsg=\"Aanvraag offerte verzekering voor is ongeldig\"   \/> Ongeboren veulen<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1425-1424-2\">\t\t\t<label  for=\"field_z3zp6047299b02c92db7df138-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1425]\" id=\"field_z3zp6047299b02c92db7df138-2\" value=\"Transport\"\n\t\t data-sectionid=\"1424\"  data-frmval=\"Paard\" data-reqmsg=\"Aanvraag offerte verzekering voor cannot be blank.\" data-invmsg=\"Aanvraag offerte verzekering voor is ongeldig\"   \/> Transport<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1425-1424-3\">\t\t\t<label  for=\"field_z3zp6047299b02c92db7df138-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1425]\" id=\"field_z3zp6047299b02c92db7df138-3\" value=\"Geplande operaties\"\n\t\t data-sectionid=\"1424\"  data-frmval=\"Paard\" data-reqmsg=\"Aanvraag offerte verzekering voor cannot be blank.\" data-invmsg=\"Aanvraag offerte verzekering voor is ongeldig\"   \/> Geplande operaties<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1427_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Paard<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1428_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_first frm_half\">\r\n    <label for=\"field_3x9yz8ebe8761cf1aaf1f798c18\" class=\"frm_primary_label col-form-label form-label\">Naam van het paard\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_3x9yz8ebe8761cf1aaf1f798c18\" name=\"item_meta[1428]\" value=\"\"  data-sectionid=\"1427\"  data-reqmsg=\"Naam van het paard cannot be blank.\" aria-required=\"true\" data-invmsg=\"Horse name is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1429_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_first frm_third vertical_radio\">\r\n    <label for=\"field_pts3g8e99fba9279df1cdb2dc38\" class=\"frm_primary_label col-form-label form-label\">Geslacht\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<div class=\"frm_radio radio\" id=\"frm_radio_1429-1427-1\">\t\t\t<label  for=\"field_pts3g8e99fba9279df1cdb2dc38-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1429]\" id=\"field_pts3g8e99fba9279df1cdb2dc38-1\" value=\"Merrie\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Geslacht cannot be blank.\" data-invmsg=\"Geslacht is ongeldig\"   \/> Merrie<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1429-1427-2\">\t\t\t<label  for=\"field_pts3g8e99fba9279df1cdb2dc38-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1429]\" id=\"field_pts3g8e99fba9279df1cdb2dc38-2\" value=\"Ruin\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Geslacht cannot be blank.\" data-invmsg=\"Geslacht is ongeldig\"   \/> Ruin<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1429-1427-3\">\t\t\t<label  for=\"field_pts3g8e99fba9279df1cdb2dc38-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1429]\" id=\"field_pts3g8e99fba9279df1cdb2dc38-3\" value=\"Hengst\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Geslacht cannot be blank.\" data-invmsg=\"Geslacht is ongeldig\"   \/> Hengst<\/label><\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1430_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_wyo806_label\" class=\"frm_primary_label col-form-label form-label\">Is de merrie drachtig?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wyo806_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1430-1427-0\">\t\t\t<label  for=\"field_wyo806-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1430]\" id=\"field_wyo806-0\" value=\"ja\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Is de merrie drachtig? cannot be blank.\" data-invmsg=\"Is de merrie drachtig? is ongeldig\"   \/> ja<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1430-1427-1\">\t\t\t<label  for=\"field_wyo806-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1430]\" id=\"field_wyo806-1\" value=\"nee\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Is de merrie drachtig? cannot be blank.\" data-invmsg=\"Is de merrie drachtig? is ongeldig\"   \/> nee<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1431_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_errtk6_label\" class=\"frm_primary_label col-form-label form-label\">Is de hengst een dekhengst?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_errtk6_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1431-1427-0\">\t\t\t<label  for=\"field_errtk6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1431]\" id=\"field_errtk6-0\" value=\"ja\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Is de hengst een dekhengst? cannot be blank.\" data-invmsg=\"Is de hengst een dekhengst? is ongeldig\"   \/> ja<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1431-1427-1\">\t\t\t<label  for=\"field_errtk6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1431]\" id=\"field_errtk6-1\" value=\"nee\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Is de hengst een dekhengst? cannot be blank.\" data-invmsg=\"Is de hengst een dekhengst? is ongeldig\"   \/> nee<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1432_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_ms4kf7_label\" class=\"frm_primary_label col-form-label form-label\">wenst u de onvruchtbaarheid te verzekeren\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ms4kf7_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1432-1427-0\">\t\t\t<label  for=\"field_ms4kf7-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1432]\" id=\"field_ms4kf7-0\" value=\"ja\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"wenst u de onvruchtbaarheid te verzekeren cannot be blank.\" data-invmsg=\"wenst u de onvruchtbaarheid te verzekeren is ongeldig\"   \/> ja<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1432-1427-1\">\t\t\t<label  for=\"field_ms4kf7-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1432]\" id=\"field_ms4kf7-1\" value=\"nee\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"wenst u de onvruchtbaarheid te verzekeren cannot be blank.\" data-invmsg=\"wenst u de onvruchtbaarheid te verzekeren is ongeldig\"   \/> nee<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1433_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_53t2i7_label\" class=\"frm_primary_label col-form-label form-label\">Wenst u de foetus te dekken ?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_53t2i7_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1433-1427-0\">\t\t\t<label  for=\"field_53t2i7-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1433]\" id=\"field_53t2i7-0\" value=\"ja\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Wenst u de foetus te dekken ? cannot be blank.\" data-invmsg=\"Wenst u de foetus te dekken ? is ongeldig\"   \/> ja<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1433-1427-1\">\t\t\t<label  for=\"field_53t2i7-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1433]\" id=\"field_53t2i7-1\" value=\"nee\"\n\t\t data-sectionid=\"1427\"  data-reqmsg=\"Wenst u de foetus te dekken ? cannot be blank.\" data-invmsg=\"Wenst u de foetus te dekken ? is ongeldig\"   \/> nee<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1578_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4 frm_first\">\n    <label for=\"field_8a423\" id=\"field_8a423_label\" class=\"frm_primary_label col-form-label form-label\">Geboortedatum\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_8a423\" name=\"item_meta[1578]\" value=\"\"  data-sectionid=\"1427\"  data-frmmask=\"00\/00\/0000\" data-reqmsg=\"Geboortedatum cannot be blank.\" aria-required=\"true\" data-invmsg=\"Geboortedatum is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_1435_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_jx7i482b4feb13dd0ef299cb538\" class=\"frm_primary_label col-form-label form-label\">Waarde\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_jx7i482b4feb13dd0ef299cb538\" name=\"item_meta[1435]\" value=\"\"  data-sectionid=\"1427\"  data-reqmsg=\"Waarde cannot be blank.\" aria-required=\"true\" data-invmsg=\"Value is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1436_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_s3s9w8fd483070b046b0d96da58\" class=\"frm_primary_label col-form-label form-label\">Valuta\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1436]\" id=\"field_s3s9w8fd483070b046b0d96da58\"  data-sectionid=\"1427\"  data-frmval=\"EUR\" data-reqmsg=\"Valuta cannot be blank.\" aria-required=\"true\" data-invmsg=\"Valuta is ongeldig\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"EUR\" selected='selected'>EUR<\/option><option  value=\"USD\">USD<\/option><option  value=\"CHF\">CHF<\/option><option  value=\"GBP\">GBP<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1579_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\n    <label for=\"field_phkg2\" id=\"field_phkg2_label\" class=\"frm_primary_label col-form-label form-label\">Datum dekdienst\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_phkg2\" name=\"item_meta[1579]\" value=\"\"  data-sectionid=\"1427\"  data-frmmask=\"00\/00\/0000\" data-reqmsg=\"Datum dekdienst cannot be blank.\" aria-required=\"true\" data-invmsg=\"Datum dekdienst is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_1438_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12  frm12 frm6\">\r\n    <label for=\"field_samtq7\" class=\"frm_primary_label col-form-label form-label\">Embryon's waarde\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_samtq7\" name=\"item_meta[1438]\" value=\"\"  data-sectionid=\"1427\"  data-reqmsg=\"Embryon&#039;s waarde cannot be blank.\" aria-required=\"true\" data-invmsg=\"Value is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1439_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm6 frm_first\">\r\n    <label for=\"field_spgqn8dfd3d673584781f3fad68\" class=\"frm_primary_label col-form-label form-label\">Land van vestiging van het paard\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1439]\" id=\"field_spgqn8dfd3d673584781f3fad68\"  data-sectionid=\"1427\"  data-reqmsg=\"Land van vestiging van het paard cannot be blank.\" aria-required=\"true\" data-invmsg=\"Land van vestiging van het paard is ongeldig\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Algeria\">Algeria<\/option><option  value=\"American Samoa\">American Samoa<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguilla\">Anguilla<\/option><option  value=\"Antarctica\">Antarctica<\/option><option  value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaijan\">Azerbaijan<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bahrain\">Bahrain<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Belarus\">Belarus<\/option><option  value=\"Belgium\">Belgium<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Benin\">Benin<\/option><option  value=\"Bermuda\">Bermuda<\/option><option  value=\"Bhutan\">Bhutan<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\">Botswana<\/option><option  value=\"Brazil\">Brazil<\/option><option  value=\"Brunei\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"Cambodia\">Cambodia<\/option><option  value=\"Cameroon\">Cameroon<\/option><option  value=\"Canada\">Canada<\/option><option  value=\"Cape Verde\">Cape Verde<\/option><option  value=\"Cayman Islands\">Cayman Islands<\/option><option  value=\"Central African Republic\">Central African Republic<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"C\u00f4te d\u2018Ivoire\">C\u00f4te d\u2018Ivoire<\/option><option  value=\"Croatia\">Croatia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/option><option  value=\"Denmark\">Denmark<\/option><option  value=\"Djibouti\">Djibouti<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Dominican Republic\">Dominican Republic<\/option><option  value=\"East Timor\">East Timor<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egypt\">Egypt<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Ethiopia\">Ethiopia<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Finland\">Finland<\/option><option  value=\"France\">France<\/option><option  value=\"French Guiana\">French Guiana<\/option><option  value=\"French Polynesia\">French Polynesia<\/option><option  value=\"Gabon\">Gabon<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Germany\">Germany<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Greece\">Greece<\/option><option  value=\"Greenland\">Greenland<\/option><option  value=\"Grenada\">Grenada<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Haiti\">Haiti<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungary\">Hungary<\/option><option  value=\"Iceland\">Iceland<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iran\">Iran<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Ireland\">Ireland<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italy\">Italy<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Japan\">Japan<\/option><option  value=\"Jordan\">Jordan<\/option><option  value=\"Kazakhstan\">Kazakhstan<\/option><option  value=\"Kenya\">Kenya<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"North Korea\">North Korea<\/option><option  value=\"South Korea\">South Korea<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Latvia\">Latvia<\/option><option  value=\"Lebanon\">Lebanon<\/option><option  value=\"Lesotho\">Lesotho<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libya\">Libya<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lithuania\">Lithuania<\/option><option  value=\"Luxembourg\">Luxembourg<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malawi\">Malawi<\/option><option  value=\"Malaysia\">Malaysia<\/option><option  value=\"Maldives\">Maldives<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marshall Islands\">Marshall Islands<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mauritius\">Mauritius<\/option><option  value=\"Mexico\">Mexico<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldova\">Moldova<\/option><option  value=\"Monaco\">Monaco<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Morocco\">Morocco<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Netherlands\">Netherlands<\/option><option  value=\"New Zealand\">New Zealand<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Norway\">Norway<\/option><option  value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option  value=\"Oman\">Oman<\/option><option  value=\"Pakistan\">Pakistan<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\">Panama<\/option><option  value=\"Papua New Guinea\">Papua New Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Peru\">Peru<\/option><option  value=\"Philippines\">Philippines<\/option><option  value=\"Poland\">Poland<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Qatar\">Qatar<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\">Saudi Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia and Montenegro\">Serbia and Montenegro<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leone\">Sierra Leone<\/option><option  value=\"Singapore\">Singapore<\/option><option  value=\"Slovakia\">Slovakia<\/option><option  value=\"Slovenia\">Slovenia<\/option><option  value=\"Solomon Islands\">Solomon Islands<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"South Africa\">South Africa<\/option><option  value=\"South Sudan\">South Sudan<\/option><option  value=\"Spain\">Spain<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Sudan\">Sudan<\/option><option  value=\"Suriname\">Suriname<\/option><option  value=\"Swaziland\">Swaziland<\/option><option  value=\"Sweden\">Sweden<\/option><option  value=\"Switzerland\">Switzerland<\/option><option  value=\"Syria\">Syria<\/option><option  value=\"Taiwan\">Taiwan<\/option><option  value=\"Tajikistan\">Tajikistan<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Thailand\">Thailand<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option  value=\"Tunisia\">Tunisia<\/option><option  value=\"Turkey\">Turkey<\/option><option  value=\"Turkmenistan\">Turkmenistan<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Ukraine\">Ukraine<\/option><option  value=\"United Arab Emirates\">United Arab Emirates<\/option><option  value=\"United Kingdom\">United Kingdom<\/option><option  value=\"United States\">United States<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabwe\">Zimbabwe<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1440_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12  frm6\">\r\n    <label for=\"field_w3yy38\" id=\"field_w3yy38_label\" class=\"frm_primary_label col-form-label form-label\">In welke stal bevindt uw paard zich?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_w3yy38\" name=\"item_meta[1440]\" value=\"\"  data-sectionid=\"1427\"  data-reqmsg=\"In welke stal bevindt uw paard zich? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1442_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Offerte embryo<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1443_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_156ycd0eafbb0cb4468b3d33f8\" class=\"frm_primary_label col-form-label form-label\">Hengst\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_156ycd0eafbb0cb4468b3d33f8\" name=\"item_meta[1443]\" value=\"\"  data-sectionid=\"1442\"  data-reqmsg=\"Hengst cannot be blank.\" aria-required=\"true\" data-invmsg=\"Stallion is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1444_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_m1pj76f4ae57deb4cd0e8aaf58\" class=\"frm_primary_label col-form-label form-label\">Merrie\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_m1pj76f4ae57deb4cd0e8aaf58\" name=\"item_meta[1444]\" value=\"\"  data-sectionid=\"1442\"  data-reqmsg=\"Merrie cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mare is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1445_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4 frm_first\">\r\n    <label for=\"field_hjaxp2353c313bcedad3552448\" class=\"frm_primary_label col-form-label form-label\">Te verzekeren waarde\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_hjaxp2353c313bcedad3552448\" name=\"item_meta[1445]\" value=\"\" data-sectionid=\"1442\"  data-reqmsg=\"Te verzekeren waarde cannot be blank.\" aria-required=\"true\" data-invmsg=\"Insured value for the embryo is invalid\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1446_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_q1pif68929a736af217630e18\" class=\"frm_primary_label col-form-label form-label\">Valuta\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1446]\" id=\"field_q1pif68929a736af217630e18\"  data-sectionid=\"1442\"  data-frmval=\"EUR\" data-reqmsg=\"Valuta cannot be blank.\" aria-required=\"true\" data-invmsg=\"Valuta is ongeldig\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"EUR\" selected='selected'>EUR<\/option><option  value=\"USD\">USD<\/option><option  value=\"CHF\">CHF<\/option><option  value=\"GBP\">GBP<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1580_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\n    <label for=\"field_q9qj4\" id=\"field_q9qj4_label\" class=\"frm_primary_label col-form-label form-label\">Datum dekdienst\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_q9qj4\" name=\"item_meta[1580]\" value=\"\"  data-sectionid=\"1442\"  data-frmmask=\"00\/00\/0000\" data-reqmsg=\"Datum dekdienst cannot be blank.\" aria-required=\"true\" data-invmsg=\"Datum dekdienst is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_1448_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_first frm_half\">\r\n    <label for=\"field_c75kf44f398f04380772db96b8\" class=\"frm_primary_label col-form-label form-label\">Land waar merrie zich bevindt\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1448]\" id=\"field_c75kf44f398f04380772db96b8\"  data-sectionid=\"1442\"  data-reqmsg=\"Land waar merrie zich bevindt cannot be blank.\" aria-required=\"true\" data-invmsg=\"Land waar merrie zich bevindt is ongeldig\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Algeria\">Algeria<\/option><option  value=\"American Samoa\">American Samoa<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguilla\">Anguilla<\/option><option  value=\"Antarctica\">Antarctica<\/option><option  value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaijan\">Azerbaijan<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bahrain\">Bahrain<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Belarus\">Belarus<\/option><option  value=\"Belgium\">Belgium<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Benin\">Benin<\/option><option  value=\"Bermuda\">Bermuda<\/option><option  value=\"Bhutan\">Bhutan<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\">Botswana<\/option><option  value=\"Brazil\">Brazil<\/option><option  value=\"Brunei\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"Cambodia\">Cambodia<\/option><option  value=\"Cameroon\">Cameroon<\/option><option  value=\"Canada\">Canada<\/option><option  value=\"Cape Verde\">Cape Verde<\/option><option  value=\"Cayman Islands\">Cayman Islands<\/option><option  value=\"Central African Republic\">Central African Republic<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"C\u00f4te d\u2018Ivoire\">C\u00f4te d\u2018Ivoire<\/option><option  value=\"Croatia\">Croatia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/option><option  value=\"Denmark\">Denmark<\/option><option  value=\"Djibouti\">Djibouti<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Dominican Republic\">Dominican Republic<\/option><option  value=\"East Timor\">East Timor<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egypt\">Egypt<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Ethiopia\">Ethiopia<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Finland\">Finland<\/option><option  value=\"France\">France<\/option><option  value=\"French Guiana\">French Guiana<\/option><option  value=\"French Polynesia\">French Polynesia<\/option><option  value=\"Gabon\">Gabon<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Germany\">Germany<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Greece\">Greece<\/option><option  value=\"Greenland\">Greenland<\/option><option  value=\"Grenada\">Grenada<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Haiti\">Haiti<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungary\">Hungary<\/option><option  value=\"Iceland\">Iceland<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iran\">Iran<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Ireland\">Ireland<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italy\">Italy<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Japan\">Japan<\/option><option  value=\"Jordan\">Jordan<\/option><option  value=\"Kazakhstan\">Kazakhstan<\/option><option  value=\"Kenya\">Kenya<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"North Korea\">North Korea<\/option><option  value=\"South Korea\">South Korea<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Latvia\">Latvia<\/option><option  value=\"Lebanon\">Lebanon<\/option><option  value=\"Lesotho\">Lesotho<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libya\">Libya<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lithuania\">Lithuania<\/option><option  value=\"Luxembourg\">Luxembourg<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malawi\">Malawi<\/option><option  value=\"Malaysia\">Malaysia<\/option><option  value=\"Maldives\">Maldives<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marshall Islands\">Marshall Islands<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mauritius\">Mauritius<\/option><option  value=\"Mexico\">Mexico<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldova\">Moldova<\/option><option  value=\"Monaco\">Monaco<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Morocco\">Morocco<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Netherlands\">Netherlands<\/option><option  value=\"New Zealand\">New Zealand<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Norway\">Norway<\/option><option  value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option  value=\"Oman\">Oman<\/option><option  value=\"Pakistan\">Pakistan<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\">Panama<\/option><option  value=\"Papua New Guinea\">Papua New Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Peru\">Peru<\/option><option  value=\"Philippines\">Philippines<\/option><option  value=\"Poland\">Poland<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Qatar\">Qatar<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\">Saudi Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia and Montenegro\">Serbia and Montenegro<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leone\">Sierra Leone<\/option><option  value=\"Singapore\">Singapore<\/option><option  value=\"Slovakia\">Slovakia<\/option><option  value=\"Slovenia\">Slovenia<\/option><option  value=\"Solomon Islands\">Solomon Islands<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"South Africa\">South Africa<\/option><option  value=\"South Sudan\">South Sudan<\/option><option  value=\"Spain\">Spain<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Sudan\">Sudan<\/option><option  value=\"Suriname\">Suriname<\/option><option  value=\"Swaziland\">Swaziland<\/option><option  value=\"Sweden\">Sweden<\/option><option  value=\"Switzerland\">Switzerland<\/option><option  value=\"Syria\">Syria<\/option><option  value=\"Taiwan\">Taiwan<\/option><option  value=\"Tajikistan\">Tajikistan<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Thailand\">Thailand<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option  value=\"Tunisia\">Tunisia<\/option><option  value=\"Turkey\">Turkey<\/option><option  value=\"Turkmenistan\">Turkmenistan<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Ukraine\">Ukraine<\/option><option  value=\"United Arab Emirates\">United Arab Emirates<\/option><option  value=\"United Kingdom\">United Kingdom<\/option><option  value=\"United States\">United States<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabwe\">Zimbabwe<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1449_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label col-form-label form-label\">Gaat het om een embryo-transplantatie?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1449-1442-0\">\t\t\t<label  for=\"field_6rp2g21547c21e1148c4ea2518-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1449]\" id=\"field_6rp2g21547c21e1148c4ea2518-0\" value=\"ja\"\n\t\t data-sectionid=\"1442\"  data-reqmsg=\"Gaat het om een embryo-transplantatie? cannot be blank.\" data-invmsg=\"Gaat het om een embryo-transplantatie? is ongeldig\"   \/> ja<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_1449-1442-1\">\t\t\t<label  for=\"field_6rp2g21547c21e1148c4ea2518-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1449]\" id=\"field_6rp2g21547c21e1148c4ea2518-1\" value=\"nee\"\n\t\t data-sectionid=\"1442\"  data-reqmsg=\"Gaat het om een embryo-transplantatie? cannot be blank.\" data-invmsg=\"Gaat het om een embryo-transplantatie? is ongeldig\"   \/> nee<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1450_container\" class=\"frm_form_field form-field  form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_qzx017\" id=\"field_qzx017_label\" class=\"frm_primary_label col-form-label form-label\">Naam van donormerrie\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qzx017\" name=\"item_meta[1450]\" value=\"\"  data-sectionid=\"1442\"  data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1451_container\" class=\"frm_form_field form-field  form-group frm_top_container frm6\">\r\n    <label for=\"field_o5hkb7\" id=\"field_o5hkb7_label\" class=\"frm_primary_label col-form-label form-label\">Naam van ontvangende merrie\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_o5hkb7\" name=\"item_meta[1451]\" value=\"\"  data-sectionid=\"1442\"  data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1452_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n    <label for=\"field_obmpd7f47e476359bf624f0a38\" class=\"frm_primary_label col-form-label form-label\">Overige informatie\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1452]\" id=\"field_obmpd7f47e476359bf624f0a38\" rows=\"5\"  data-sectionid=\"1442\"  data-invmsg=\"Other informations is invalid\" class=\"form-control\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1454_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Vervoer<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1581_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\n    <label for=\"field_mhh2f\" id=\"field_mhh2f_label\" class=\"frm_primary_label col-form-label form-label\">Datum van vertrek\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_mhh2f\" name=\"item_meta[1581]\" value=\"\"  data-sectionid=\"1454\"  data-frmmask=\"00\/00\/0000\" data-reqmsg=\"Datum van vertrek cannot be blank.\" aria-required=\"true\" data-invmsg=\"Datum van vertrek is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_1456_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_fsxf67\" id=\"field_fsxf67_label\" class=\"frm_primary_label col-form-label form-label\">Land van vertrek\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1456]\" id=\"field_fsxf67\"  data-sectionid=\"1454\"  data-reqmsg=\"Land van vertrek cannot be blank.\" aria-required=\"true\" data-invmsg=\"Land van vertrek is ongeldig\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Algeria\">Algeria<\/option><option  value=\"American Samoa\">American Samoa<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguilla\">Anguilla<\/option><option  value=\"Antarctica\">Antarctica<\/option><option  value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaijan\">Azerbaijan<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bahrain\">Bahrain<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Belarus\">Belarus<\/option><option  value=\"Belgium\">Belgium<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Benin\">Benin<\/option><option  value=\"Bermuda\">Bermuda<\/option><option  value=\"Bhutan\">Bhutan<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, Sint Eustatius and Saba\">Bonaire, Sint Eustatius and Saba<\/option><option  value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\">Botswana<\/option><option  value=\"Bouvet Island\">Bouvet Island<\/option><option  value=\"Brazil\">Brazil<\/option><option  value=\"British Indian Ocean Territory\">British Indian Ocean Territory<\/option><option  value=\"Brunei\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C\u00f4te d&#039;Ivoire\">C\u00f4te d&#039;Ivoire<\/option><option  value=\"Cambodia\">Cambodia<\/option><option  value=\"Cameroon\">Cameroon<\/option><option  value=\"Canada\">Canada<\/option><option  value=\"Cape Verde\">Cape Verde<\/option><option  value=\"Cayman Islands\">Cayman Islands<\/option><option  value=\"Central African Republic\">Central African Republic<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Christmas Island\">Christmas Island<\/option><option  value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cook Islands\">Cook Islands<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Croatia\">Croatia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/option><option  value=\"Denmark\">Denmark<\/option><option  value=\"Djibouti\">Djibouti<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Dominican Republic\">Dominican Republic<\/option><option  value=\"East Timor\">East Timor<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egypt\">Egypt<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option><option  value=\"Faroe Islands\">Faroe Islands<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Finland\">Finland<\/option><option  value=\"France\">France<\/option><option  value=\"French Guiana\">French Guiana<\/option><option  value=\"French Polynesia\">French Polynesia<\/option><option  value=\"French Southern Territories\">French Southern Territories<\/option><option  value=\"Gabon\">Gabon<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Germany\">Germany<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Greece\">Greece<\/option><option  value=\"Greenland\">Greenland<\/option><option  value=\"Grenada\">Grenada<\/option><option  value=\"Guadeloupe\">Guadeloupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Haiti\">Haiti<\/option><option  value=\"Heard Island and McDonald Islands\">Heard Island and McDonald Islands<\/option><option  value=\"Holy See\">Holy See<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungary\">Hungary<\/option><option  value=\"Iceland\">Iceland<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iran\">Iran<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Ireland\">Ireland<\/option><option  value=\"Isle of Man\">Isle of Man<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italy\">Italy<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Japan\">Japan<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordan\">Jordan<\/option><option  value=\"Kazakhstan\">Kazakhstan<\/option><option  value=\"Kenya\">Kenya<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Latvia\">Latvia<\/option><option  value=\"Lebanon\">Lebanon<\/option><option  value=\"Lesotho\">Lesotho<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libya\">Libya<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lithuania\">Lithuania<\/option><option  value=\"Luxembourg\">Luxembourg<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malawi\">Malawi<\/option><option  value=\"Malaysia\">Malaysia<\/option><option  value=\"Maldives\">Maldives<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marshall Islands\">Marshall Islands<\/option><option  value=\"Martinique\">Martinique<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mauritius\">Mauritius<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Mexico\">Mexico<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldova\">Moldova<\/option><option  value=\"Monaco\">Monaco<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Morocco\">Morocco<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Netherlands\">Netherlands<\/option><option  value=\"New Caledonia\">New Caledonia<\/option><option  value=\"New Zealand\">New Zealand<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Norfolk Island\">Norfolk Island<\/option><option  value=\"North Korea\">North Korea<\/option><option  value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option  value=\"Norway\">Norway<\/option><option  value=\"Oman\">Oman<\/option><option  value=\"Pakistan\">Pakistan<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\">Panama<\/option><option  value=\"Papua New Guinea\">Papua New Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Peru\">Peru<\/option><option  value=\"Philippines\">Philippines<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Poland\">Poland<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Qatar\">Qatar<\/option><option  value=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/option><option  value=\"Saint Pierre and Miquelon\">Saint Pierre and Miquelon<\/option><option  value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\">Saudi Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leone\">Sierra Leone<\/option><option  value=\"Singapore\">Singapore<\/option><option  value=\"Sint Maarten (Dutch part)\">Sint Maarten (Dutch part)<\/option><option  value=\"Slovakia\">Slovakia<\/option><option  value=\"Slovenia\">Slovenia<\/option><option  value=\"Solomon Islands\">Solomon Islands<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"South Africa\">South Africa<\/option><option  value=\"South Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/option><option  value=\"South Korea\">South Korea<\/option><option  value=\"South Sudan\">South Sudan<\/option><option  value=\"Spain\">Spain<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Sudan\">Sudan<\/option><option  value=\"Suriname\">Suriname<\/option><option  value=\"Svalbard and Jan Mayen\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/option><option  value=\"Sweden\">Sweden<\/option><option  value=\"Switzerland\">Switzerland<\/option><option  value=\"Syria\">Syria<\/option><option  value=\"Taiwan\">Taiwan<\/option><option  value=\"Tajikistan\">Tajikistan<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Thailand\">Thailand<\/option><option  value=\"Timor-Leste\">Timor-Leste<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option  value=\"Tunisia\">Tunisia<\/option><option  value=\"Turkey\">Turkey<\/option><option  value=\"Turkmenistan\">Turkmenistan<\/option><option  value=\"Turks and Caicos Islands\">Turks and Caicos Islands<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Ukraine\">Ukraine<\/option><option  value=\"United Arab Emirates\">United Arab Emirates<\/option><option  value=\"United Kingdom\">United Kingdom<\/option><option  value=\"United States\">United States<\/option><option  value=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Wallis and Futuna\">Wallis and Futuna<\/option><option  value=\"Western Sahara\">Western Sahara<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabwe\">Zimbabwe<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1582_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\n    <label for=\"field_gqvti\" id=\"field_gqvti_label\" class=\"frm_primary_label col-form-label form-label\">Datum van aankomst\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_gqvti\" name=\"item_meta[1582]\" value=\"\"  data-sectionid=\"1454\"  data-frmmask=\"00\/00\/0000\" data-reqmsg=\"Datum van aankomst cannot be blank.\" aria-required=\"true\" data-invmsg=\"Datum van aankomst is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_1458_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_2bwf97\" id=\"field_2bwf97_label\" class=\"frm_primary_label col-form-label form-label\">Land van aankomst\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[1458]\" id=\"field_2bwf97\"  data-sectionid=\"1454\"  data-reqmsg=\"Land van aankomst cannot be blank.\" aria-required=\"true\" data-invmsg=\"Land van aankomst is ongeldig\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Algeria\">Algeria<\/option><option  value=\"American Samoa\">American Samoa<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguilla\">Anguilla<\/option><option  value=\"Antarctica\">Antarctica<\/option><option  value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaijan\">Azerbaijan<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bahrain\">Bahrain<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Belarus\">Belarus<\/option><option  value=\"Belgium\">Belgium<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Benin\">Benin<\/option><option  value=\"Bermuda\">Bermuda<\/option><option  value=\"Bhutan\">Bhutan<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, Sint Eustatius and Saba\">Bonaire, Sint Eustatius and Saba<\/option><option  value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\">Botswana<\/option><option  value=\"Bouvet Island\">Bouvet Island<\/option><option  value=\"Brazil\">Brazil<\/option><option  value=\"British Indian Ocean Territory\">British Indian Ocean Territory<\/option><option  value=\"Brunei\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C\u00f4te d&#039;Ivoire\">C\u00f4te d&#039;Ivoire<\/option><option  value=\"Cambodia\">Cambodia<\/option><option  value=\"Cameroon\">Cameroon<\/option><option  value=\"Canada\">Canada<\/option><option  value=\"Cape Verde\">Cape Verde<\/option><option  value=\"Cayman Islands\">Cayman Islands<\/option><option  value=\"Central African Republic\">Central African Republic<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Christmas Island\">Christmas Island<\/option><option  value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cook Islands\">Cook Islands<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Croatia\">Croatia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/option><option  value=\"Denmark\">Denmark<\/option><option  value=\"Djibouti\">Djibouti<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Dominican Republic\">Dominican Republic<\/option><option  value=\"East Timor\">East Timor<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egypt\">Egypt<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option><option  value=\"Faroe Islands\">Faroe Islands<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Finland\">Finland<\/option><option  value=\"France\">France<\/option><option  value=\"French Guiana\">French Guiana<\/option><option  value=\"French Polynesia\">French Polynesia<\/option><option  value=\"French Southern Territories\">French Southern Territories<\/option><option  value=\"Gabon\">Gabon<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Germany\">Germany<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Greece\">Greece<\/option><option  value=\"Greenland\">Greenland<\/option><option  value=\"Grenada\">Grenada<\/option><option  value=\"Guadeloupe\">Guadeloupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Haiti\">Haiti<\/option><option  value=\"Heard Island and McDonald Islands\">Heard Island and McDonald Islands<\/option><option  value=\"Holy See\">Holy See<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungary\">Hungary<\/option><option  value=\"Iceland\">Iceland<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iran\">Iran<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Ireland\">Ireland<\/option><option  value=\"Isle of Man\">Isle of Man<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italy\">Italy<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Japan\">Japan<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordan\">Jordan<\/option><option  value=\"Kazakhstan\">Kazakhstan<\/option><option  value=\"Kenya\">Kenya<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Latvia\">Latvia<\/option><option  value=\"Lebanon\">Lebanon<\/option><option  value=\"Lesotho\">Lesotho<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libya\">Libya<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lithuania\">Lithuania<\/option><option  value=\"Luxembourg\">Luxembourg<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malawi\">Malawi<\/option><option  value=\"Malaysia\">Malaysia<\/option><option  value=\"Maldives\">Maldives<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marshall Islands\">Marshall Islands<\/option><option  value=\"Martinique\">Martinique<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mauritius\">Mauritius<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Mexico\">Mexico<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldova\">Moldova<\/option><option  value=\"Monaco\">Monaco<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Morocco\">Morocco<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Netherlands\">Netherlands<\/option><option  value=\"New Caledonia\">New Caledonia<\/option><option  value=\"New Zealand\">New Zealand<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Norfolk Island\">Norfolk Island<\/option><option  value=\"North Korea\">North Korea<\/option><option  value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option  value=\"Norway\">Norway<\/option><option  value=\"Oman\">Oman<\/option><option  value=\"Pakistan\">Pakistan<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\">Panama<\/option><option  value=\"Papua New Guinea\">Papua New Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Peru\">Peru<\/option><option  value=\"Philippines\">Philippines<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Poland\">Poland<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Qatar\">Qatar<\/option><option  value=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/option><option  value=\"Saint Pierre and Miquelon\">Saint Pierre and Miquelon<\/option><option  value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\">Saudi Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leone\">Sierra Leone<\/option><option  value=\"Singapore\">Singapore<\/option><option  value=\"Sint Maarten (Dutch part)\">Sint Maarten (Dutch part)<\/option><option  value=\"Slovakia\">Slovakia<\/option><option  value=\"Slovenia\">Slovenia<\/option><option  value=\"Solomon Islands\">Solomon Islands<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"South Africa\">South Africa<\/option><option  value=\"South Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/option><option  value=\"South Korea\">South Korea<\/option><option  value=\"South Sudan\">South Sudan<\/option><option  value=\"Spain\">Spain<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Sudan\">Sudan<\/option><option  value=\"Suriname\">Suriname<\/option><option  value=\"Svalbard and Jan Mayen\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/option><option  value=\"Sweden\">Sweden<\/option><option  value=\"Switzerland\">Switzerland<\/option><option  value=\"Syria\">Syria<\/option><option  value=\"Taiwan\">Taiwan<\/option><option  value=\"Tajikistan\">Tajikistan<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Thailand\">Thailand<\/option><option  value=\"Timor-Leste\">Timor-Leste<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option  value=\"Tunisia\">Tunisia<\/option><option  value=\"Turkey\">Turkey<\/option><option  value=\"Turkmenistan\">Turkmenistan<\/option><option  value=\"Turks and Caicos Islands\">Turks and Caicos Islands<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Ukraine\">Ukraine<\/option><option  value=\"United Arab Emirates\">United Arab Emirates<\/option><option  value=\"United Kingdom\">United Kingdom<\/option><option  value=\"United States\">United States<\/option><option  value=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Wallis and Futuna\">Wallis and Futuna<\/option><option  value=\"Western Sahara\">Western Sahara<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabwe\">Zimbabwe<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1460_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Geplande operatie<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1461_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_oaegj7\" id=\"field_oaegj7_label\" class=\"frm_primary_label col-form-label form-label\">Naam kliniek\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_oaegj7\" name=\"item_meta[1461]\" value=\"\"  data-sectionid=\"1460\"  data-reqmsg=\"Naam kliniek cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1583_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\n    <label for=\"field_tpz5z\" id=\"field_tpz5z_label\" class=\"frm_primary_label col-form-label form-label\">Datum van operatie\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_tpz5z\" name=\"item_meta[1583]\" value=\"\"  data-sectionid=\"1460\"  data-frmmask=\"00\/00\/0000\" data-reqmsg=\"Datum van operatie cannot be blank.\" aria-required=\"true\" data-invmsg=\"Datum van operatie is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_1463_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_fj04b7\" id=\"field_fj04b7_label\" class=\"frm_primary_label col-form-label form-label\">Type operatie\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1463]\" id=\"field_fj04b7\" rows=\"5\"  data-sectionid=\"1460\"  data-reqmsg=\"Type operatie cannot be blank.\" aria-required=\"true\" data-invmsg=\"Paragraph is invalid\" class=\"form-control\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1465_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Gebruik<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1466_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_first frm_half vertical_radio\">\r\n    <label  class=\"frm_primary_label col-form-label form-label\">Sport\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-0\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-0\" value=\"Fokkerij\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Fokkerij<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-1\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-1\" value=\"Rijpaard\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Rijpaard<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-2\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-2\" value=\"Mennen\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Mennen<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-3\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-3\" value=\"Jumping\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Jumping<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-4\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-4\" value=\"Dressuur\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Dressuur<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-5\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-5\" value=\"Western riding\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Western riding<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-6\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-6\" value=\"Uithoudings wedstrijden\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Uithoudings wedstrijden<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-7\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-7\" value=\"Eventing\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Eventing<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1466-1465-8\">\t\t\t<label  for=\"field_lxrvo874e418bb51eb8ed009dd8-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1466][]\" id=\"field_lxrvo874e418bb51eb8ed009dd8-8\" value=\"Reining\"  data-sectionid=\"1465\"  data-invmsg=\"Sport is ongeldig\"   \/> Reining<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1467_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_first frm_half vertical_radio\">\r\n    <label  class=\"frm_primary_label col-form-label form-label\">Racing\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1467-1465-0\">\t\t\t<label  for=\"field_kuwg58c3f6a8cb775405fa9c648-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1467][]\" id=\"field_kuwg58c3f6a8cb775405fa9c648-0\" value=\"Draf\"  data-sectionid=\"1465\"  data-invmsg=\"Racing is ongeldig\"   \/> Draf<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1467-1465-1\">\t\t\t<label  for=\"field_kuwg58c3f6a8cb775405fa9c648-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1467][]\" id=\"field_kuwg58c3f6a8cb775405fa9c648-1\" value=\"Galop\"  data-sectionid=\"1465\"  data-invmsg=\"Racing is ongeldig\"   \/> Galop<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1467-1465-2\">\t\t\t<label  for=\"field_kuwg58c3f6a8cb775405fa9c648-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1467][]\" id=\"field_kuwg58c3f6a8cb775405fa9c648-2\" value=\"Steeple Chase\"  data-sectionid=\"1465\"  data-invmsg=\"Racing is ongeldig\"   \/> Steeple Chase<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1468_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_half vertical_radio\">\r\n    <label  class=\"frm_primary_label col-form-label form-label\">Trekpaarden\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1468-1465-0\">\t\t\t<label  for=\"field_ck9ot80bb7f61d799bc0cf5c598-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1468][]\" id=\"field_ck9ot80bb7f61d799bc0cf5c598-0\" value=\"Fokkerij\"  data-sectionid=\"1465\"  data-invmsg=\"Trekpaarden is ongeldig\"   \/> Fokkerij<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_1468-1465-1\">\t\t\t<label  for=\"field_ck9ot80bb7f61d799bc0cf5c598-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[1468][]\" id=\"field_ck9ot80bb7f61d799bc0cf5c598-1\" value=\"Boswerken\"  data-sectionid=\"1465\"  data-invmsg=\"Trekpaarden is ongeldig\"   \/> Boswerken<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1469_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_first frm_half\">\r\n    <label for=\"field_ptok98be5da475a4d139b27b718\" class=\"frm_primary_label col-form-label form-label\">Naam van de ruiter\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ptok98be5da475a4d139b27b718\" name=\"item_meta[1469]\" value=\"\"  data-sectionid=\"1465\"  data-invmsg=\"Name of the rider is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1470_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_first frm_half\">\r\n    <label for=\"field_29l098b924322266361aef891c8\" class=\"frm_primary_label col-form-label form-label\">Andere\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[1470]\" id=\"field_29l098b924322266361aef891c8\" rows=\"5\"  data-sectionid=\"1465\"  data-invmsg=\"other is invalid\" class=\"form-control\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1472_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contactgegevens<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1473_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_first frm_half\">\r\n    <label for=\"field_x1dzdf6f2d618b54fb238297e9c8\" class=\"frm_primary_label col-form-label form-label\">Voornaam\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_x1dzdf6f2d618b54fb238297e9c8\" name=\"item_meta[1473]\" value=\"\"  data-sectionid=\"1472\"  data-reqmsg=\"Voornaam cannot be blank.\" aria-required=\"true\" data-invmsg=\"First name is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1474_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_57mz9h6a84150c7def0068acd1b8\" class=\"frm_primary_label col-form-label form-label\">Naam\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_57mz9h6a84150c7def0068acd1b8\" name=\"item_meta[1474]\" value=\"\"  data-sectionid=\"1472\"  data-reqmsg=\"Naam cannot be blank.\" aria-required=\"true\" data-invmsg=\"Surname is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1475_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_full\">\r\n    <label for=\"field_vnv7we6e126343d9827bd8868a08\" class=\"frm_primary_label col-form-label form-label\">Adres\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_vnv7we6e126343d9827bd8868a08_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAdres<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_1475-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_vnv7we6e126343d9827bd8868a08_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAdres\t<\/label>\n\t\t<input type=\"text\" id=\"field_vnv7we6e126343d9827bd8868a08_line1\" value=\"\" name=\"item_meta[1475][line1]\"  data-sectionid=\"1472\"  data-reqmsg=\"Adres cannot be blank.\" aria-required=\"true\" data-invmsg=\"Adres is ongeldig\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_1475-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_vnv7we6e126343d9827bd8868a08_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAdres\t<\/label>\n\t\t<input type=\"text\" id=\"field_vnv7we6e126343d9827bd8868a08_line2\" value=\"\" name=\"item_meta[1475][line2]\"  data-sectionid=\"1472\"  data-reqmsg=\"Adres cannot be blank.\" aria-required=\"true\" data-invmsg=\"Adres is ongeldig\" class=\"form-control frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_1475-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_vnv7we6e126343d9827bd8868a08_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tGemeente\t<\/label>\n\t\t<input type=\"text\" id=\"field_vnv7we6e126343d9827bd8868a08_city\" value=\"\" name=\"item_meta[1475][city]\"  data-sectionid=\"1472\"  data-reqmsg=\"Adres cannot be blank.\" aria-required=\"true\" data-invmsg=\"Adres is ongeldig\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">Gemeente<\/div><\/div>\n<div id=\"frm_field_1475-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_vnv7we6e126343d9827bd8868a08_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tStaat\/provincie\t<\/label>\n\t\t<input type=\"text\" id=\"field_vnv7we6e126343d9827bd8868a08_state\" value=\"\" name=\"item_meta[1475][state]\"  data-sectionid=\"1472\"  data-reqmsg=\"Adres cannot be blank.\" aria-required=\"true\" data-invmsg=\"Adres is ongeldig\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">Staat\/provincie<\/div><\/div>\n<div id=\"frm_field_1475-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_vnv7we6e126343d9827bd8868a08_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tPostcode\t<\/label>\n\t\t<input type=\"text\" id=\"field_vnv7we6e126343d9827bd8868a08_zip\" value=\"\" name=\"item_meta[1475][zip]\"  data-sectionid=\"1472\"  data-reqmsg=\"Adres cannot be blank.\" aria-required=\"true\" data-invmsg=\"Adres is ongeldig\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Postcode<\/div><\/div>\n<div id=\"frm_field_1475-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_vnv7we6e126343d9827bd8868a08_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tLand\t<\/label>\n\t\t\t<select name=\"item_meta[1475][country]\" id=\"field_vnv7we6e126343d9827bd8868a08_country\"  data-sectionid=\"1472\"  data-reqmsg=\"Adres cannot be blank.\" aria-required=\"true\" data-invmsg=\"Adres is ongeldig\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\" data-code=\"AF\">Afghanistan<\/option><option  value=\"Aland eilanden\">Aland eilanden<\/option><option  value=\"Albani\u00eb\">Albani\u00eb<\/option><option  value=\"Algerije\">Algerije<\/option><option  value=\"Amerikaans Samoa\">Amerikaans Samoa<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguilla\" data-code=\"AI\">Anguilla<\/option><option  value=\"Antarctica\" data-code=\"AQ\">Antarctica<\/option><option  value=\"Antigua en Barbuda\">Antigua en Barbuda<\/option><option  value=\"Argentini\u00eb\">Argentini\u00eb<\/option><option  value=\"Armeni\u00eb\">Armeni\u00eb<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australi\u00eb\">Australi\u00eb<\/option><option  value=\"Azerbaijan\" data-code=\"AZ\">Azerbaijan<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bahrein\">Bahrein<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Bangladesh<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Belgi\u00eb\">Belgi\u00eb<\/option><option  value=\"Belize\" data-code=\"BZ\">Belize<\/option><option  value=\"Benin\" data-code=\"BJ\">Benin<\/option><option  value=\"Bermuda\" data-code=\"BM\">Bermuda<\/option><option  value=\"Boetan\">Boetan<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, Sint Eustatius en Saba\">Bonaire, Sint Eustatius en Saba<\/option><option  value=\"Bosni\u00eb en Herzegovina\">Bosni\u00eb en Herzegovina<\/option><option  value=\"Botswana\" data-code=\"BW\">Botswana<\/option><option  value=\"Bouvet Island\" data-code=\"BV\">Bouvet Island<\/option><option  value=\"Brazili\u00eb\">Brazili\u00eb<\/option><option  value=\"Brits Indische Oceaanterritorium\">Brits Indische Oceaanterritorium<\/option><option  value=\"Brunei\" data-code=\"BN\">Brunei<\/option><option  value=\"Bulgarije\">Bulgarije<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"Cambodja\">Cambodja<\/option><option  value=\"Canada\" data-code=\"CA\">Canada<\/option><option  value=\"Centraal Afrikaanse Republiek\">Centraal Afrikaanse Republiek<\/option><option  value=\"Chili\">Chili<\/option><option  value=\"China\" data-code=\"CN\">China<\/option><option  value=\"Cocos (Keeling) eilanden\">Cocos (Keeling) eilanden<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoren\">Comoren<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cook eilanden\">Cook eilanden<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Cura\u00e7ao\">Cura\u00e7ao<\/option><option  value=\"Cyprus\" data-code=\"CY\">Cyprus<\/option><option  value=\"Denemarken\">Denemarken<\/option><option  value=\"Djibouti\" data-code=\"DJ\">Djibouti<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Dominicaanse Republiek\">Dominicaanse Republiek<\/option><option  value=\"Duitsland\">Duitsland<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egypte\">Egypte<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Engeland\">Engeland<\/option><option  value=\"Equatoriaal Guinea\">Equatoriaal Guinea<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Estland\">Estland<\/option><option  value=\"Ethiopi\u00eb\">Ethiopi\u00eb<\/option><option  value=\"Faero\u00ebr Eilanden\">Faero\u00ebr Eilanden<\/option><option  value=\"Falkland eilanden (Malvinas)\">Falkland eilanden (Malvinas)<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiji<\/option><option  value=\"Filippijnen\">Filippijnen<\/option><option  value=\"Finland\" data-code=\"FI\">Finland<\/option><option  value=\"Frankrijk\">Frankrijk<\/option><option  value=\"Frans Guyana\">Frans Guyana<\/option><option  value=\"Frans Polynesi\u00eb\">Frans Polynesi\u00eb<\/option><option  value=\"Franse Zuidelijke Gebieden\">Franse Zuidelijke Gebieden<\/option><option  value=\"Gabon\" data-code=\"GA\">Gabon<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Grenada\" data-code=\"GD\">Grenada<\/option><option  value=\"Griekenland\">Griekenland<\/option><option  value=\"Groenland\">Groenland<\/option><option  value=\"Guadeloupe\" data-code=\"GP\">Guadeloupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinee-Bissau\">Guinee-Bissau<\/option><option  value=\"Guyana\" data-code=\"GY\">Guyana<\/option><option  value=\"Haiti\" data-code=\"HT\">Haiti<\/option><option  value=\"Heard eiland en McDonald eilanden\">Heard eiland en McDonald eilanden<\/option><option  value=\"Holy See\">Holy See<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hongarije\">Hongarije<\/option><option  value=\"IJsland\">IJsland<\/option><option  value=\"Ierland\">Ierland<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesi\u00eb\">Indonesi\u00eb<\/option><option  value=\"Irak\">Irak<\/option><option  value=\"Iran\" data-code=\"IR\">Iran<\/option><option  value=\"Isle of Man\" data-code=\"IM\">Isle of Man<\/option><option  value=\"Isra\u00ebl\">Isra\u00ebl<\/option><option  value=\"Itali\u00eb\">Itali\u00eb<\/option><option  value=\"Ivoorkust\">Ivoorkust<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Japan\" data-code=\"JP\">Japan<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordani\u00eb\">Jordani\u00eb<\/option><option  value=\"Kaaiman Eilanden\">Kaaiman Eilanden<\/option><option  value=\"Kaap Verdi\u00eb\">Kaap Verdi\u00eb<\/option><option  value=\"Kameroen\">Kameroen<\/option><option  value=\"Kazachstan\">Kazachstan<\/option><option  value=\"Kenya\" data-code=\"KE\">Kenya<\/option><option  value=\"Kersteiland\">Kersteiland<\/option><option  value=\"Kirgizi\u00eb\">Kirgizi\u00eb<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kleine afgelegen eilanden van de Verenigde Staten\">Kleine afgelegen eilanden van de Verenigde Staten<\/option><option  value=\"Koeweit\">Koeweit<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kroati\u00eb\">Kroati\u00eb<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Lesotho\" data-code=\"LS\">Lesotho<\/option><option  value=\"Letland\">Letland<\/option><option  value=\"Libanon\">Libanon<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libi\u00eb\">Libi\u00eb<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Litouwen\">Litouwen<\/option><option  value=\"Luxemburg\">Luxemburg<\/option><option  value=\"Maagden Eilanden, Brits\">Maagden Eilanden, Brits<\/option><option  value=\"Maagden Eilanden, U.S.\">Maagden Eilanden, U.S.<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Macedoni\u00eb\">Macedoni\u00eb<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malawi\" data-code=\"MW\">Malawi<\/option><option  value=\"Malediven\">Malediven<\/option><option  value=\"Maleisi\u00eb\">Maleisi\u00eb<\/option><option  value=\"Mali\" data-code=\"ML\">Mali<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marokko\">Marokko<\/option><option  value=\"Marshall Eilanden\">Marshall Eilanden<\/option><option  value=\"Martinique\" data-code=\"MQ\">Martinique<\/option><option  value=\"Mauritani\u00eb\">Mauritani\u00eb<\/option><option  value=\"Mauritius\" data-code=\"MU\">Mauritius<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Mexico\" data-code=\"MX\">Mexico<\/option><option  value=\"Micronesi\u00eb\">Micronesi\u00eb<\/option><option  value=\"Moldavi\u00eb\">Moldavi\u00eb<\/option><option  value=\"Monaco\" data-code=\"MC\">Monaco<\/option><option  value=\"Mongoli\u00eb\">Mongoli\u00eb<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Myanmar<\/option><option  value=\"Namibi\u00eb\">Namibi\u00eb<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nederland\">Nederland<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"New Caledonia\" data-code=\"NC\">New Caledonia<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Nieuw Zeeland\">Nieuw Zeeland<\/option><option  value=\"Niger\" data-code=\"NE\">Niger<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Noord Korea\">Noord Korea<\/option><option  value=\"Noordelijke Marianen\">Noordelijke Marianen<\/option><option  value=\"Norfolk Island\" data-code=\"NF\">Norfolk Island<\/option><option  value=\"Norwegen\">Norwegen<\/option><option  value=\"Oekra\u00efne\">Oekra\u00efne<\/option><option  value=\"Oezbekistan\">Oezbekistan<\/option><option  value=\"Oman\" data-code=\"OM\">Oman<\/option><option  value=\"Oost Timor\">Oost Timor<\/option><option  value=\"Oost-Timor\">Oost-Timor<\/option><option  value=\"Oostenrijk\">Oostenrijk<\/option><option  value=\"Pakistan\" data-code=\"PK\">Pakistan<\/option><option  value=\"Palau\" data-code=\"PW\">Palau<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panama\" data-code=\"PA\">Panama<\/option><option  value=\"Papoea Nieuw Guinea\">Papoea Nieuw Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Peru\" data-code=\"PE\">Peru<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Pitcairn<\/option><option  value=\"Polen\">Polen<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Qatar\" data-code=\"QA\">Qatar<\/option><option  value=\"Romeni\u00eb\">Romeni\u00eb<\/option><option  value=\"Rusland\">Rusland<\/option><option  value=\"Rwanda\" data-code=\"RW\">Rwanda<\/option><option  value=\"R\u00e9unie\">R\u00e9unie<\/option><option  value=\"Saint Kitts en Nevis\">Saint Kitts en Nevis<\/option><option  value=\"Saint Lucia\" data-code=\"LC\">Saint Lucia<\/option><option  value=\"Saint Pierre en Miquelon\">Saint Pierre en Miquelon<\/option><option  value=\"Saint Vincent en de Grenadines\">Saint Vincent en de Grenadines<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"Sao Tome en Principe\">Sao Tome en Principe<\/option><option  value=\"Saudi Arabi\u00eb\">Saudi Arabi\u00eb<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Servi\u00eb\">Servi\u00eb<\/option><option  value=\"Seychellen\">Seychellen<\/option><option  value=\"Sierra Leone\" data-code=\"SL\">Sierra Leone<\/option><option  value=\"Singapore\" data-code=\"SG\">Singapore<\/option><option  value=\"Sint Bartholomeus\">Sint Bartholomeus<\/option><option  value=\"Sint Helena, Ascension en Tristan da Cunha\">Sint Helena, Ascension en Tristan da Cunha<\/option><option  value=\"Sint Maarten (Franse deel)\">Sint Maarten (Franse deel)<\/option><option  value=\"Sint Maarten (Nederlandse deel)\">Sint Maarten (Nederlandse deel)<\/option><option  value=\"Sloveni\u00eb\">Sloveni\u00eb<\/option><option  value=\"Slowakije\">Slowakije<\/option><option  value=\"Soedan\">Soedan<\/option><option  value=\"Solomon Eilanden\">Solomon Eilanden<\/option><option  value=\"Somali\u00eb\">Somali\u00eb<\/option><option  value=\"Spanje\">Spanje<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Suriname\" data-code=\"SR\">Suriname<\/option><option  value=\"Svalbard en Jan Mayen\">Svalbard en Jan Mayen<\/option><option  value=\"Swaziland\" data-code=\"SZ\">Swaziland<\/option><option  value=\"Syri\u00eb\">Syri\u00eb<\/option><option  value=\"Tadzjikistan\">Tadzjikistan<\/option><option  value=\"Taiwan\" data-code=\"TW\">Taiwan<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Thailand\" data-code=\"TH\">Thailand<\/option><option  value=\"Togo\" data-code=\"TG\">Togo<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad en Tobago\">Trinidad en Tobago<\/option><option  value=\"Tsjaad\">Tsjaad<\/option><option  value=\"Tsjechi\u00eb\">Tsjechi\u00eb<\/option><option  value=\"Tunesi\u00eb\">Tunesi\u00eb<\/option><option  value=\"Turkije\">Turkije<\/option><option  value=\"Turkmenistan\" data-code=\"TM\">Turkmenistan<\/option><option  value=\"Turks en Caicos eilanden\">Turks en Caicos eilanden<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Vaticaanstad\">Vaticaanstad<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Ver. Arabische Emiraten\">Ver. Arabische Emiraten<\/option><option  value=\"Verenigde Staten\">Verenigde Staten<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Wallis en Futuna\">Wallis en Futuna<\/option><option  value=\"Westelijke Sahara\">Westelijke Sahara<\/option><option  value=\"Wit-Rusland\">Wit-Rusland<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabwe\" data-code=\"ZW\">Zimbabwe<\/option><option  value=\"Zuid Afrika\">Zuid Afrika<\/option><option  value=\"Zuid Korea\">Zuid Korea<\/option><option  value=\"Zuid Sudan\">Zuid Sudan<\/option><option  value=\"Zuid-Georgi\u00eb en de Zuidelijke Sandwich Eilanden\">Zuid-Georgi\u00eb en de Zuidelijke Sandwich Eilanden<\/option><option  value=\"Zweden\">Zweden<\/option><option  value=\"Zwitzerland\">Zwitzerland<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Land<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    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