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<head><title>www.gosantiago.be</title></head>
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<FORM ACTION="mailto:info@gosantiago.be" METHOD="POST" ENCTYPE="text/plain">
<INPUT TYPE="HIDDEN" NAME="to" VALUE="info@gosantiago.be">
<INPUT TYPE="HIDDEN" NAME="nextpage" VALUE="http://www.gosantiago.be/contact2">
<INPUT TYPE="HIDDEN" NAME="subject" VALUE="enquete">
<b><font color="darkblue">Ik wens meer informatie over:</font></b><br>
<INPUT TYPE="checkbox" NAME="info.sponsering" VALUE="YEP">Sponsoring<br>
<INPUT TYPE="checkbox" NAME="info.feest" VALUE="YEP">Het feest op 25 juli<br>
<INPUT TYPE="checkbox" NAME="info.andere" VALUE="inderdaad">Andere vragen<br>
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<b><font color="darkblue">Naam:</font></b><br>
<INPUT TYPE="text" name="Naam" size="40" maxlength="40"> <br>
<b><font color="darkblue">Voornaam:</font> </b><br>
<input type="text" name="Voornaam" size="40" maxlength="40"> <br>
<b><font color="darkblue">Straat + Nr:</font> </b><br>
<input type="text" name="Straat + Nr" size="40" maxlength="40"> <br>
<b><font color="darkblue">Postcode:</font> </b><br>
<input type="text" name="Postcode" size="8" maxlength="8"> <br>
<b><font color="darkblue">Gemeente:</font> </b><br>
<input type="text" name="Gemeente" size="40" maxlength="40"> <br>
<b><font color="darkblue">Telefoonnummer:</font> </b><br>
<input type="text" name="Telefoonnummer" size="40" maxlength="40"> <br>
<b
><font color
="darkblue">E
-mail:</font
> </b
><br
> <input type="text" name="E-mail" size="40" maxlength="40"> <br>
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<b> <font color="darkblue">Mijn vraag:</font></b><br>
<textarea name="vraag" rows="5" cols="45" > Typ hier uw vraag... </textarea>
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<input type="submit" value="verzenden">
<input type="reset" value="wissen">
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