<head>
<script language="JavaScript">
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<body>
<p align="left"><font face="Agency FB"><b><font size="3">
<span style="background-color: #00FF00">Aanvraag oefenmatch</span></font></b><!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"></font></p>
<form onsubmit="return checkrequired(this)" method="post" action="http://users.skynet.be/cgi-bin/formd.cgi">
<input type="hidden" name="to" value="test@gmail.com">
<input type="hidden" name="next" value="http://www.zvcolympus.net/bedankt.htm">
<input type="hidden" name="subject" value="Wedstrijdaanvraag">
<table border="0">
<tr>
<td align="right"><b><font face="Agency FB">Naam:</font></b></td>
<td><font face="Agency FB"><input type="text" name="requirednaam" /></font></td>
</tr>
<tr>
<td align="right"><b><font face="Agency FB">Ploegnaam:</font></b></td>
<td><font face="Agency FB"><input type="text" name="Ploegnaam" /></font></td>
</tr>
<tr>
<td align="right"><b><font face="Agency FB">Emailadres:</font></b></td>
<td><font face="Agency FB"><input type="text" name="requiredemail" /></font></td>
</tr>
<tr>
<td align="right"><b><font face="Agency FB">Gsm Nummer:</font></b></td>
<td><font face="Agency FB"><input type="text" name="Gsm" /></font></td>
</tr>
<tr>
<td align="right"><b><font face="Agency FB">Waar:</font></b></td>
<td><font face="Agency FB">Eigen Terrein:</font></td>
<td><font face="Agency FB"><input type="radio" name="terrein" value="Eigen Terrein"/></font></td>
</tr>
<tr>
<td><b><font face="Agency FB"> </font></b></td>
<td><font face="Agency FB">Terrein Z.v.c. Olympus:</font></td>
<td><font face="Agency FB"><input type="radio" name="terrein" value="Ons Terrein"/></font></td>
</tr>
<tr>
<td align="right"><b><font face="Agency FB">Indien ons terrein,wij kunnen zeker:</font></b></td>
<td><font face="Agency FB"><select name="Uur">
<option selected="selected">- - - Kies een datum - - -</option>
<option value="29/02">29/02/2008</option>
<option value="07/03">07/03/2008</option>
<option value="25/04">25/04/2008</option>
</select></font></td>
</tr>
<tr>
<td align="right" valign="top">
<b>
<font face="Agency FB">
Gegevens (Wanneer/Hoelaat)</font></b>
</td>
<td align="left" valign="top">
<font face="Agency FB">
<textarea name="Adres" cols="25" rows="6">
</textarea>
</font>
</td>
</tr>
<tr>
<td> <font face="Agency FB"> </font></td>
<td><font face="Agency FB"><input type="submit" value="Verzend" /></font></td>
<td><font face="Agency FB"><input type="reset" value="Wis" /></font></td>
</tr>
</table>
</form>
<p><font face="Agency FB"><b>Gelieve er rekening mee te houden dat alle contact hierna gebeurt via</b>
<a href="mailto:test@gmail.com">test@gmail.com</a></font></p>
</body>