<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="nl" lang="nl">
	<head>
		<title>Signup for the Exin Newsletter - EXIN Exams</title>
		<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
		<meta name="vs_defaultClientScript" content="JavaScript" />
		<meta name="vs_targetSchema" content="http://schemas.microsoft.com/intellisense/ie5" />

		<link rel="shortcut icon" href="/favicon.ico" />
		<link rel="stylesheet" type="text/css" href="/include/main.css" />
		<link rel="stylesheet" type="text/css" href="/include/home.css" />
	</head>
	<body>
	        <style>
	            body, html {
                    margin: 0;
                    padding: 0;
                    height: 100%;
                }

                body, p, td, h1, h2, h3, h4, h5, h6, input, textarea, select {
                    font-family: Arial, Helvetica, Verdana, sans-serif;
                }

                body {
                    font-size: 0.8em;
                    color: #000000;
                    background-color: #ffffff;
                }
	            
                #form1 input, textarea {
	                width: 298px;
	                height: 17px;
                }
                
                #form .sendKnop {
	                font-weight: bold;
	                color: #ffffff;
	                height: 21px;
	                margin: 22px 0 9px;
	                padding: 0 24px 1px 5px;
	                background: url(../images/ico_poll.gif) #091863 no-repeat right center;
	                border-style: none;
	                width: 79px;
                }
                #form1 select {
	                float: left;
	                width: 67px;
	                height: 17px;
                }

                html>body #form select {
                    height: 19px;
                }

                #form1 input, textarea {
	                width: 298px;
	                height: 17px;
                }
                
                #form` td {
	                width: 302px;
	                padding: 0 29px 3px 0;
                }

                html>body #form1 td {
	                padding: 0 29px 5px 0;
                }

                
                input, select, textarea {
	                font-size: 1.0em;
	                color: #003366;
	                margin: 0;
	                background-color: #e9f2f7;
	                border-width: 1px;
	                border-style: solid;
	                border-color: #0055aa #bcd4e9 #bcd4e9 #0055aa;
                }
                
            </style>
		<form action="http://a.1y.nl/s/persooninvoeren.php" method="post" name="Form1">
			<input type="hidden" name="in_database" value="1" />
			<input type="hidden" name="klantnaam" value="exin_inter" />
			<input type="hidden" name="klantid" value="491" />
			<input type="hidden" name="nbriefid" value="3" />

			<input type="hidden" name="ontvangst" value="7480" />
			<input type="hidden" name="redirect" value="http://account.yourzine.nl/scripts/pagina.php?klantid=491&nid=3&dbnaam=exin_inter&template_typeid=11" />

			<input type="hidden" name="doorsturen" value="0" />
			<input type="hidden" name="onderwerp" value="" />
			<input type="hidden" name="afzender" value="" />
			<input type="hidden" name="doorstuuradres" value="" />
			<input type="hidden" name="doorstuurformaat" value="HTML" />
			<input type="hidden" name="persoon_doelgroep" value="8" />
			<input type="hidden" name="persoon_doelgroep_8" value="1" />
            <input type="hidden" value="http://www.exin.nl/layouts/NieuwsbriefBedankt.html" name="redirect">

            
            
			<table style="width: 555; font-size: 95%;">
			    <tr>
			        <td>
			        Subscribe now. It’s free!
			        </td>
			    </tr>
				<tr>
					<td style="width: 199px; height: 30px;">
						E-mail:*
					</td>
					<td style="width: 344px;">
						<input name="email" type="text" size="30" />
					</td>
				</tr>

				<tr>
					<td style="height: 30px;">
						Gender:*
					</td>
					<td>
						<table style="width: 100%; font-size: 95%">
							<tr>
								<td style="width: 34%">
									<input type="radio" name="gender" value="7482" />
									Mr.
								</td>
								<td style="width: 66%">
									<input type="radio" name="gender" value="7483" />
									Ms.
								</td>
							</tr>
						</table>
				   </td>
				</tr>

				<tr>
					<td style="height: 30px;">
						Initials: &nbsp;&nbsp;
					</td>
					<td>
						<input name="initials" type="text" size="10" />
					</td>
				</tr>

				<tr>
					<td style="height: 30px;">
						First name:*
					</td>
					<td>
						<input name="first_name" type="text" size="30" />
					</td>
				</tr>

				<tr>
					<td style="height: 30px;">
						Prefix:
					</td>
					<td>
						<input name="prefix" type="text" size="10" />
					</td>
				</tr>

				<tr>
					<td style="height: 30px;">
						Last name:*
					</td>
					<td>
						<input name="last_name" type="text" size="30" />
					</td>
				</tr>

				<tr>
					<td style="height: 30px;">
						Exam candidate number:<br />
						<span class="style3">(if	applicable)</span>    &nbsp;&nbsp;
					</td>
					<td>
						<input name="klant_id" type="text" size="20" />
					</td>
				</tr>

				<tr>
					<td style="height: 30px;">
					    Country/Region:*
						<!--Where do you stay:*<br />
						<span class="style3">(country)</span> &nbsp;&nbsp;-->
					</td>
					<td>
						<input name="country" type="text" size="30" />
					</td>
				</tr>

				<tr id="form">
					<td>
						<input type="hidden" name="trajecten" value="" />
					</td>
					<td style="height: 40px;">
						<input type="submit" class="sendKnop" value="Sign up" onclick="CheckForm(document.Form1); return false;" />
					</td>
				</tr>
			</table>
		</form>

		<script type="text/javascript">
			
			// Function to fill the e-mail adress out of the querystring (added 20-11-2007)
			
				function fillEmailField(email)
				{
					document.Form1.email.value = email;					
				}
				
				if (location.href.indexOf('email=') > 0)
				{
					fillEmailField(location.href.substring(location.href.indexOf('email=')+6,location.href.length));
				}
				
			// End function
			
			function uncheck(name1, name2)
			{
				if(name1.checked)
				{
					name2.checked = false;
				}
				else
				{
					name2.checked = true;
				}
			}

			function checkbox_toggle(chbx, hiddenfield, aan_value, uit_value)
			{
				//hiddenfield = "document.Form1."+hidden_name;
				//window.alert(hiddenfield);

				if (chbx.checked)
				{
					hiddenfield.value = aan_value;
				}
				else
				{
					hiddenfield.value= uit_value;
				}
			}

			function CheckNumber(checkString)
			{
				newString = "";
				count = 0;

				for (i = 0; i < checkString.length; i++) 
				{
					ch = checkString.substring(i, i+1);
					if ((ch >= "0" && ch <= "9") || (ch == ".") || (ch == ","))
					{
						newString += ch;
					}
				}

				if (checkString != newString)
				{
					res = false; 
				}
				else
				{
					res = true;
				}

				if (checkString.length ==0)
				{
					res = false; 
				}

				return res
			}

			function CheckEmail(address)
			{
				return address.match(/\b(^(\S+@).+((\.com)|(\.net)|(\.edu)|(\.mil)|(\.int)|(\.gov)|(\.org)|(\.biz)|(\.info)|(\..{2,2}))$)\b/gi);
			}

			function daysInFebruary(year)
			{
				return (((year % 4 == 0) && ( (!(year % 100 == 0)) || (year % 400 == 0) ) ) ? 29 : 28 );
			}

			function CheckDate(name)
			{
				var daysInMonth = new Array(0,31,28,31,30,31,30,31,31,30,31,30,31);

				el_month = eval("document.Form1."+name+"Month")
				el_day = eval("document.Form1."+name+"Day")
				el_year = eval("document.Form1."+name+"Year")

				if (el_day.value == '-1') return false;
				if (el_month.value == '-1') return false;
				if (el_year.value == '-1') return false;    

				month = el_month.options[el_month.selectedIndex].value;
				day = el_day.options[el_day.selectedIndex].value;
				year = el_year.options[el_year.selectedIndex].value;

				// Explicitly change type to integer to make code work in both
				// JavaScript 1.1 and JavaScript 1.2.
				var intYear = parseInt(year);
				var intMonth = parseInt(month);
				var intDay = parseInt(day);

				// catch invalid days, except for February
				if ((intMonth != 2) && (intDay > daysInMonth[intMonth])) return false;

				if ((intMonth == 2) && (intDay > daysInFebruary(intYear))) return false;

				return true;
			}

			function CheckForm(theForm)
			{
				result = true;

				if (theForm.email.value == "")
				{
					window.alert("You must type an e-mailaddress");
					theForm.email.focus();
					result=false;
				}
				else if (theForm.email.value!="" && !CheckEmail(theForm.email.value))
				{
					window.alert("This e-mailaddress is not correct!");
					theForm.email.focus();
					result=false;
				}  
				else if (theForm.email.value=="")
				{
					window.alert("Required: 'E-mail'");
					theForm.email.focus();
					result=false;
				}
				else if (theForm.gender[0].checked == false && theForm.gender[1].checked == false )
				{
					window.alert("Choice required: 'Gender'");
					result=false;
				}
				else if (theForm.first_name.value == "")
				{
					window.alert("Required: 'First name'");
					theForm.first_name.focus();
					result=false;
				}
				else if (theForm.last_name.value == "")
				{
					window.alert("Required: 'Last name'");
					theForm.last_name.focus();
					result=false;
				}
				else if (theForm.country.value == "")
				{
					window.alert("Required: 'Where do you stay'");
					theForm.country.focus();
					result=false;
				}				
				if(result)
				{		
				    parent.document.getElementById('newsletter').style.cssText = "display:none";
					theForm.submit();
				}
			}
		</script>
	</body>
</html>