{"id":26068,"date":"2024-09-14T07:46:07","date_gmt":"2024-09-14T07:46:07","guid":{"rendered":"https:\/\/orthoptie.be\/?page_id=26068"},"modified":"2024-11-12T20:06:31","modified_gmt":"2024-11-12T20:06:31","slug":"affiliation","status":"publish","type":"page","link":"https:\/\/orthoptie.be\/nl\/affiliation\/","title":{"rendered":"Inschrijvingsformulier \u2192"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"26068\" class=\"elementor elementor-26068\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-49686de elementor-section-height-min-height elementor-section-content-top elementor-section-items-top elementor-section-boxed elementor-section-height-default sc_fly_static\" data-id=\"49686de\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f1dbf11 sc_layouts_column_align_center sc_layouts_column sc_inner_width_none sc_content_align_inherit sc_layouts_column_icons_position_left sc_fly_static\" data-id=\"f1dbf11\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b5f1be0 elementor-view-default sc_fly_static elementor-widget elementor-widget-icon\" data-id=\"b5f1be0\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"#anchor\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"14.626\" height=\"8.639\" viewbox=\"0 0 14.626 8.639\"><g id=\"down-arrow\" transform=\"translate(0 -70.698)\"><g id=\"Group_8820\" data-name=\"Group 8820\" transform=\"translate(0 100.698)\"><path id=\"Path_6507\" data-name=\"Path 6507\" d=\"M14.392,101.42l-.479-.482a.8.8,0,0,0-1.132,0L7.316,106.4l-5.472-5.472a.8.8,0,0,0-1.132,0l-.479.479a.8.8,0,0,0,0,1.131l6.515,6.538a.818.818,0,0,0,.567.257h0a.818.818,0,0,0,.566-.257l6.508-6.52a.808.808,0,0,0,.234-.571A.8.8,0,0,0,14.392,101.42Z\" transform=\"translate(0 -130.698)\"><\/path><\/g><\/g><\/svg>\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-461122c5 elementor-section-boxed elementor-section-height-default elementor-section-height-default sc_fly_static\" data-id=\"461122c5\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-23898715 sc_inner_width_none sc_content_align_inherit sc_layouts_column_icons_position_left sc_fly_static\" data-id=\"23898715\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-20d76595 sc_height_huge sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"20d76595\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b45a455 scheme_default elementor-section-boxed elementor-section-height-default elementor-section-height-default sc_fly_static\" data-id=\"b45a455\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4b61f05 sc_inner_width_none sc_content_align_inherit sc_layouts_column_icons_position_left sc_fly_static\" data-id=\"4b61f05\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6de8812 sc_height_huge sc_fly_static elementor-widget elementor-widget-spacer\" data-id=\"6de8812\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-11c3cdd sc_fly_static elementor-widget elementor-widget-wpforms\" data-id=\"11c3cdd\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-26442\"><form id=\"wpforms-form-26442\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"26442\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp-json\/wp\/v2\/pages\/26068\" data-token=\"3b57ef2e64a799b1087322a822daf929\" data-trp-original-action=\"\/nl\/wp-json\/wp\/v2\/pages\/26068?wpforms_form_id=26442\"><noscript class=\"wpforms-error-noscript\">Schakel JavaScript in je browser in om dit formulier in te vullen.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Schakel JavaScript in je browser in om dit formulier in te vullen.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-26442-field_9-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"9\"><div id=\"wpforms-26442-field_9\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-26442-field_9-error\"><h4>Over u zelf<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-26442-field_3-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"3\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-26442-field_3\" aria-hidden=\"false\">Vos coordonn\u00e9es officielles<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-26442-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Naam van orthoptist <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-26442-field_4\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][4][first]\" aria-errormessage=\"wpforms-26442-field_4-error\" required><label for=\"wpforms-26442-field_4\" class=\"wpforms-field-sublabel after\">Voornaam<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26442-field_4-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][4][last]\" aria-errormessage=\"wpforms-26442-field_4-last-error\" required><label for=\"wpforms-26442-field_4-last\" class=\"wpforms-field-sublabel after\">Achternaam<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-26442-field_7-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Specialisaties<\/legend><ul id=\"wpforms-26442-field_7\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_1\" name=\"wpforms[fields][7][]\" value=\"Bilan orthoptique\" aria-errormessage=\"wpforms-26442-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_1\">Orthoptisch bilan<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_2\" name=\"wpforms[fields][7][]\" value=\"Bilan troubles d&#039;apprentissage et neurovisuel\" aria-errormessage=\"wpforms-26442-field_7_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_2\">Onderzoek van leerstoornissen en neurovisuele problemen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_3\" name=\"wpforms[fields][7][]\" value=\"Bilan vestibulo-oculaire\" aria-errormessage=\"wpforms-26442-field_7_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_3\">Vestibulo-oculair onderzoek<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_4\" name=\"wpforms[fields][7][]\" value=\"R\u00e9\u00e9ducation des troubles neurovisuels\" aria-errormessage=\"wpforms-26442-field_7_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_4\">Revalidatie van neurovisuele stoornissen<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_5\" name=\"wpforms[fields][7][]\" value=\"R\u00e9\u00e9ducation en basse vision\" aria-errormessage=\"wpforms-26442-field_7_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_5\">Revalidatie bij slechtziendheid<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_6\" name=\"wpforms[fields][7][]\" value=\"R\u00e9\u00e9ducation orthoptique (troubles de convergence et d&#039;apprentissage...)\" aria-errormessage=\"wpforms-26442-field_7_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_6\">Orthoptische revalidatie (convergentieproblemen en leerstoornissen...)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_7\" name=\"wpforms[fields][7][]\" value=\"R\u00e9\u00e9ducation vestibulo-oculaire\" aria-errormessage=\"wpforms-26442-field_7_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_7\">Vestibulo-oculaire revalidatie<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_7_8\" name=\"wpforms[fields][7][]\" value=\"Strabisme, amblyopie, diplopie, nystagmus\" aria-errormessage=\"wpforms-26442-field_7_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_7_8\">Scheelzien, Lui oog, Dubbelzien, Nystagmus<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26442-field_11-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Werksituatie<\/legend><ul id=\"wpforms-26442-field_11\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_11_1\" name=\"wpforms[fields][11][]\" value=\"En structure (employ\u00e9 ou assimil\u00e9)\" aria-errormessage=\"wpforms-26442-field_11_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_11_1\">In dienstverband (werknemer of gelijkgesteld)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-26442-field_11_2\" name=\"wpforms[fields][11][]\" value=\"Lib\u00e9ral (cabinet)\" aria-errormessage=\"wpforms-26442-field_11_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_11_2\">Vrij beroep (praktijk)<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-26442-field_5-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_5\">E-mail adres <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-26442-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" spellcheck=\"false\" aria-errormessage=\"wpforms-26442-field_5-error\" required><\/div><div id=\"wpforms-26442-field_6-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_6\">Telefoon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-26442-field_6\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-26442-field_6-error\" required><\/div><div id=\"wpforms-26442-field_10-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Officieel factuuradres <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26442-field_10\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][10][address1]\" aria-errormessage=\"wpforms-26442-field_10-error\" required><label for=\"wpforms-26442-field_10\" class=\"wpforms-field-sublabel after\">Adres lijn 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26442-field_10-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][10][address2]\" aria-errormessage=\"wpforms-26442-field_10-address2-error\" ><label for=\"wpforms-26442-field_10-address2\" class=\"wpforms-field-sublabel after\">Adres lijn 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-26442-field_10-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][10][city]\" aria-errormessage=\"wpforms-26442-field_10-city-error\" required><label for=\"wpforms-26442-field_10-city\" class=\"wpforms-field-sublabel after\">Stad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26442-field_10-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][10][state]\" aria-errormessage=\"wpforms-26442-field_10-state-error\" required><label for=\"wpforms-26442-field_10-state\" class=\"wpforms-field-sublabel after\">Provincie<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-26442-field_10-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][10][postal]\" aria-errormessage=\"wpforms-26442-field_10-postal-error\" required><label for=\"wpforms-26442-field_10-postal\" class=\"wpforms-field-sublabel after\">Postcode<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-26442-field_10-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][10][country]\" value=\"BE\" aria-errormessage=\"wpforms-26442-field_10-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albani\u00eb<\/option><option value=\"DZ\" >Algerije<\/option><option value=\"AS\" >Amerikaans Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua en Barbuda<\/option><option value=\"AR\" >Argentini\u00eb<\/option><option value=\"AM\" >Armeni\u00eb<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australi\u00eb<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\"  selected='selected'>Belgi\u00eb<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Sint Eustatius en Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouveteiland<\/option><option value=\"BR\" >Brazili\u00eb<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgarije<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocoseilanden<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoren<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cookeilanden<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"DK\" >Denemarken<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"DE\" >Duitsland<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypte<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estland<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopi\u00eb<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >Frankrijk<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GR\" >Griekenland<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongarije<\/option><option value=\"IS\" >IJsland<\/option><option value=\"IE\" >Ierland (Republiek van)<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesi\u00eb<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (Islamitische Republiek van)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Itali\u00eb<\/option><option value=\"CI\" >Ivoorkust<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordani\u00eb<\/option><option value=\"KY\" >Kaaiman Eilanden<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenia<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"HR\" >Kroati\u00eb<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Laos (Democratische Volksrepubliek)<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Letland<\/option><option value=\"LB\" >Libanon<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libi\u00eb<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithouwen<\/option><option value=\"LU\" >Luxemburg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Malediven<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marokko<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federale Staten van)<\/option><option value=\"MD\" >Moldavi\u00eb<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongoli\u00eb<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands, The<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NZ\" >Nieuw-Zeeland<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"MK\" >Noord Macedoni\u00eb (Republiek van)<\/option><option value=\"KP\" >Noord-Korea (Democratische Volksrepubliek)<\/option><option value=\"NO\" >Noorwegen<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"UA\" >Oekraine<\/option><option value=\"OM\" >Oman<\/option><option value=\"AT\" >Oostenrijk<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestina<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Polen<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roemeni\u00eb<\/option><option value=\"RU\" >Russische Federatie<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabi\u00eb<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Servi\u00eb<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SI\" >Sloveni\u00eb<\/option><option value=\"SK\" >Slowakije<\/option><option value=\"SD\" >Soedan<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spanje<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard en Jan Mayen<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republiek China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"CZ\" >Tsjechi\u00eb<\/option><option value=\"TN\" >Tunesi\u00eb<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vaticaanstad<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"ZA\" >Zuid Afrika<\/option><option value=\"KR\" >Zuid-Korea (Republiek van)<\/option><option value=\"SE\" >Zweden<\/option><option value=\"CH\" >Zwitserland<\/option><option value=\"AX\" >\u00c5land<\/option><\/select><label for=\"wpforms-26442-field_10-country\" class=\"wpforms-field-sublabel after\">Land<\/label><\/div><\/div><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-26442-field_12-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"12\"><div id=\"wpforms-26442-field_12\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-26442-field_12-error\"><h4>Wat betreft uw erkenning<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-26442-field_13-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"13\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-26442-field_13\" aria-hidden=\"false\">Mise en page<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-26442-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_15\">Eindjaar van de studies<\/label><input type=\"text\" id=\"wpforms-26442-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-26442-field_15-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-26442-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_16\">School<\/label><input type=\"text\" id=\"wpforms-26442-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-26442-field_16-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-26442-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_17\">VISUM-Nummer<\/label><input type=\"text\" id=\"wpforms-26442-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-26442-field_17-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-26442-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_18\">RIZIV-Nummer<\/label><input type=\"text\" id=\"wpforms-26442-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-26442-field_18-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-26442-field_20-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_20\">Bestand verzenden <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"20\"\n\t\tdata-form-id=\"26442\"\n\t\tdata-input-name=\"wpforms_26442_20\"\n\t\tdata-extensions=\"doc,xls,ppt,pdf,png,gif,jpg\"\n\t\tdata-max-size=\"104857600\"\n\t\tdata-max-file-number=\"4\"\n\t\tdata-post-max-size=\"8388608\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewbox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 4 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-26442-field_20\"\n\t\tname=\"wpforms_26442_20\" required\t\tvalue=\"\">\n<div id=\"wpforms-26442-field_20-description\" class=\"wpforms-field-description\">Stuur via dit veld een kopie van uw diploma en\/of visum of een inschrijvingsbewijs voor het derde jaar van een bachelor in orthoptie. Dit document (deze documenten) is (zijn) noodzakelijk om uw inschrijving bij de ABO-BOV te valideren.<\/div><\/div><div id=\"wpforms-26442-field_19-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"19\"><div id=\"wpforms-26442-field_19\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-26442-field_19-error\"><h4>A propos de votre structure de travail<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-26442-field_21-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"21\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-26442-field_21\" aria-hidden=\"false\">Lieu de travail 1<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-26442-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_22\">Naam van het bedrijf \/ de organisatie<\/label><input type=\"text\" id=\"wpforms-26442-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-26442-field_22-error\" ><\/div><div id=\"wpforms-26442-field_23-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Adres<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26442-field_23\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][23][address1]\" aria-errormessage=\"wpforms-26442-field_23-error\" ><label for=\"wpforms-26442-field_23\" class=\"wpforms-field-sublabel after\">Adres lijn 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26442-field_23-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][23][address2]\" aria-errormessage=\"wpforms-26442-field_23-address2-error\" ><label for=\"wpforms-26442-field_23-address2\" class=\"wpforms-field-sublabel after\">Adres lijn 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-26442-field_23-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][23][city]\" aria-errormessage=\"wpforms-26442-field_23-city-error\" ><label for=\"wpforms-26442-field_23-city\" class=\"wpforms-field-sublabel after\">Stad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26442-field_23-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][23][state]\" aria-errormessage=\"wpforms-26442-field_23-state-error\" ><label for=\"wpforms-26442-field_23-state\" class=\"wpforms-field-sublabel after\">Provincie<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-26442-field_23-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][23][postal]\" aria-errormessage=\"wpforms-26442-field_23-postal-error\" ><label for=\"wpforms-26442-field_23-postal\" class=\"wpforms-field-sublabel after\">Postcode<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-26442-field_23-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][23][country]\" value=\"BE\" aria-errormessage=\"wpforms-26442-field_23-country-error\" ><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albani\u00eb<\/option><option value=\"DZ\" >Algerije<\/option><option value=\"AS\" >Amerikaans Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua en Barbuda<\/option><option value=\"AR\" >Argentini\u00eb<\/option><option value=\"AM\" >Armeni\u00eb<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australi\u00eb<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\"  selected='selected'>Belgi\u00eb<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Sint Eustatius en Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouveteiland<\/option><option value=\"BR\" >Brazili\u00eb<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgarije<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocoseilanden<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoren<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cookeilanden<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"DK\" >Denemarken<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"DE\" >Duitsland<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypte<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estland<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopi\u00eb<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >Frankrijk<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GR\" >Griekenland<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongarije<\/option><option value=\"IS\" >IJsland<\/option><option value=\"IE\" >Ierland (Republiek van)<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesi\u00eb<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (Islamitische Republiek van)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Itali\u00eb<\/option><option value=\"CI\" >Ivoorkust<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordani\u00eb<\/option><option value=\"KY\" >Kaaiman Eilanden<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenia<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"HR\" >Kroati\u00eb<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Laos (Democratische Volksrepubliek)<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Letland<\/option><option value=\"LB\" >Libanon<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libi\u00eb<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithouwen<\/option><option value=\"LU\" >Luxemburg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Malediven<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marokko<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federale Staten van)<\/option><option value=\"MD\" >Moldavi\u00eb<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongoli\u00eb<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands, The<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NZ\" >Nieuw-Zeeland<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"MK\" >Noord Macedoni\u00eb (Republiek van)<\/option><option value=\"KP\" >Noord-Korea (Democratische Volksrepubliek)<\/option><option value=\"NO\" >Noorwegen<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"UA\" >Oekraine<\/option><option value=\"OM\" >Oman<\/option><option value=\"AT\" >Oostenrijk<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestina<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Polen<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roemeni\u00eb<\/option><option value=\"RU\" >Russische Federatie<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabi\u00eb<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Servi\u00eb<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SI\" >Sloveni\u00eb<\/option><option value=\"SK\" >Slowakije<\/option><option value=\"SD\" >Soedan<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spanje<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard en Jan Mayen<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republiek China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"CZ\" >Tsjechi\u00eb<\/option><option value=\"TN\" >Tunesi\u00eb<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vaticaanstad<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"ZA\" >Zuid Afrika<\/option><option value=\"KR\" >Zuid-Korea (Republiek van)<\/option><option value=\"SE\" >Zweden<\/option><option value=\"CH\" >Zwitserland<\/option><option value=\"AX\" >\u00c5land<\/option><\/select><label for=\"wpforms-26442-field_23-country\" class=\"wpforms-field-sublabel after\">Land<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-26442-field_25-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_25\">E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-26442-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" spellcheck=\"false\" aria-errormessage=\"wpforms-26442-field_25-error\" required><\/div><div id=\"wpforms-26442-field_26-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_26\">Telefoon<\/label><input type=\"tel\" id=\"wpforms-26442-field_26\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-26442-field_26-error\" ><\/div><div id=\"wpforms-26442-field_27-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-26442-field_27\">Site \/ URL<\/label><input type=\"url\" id=\"wpforms-26442-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-26442-field_27-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-26442-field_44-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"44\"><div id=\"wpforms-26442-field_44\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-26442-field_44-error\"><h4>Bevestiging<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-26442-field_45-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Cases \u00e0 cocher <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26442-field_45\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"checkbox\" id=\"wpforms-26442-field_45_1\" name=\"wpforms[fields][45][]\" value=\"J&#039;accepte que mes coordonn\u00e9es soient affich\u00e9es sur la carte des orthoptistes de Belgique\" aria-errormessage=\"wpforms-26442-field_45_1-error\" required checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_45_1\">Ik ga ermee akkoord dat mijn contactgegevens worden weergegeven op de kaart van orthoptisten in Belgi\u00eb.<\/label><\/li><li class=\"choice-2 depth-1 wpforms-selected\"><input type=\"checkbox\" id=\"wpforms-26442-field_45_2\" name=\"wpforms[fields][45][]\" value=\"J&#039;accepte que mon adresse soit transmise aux associations nationales et internationales d\u2019orthoptistes et ophtalmologues suite \u00e0 votre adh\u00e9sion \u00e0 l\u2019ABO : AOB, OCE, IOA\u2026\" aria-errormessage=\"wpforms-26442-field_45_2-error\" required checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_45_2\">Ik ga ermee akkoord dat mijn adres wordt doorgegeven aan nationale en internationale verenigingen van orthoptisten en oogartsen: AOB,\u00a0OCE,\u00a0IOA...<\/label><\/li><li class=\"choice-3 depth-1 wpforms-selected\"><input type=\"checkbox\" id=\"wpforms-26442-field_45_3\" name=\"wpforms[fields][45][]\" value=\"J&#039;accepte que mon adresse soit transmise aux sponsors : symposium, journ\u00e9e scientifique\u2026\" aria-errormessage=\"wpforms-26442-field_45_3-error\" required checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-26442-field_45_3\">Ik ga ermee akkoord dat mijn adres wordt doorgegeven aan sponsors: symposium, wetenschappelijke dag...<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26442-field_46-container\" class=\"wpforms-field wpforms-field-content\" 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