donate.msf-azg.be
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Submitted URL: https://contact.msf-azg.be/e3t/Ctc/2L+113/cPR2z04/VW494j8R5X8_W7XnYK13qCDtbV1-ywc4HbbqKN1m0FrQ3q3n_V1-WJV7CgLzfW14MBb882tkR...
Effective URL: https://donate.msf-azg.be/b/mijn-gift?ns_ira_cr_arg=IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd%2F3CmGO%2FsR...
Submission: On April 04 via api from BE — Scanned from DE
Effective URL: https://donate.msf-azg.be/b/mijn-gift?ns_ira_cr_arg=IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd%2F3CmGO%2FsR...
Submission: On April 04 via api from BE — Scanned from DE
Form analysis 3 forms found in the DOM
<form><span class="fieldset">
<p><input type="checkbox" value="check" id="chkMain" checked="checked" class="legacy-group-status optanon-status-checkbox"><label for="chkMain">Actief</label></p>
</span></form>GET /index.php
<form action="/index.php" method="get" id="form_lang">
<fieldset>
<p>
<label>
<span>Taal:</span>
<select name="lang">
<option data-value="fr_FR"
value="/b/mon-don?cid=121&_cv=1&ns_ira_cr_arg=IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd%2F3CmGO%2FsRvjdvhxoDcATptqkCJmJWTaWV6fWAE4iqTSUpIJ1JrWYjf5EifkZVEUhug5O26IyVYdGE4tMZaS6DxcADSLyHF4HvaTbuOvPgI5zECDf1Ep6EnNLztzU3s%2Ft8JocSx%2FMz2gEpHycZnR4BpdwC4OxuIuyCjaNd%2Bz%2BhEenMeYxIdwPeUlY6j0XOCI%2FG0tpViN%2FcBrSdWeMZq1lvkNttZOT1q2wsks79CuXlYZi4KXLRI%3D">
Français</option>
<option data-value="nl_BE"
value="/b/mijn-gift?cid=121&_cv=1&ns_ira_cr_arg=IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd%2F3CmGO%2FsRvjdvhxoDcATptqkCJmJWTaWV6fWAE4iqTSUpIJ1JrWYjf5EifkZVEUhug5O26IyVYdGE4tMZaS6DxcADSLyHF4HvaTbuOvPgI5zECDf1Ep6EnNLztzU3s%2Ft8JocSx%2FMz2gEpHycZnR4BpdwC4OxuIuyCjaNd%2Bz%2BhEenMeYxIdwPeUlY6j0XOCI%2FG0tpViN%2FcBrSdWeMZq1lvkNttZOT1q2wsks79CuXlYZi4KXLRI%3D"
selected="selected">Nederlands</option>
<option data-value="en_EN"
value="/b/my-donation?cid=121&_cv=1&ns_ira_cr_arg=IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd%2F3CmGO%2FsRvjdvhxoDcATptqkCJmJWTaWV6fWAE4iqTSUpIJ1JrWYjf5EifkZVEUhug5O26IyVYdGE4tMZaS6DxcADSLyHF4HvaTbuOvPgI5zECDf1Ep6EnNLztzU3s%2Ft8JocSx%2FMz2gEpHycZnR4BpdwC4OxuIuyCjaNd%2Bz%2BhEenMeYxIdwPeUlY6j0XOCI%2FG0tpViN%2FcBrSdWeMZq1lvkNttZOT1q2wsks79CuXlYZi4KXLRI%3D">
English</option>
</select>
</label>
</p>
</fieldset>
</form>POST /b/steps/save
<form action="/b/steps/save" method="post" id="form-steps" autocomplete="off">
<input type="hidden" name="context_form" value="">
<input type="hidden" name="private_monitoring_session_id" value="donate.msf-azg.be/5261486454.1649037713"><input type="hidden" name="context_form_id" value="form_cached_435328303">
<input type="hidden" name="cid" value="121">
<input type="hidden" name="lang" value="nl_BE"><input type="hidden" name="form_version" value="b">
<input type="hidden" name="scope" value="" id="scope">
<input type="hidden" name="ns_ira_cr_arg"
value="IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd/3CmGO/sRvjdvhxoDcATptqkCJmJWTaWV6fWAE4iqTSUpIJ1JrWYjf5EifkZVEUhug5O26IyVYdGE4tMZaS6DxcADSLyHF4HvaTbuOvPgI5zECDf1Ep6EnNLztzU3s/t8JocSx/Mz2gEpHycZnR4BpdwC4OxuIuyCjaNd+z+hEenMeYxIdwPeUlY6j0XOCI/G0tpViN/cBrSdWeMZq1lvkNttZOT1q2wsks79CuXlYZi4KXLRI=">
<input id="useragent_input_0" type="hidden" name="private_user_agent_cli" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/100.0.4896.60 Safari/537.36">
<script type="text/javascript">
document.getElementById("useragent_input_0").value = navigator.userAgent;
</script>
<input id="referer_input_0" type="hidden" name="private_referer" value="">
<script type="text/javascript">
document.getElementById("referer_input_0").value = document.referrer;
</script>
<input id="random_input_0" type="hidden" name="private_random" value="0.24334773006405386">
<script type="text/javascript">
document.getElementById("random_input_0").value = Math.random();
setTimeout(function() {
document.getElementById("random_input_0").value = Math.random();
}, 3000);
</script>
<div id="step-1" class="unit size1of3">
<div class="step-container">
<div class="step-title light-text" style="font-family: "Source Sans Pro";">
<h2 style="height: 51px;">1. Uw inschrijving</h2>
</div>
<div class="step-content" style="height: 1223px;">
<div class="height_adaptor">
<div>
</div>
<div class="tabs ui-tabs ui-corner-all ui-widget ui-widget-content">
<ul class="tabs_menu single_frequency ui-tabs-nav ui-corner-all ui-helper-reset ui-helper-clearfix ui-widget-header" role="tablist">
<li class="title ui-tabs-tab ui-corner-top ui-state-default ui-tab ui-tabs-active ui-state-active light-text" id="once-item" role="tab" tabindex="0" aria-controls="once" aria-labelledby="ui-id-1" aria-selected="true"
aria-expanded="true"><a href="#once" role="presentation" tabindex="-1" class="ui-tabs-anchor" id="ui-id-1"><h3>20KM DOOR BRUSSEL 2022</h3></a></li>
</ul>
<div id="once" class="bloc ui-tabs-panel ui-corner-bottom ui-widget-content active-panel" aria-labelledby="ui-id-1" role="tabpanel" aria-hidden="false">
<div class="bloc-content">
<div id="bloc-amount-once">
<fieldset class="amount">
<p class="thumbs"><img src="/cdn.iraiser.eu/UoXVcCw8x8W2Yxt+73i8gQ==/default/origin/logo20kmbruxellesmsfbe.jpg" width="256" height="192" alt="Photo"></p>
<ul class="radio-desc line" id="amount-list-once">
<li data-detail="tabs_0_amount-list-once">
<label><input autocomplete="false" name="amount-once" type="radio" value="3500" id="amount-once-3500"> <span id="value_of_amount-once-3500">€35</span></label>
</li>
</ul>
</fieldset>
<div class="detail" id="tabs_0_amount-list-once" style="display: none;">
<p>Inschrijfgeld bedraagt</p>
<div></div>
</div>
<p class="tax-info light-text" style="display: none;"></p>
<!--<input type="hidden" value="" name="iraiser_analytics_session_id" id="iraiser_analytics_session_id"/>-->
<input type="hidden" name="referrer" value=""><input type="hidden" name="query_string"
value="ns_ira_cr_arg=IyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyMjIyPk3l8cz5Dp2ADJd%2F3CmGO%2FsRvjdvhxoDcATptqkCJmJWTaWV6fWAE4iqTSUpIJ1JrWYjf5EifkZVEUhug5O26IyVYdGE4tMZaS6DxcADSLyHF4HvaTbuOvPgI5zECDf1Ep6EnNLztzU3s%2Ft8JocSx%2FMz2gEpHycZnR4BpdwC4OxuIuyCjaNd%2Bz%2BhEenMeYxIdwPeUlY6j0XOCI%2FG0tpViN%2FcBrSdWeMZq1lvkNttZOT1q2wsks79CuXlYZi4KXLRI%3D&cid=121&_cv=1">
<script type="text/javascript">
try {
$("input[name=referrer]").val(document.referrer);
if (document.location.search.indexOf('_cv') > 1) {
$('input[name=referrer]').after($('<input type="hidden" name="query_string" />').val(document.location.search.substring(1)));
}
} catch (e) {}
</script>
</div>
</div>
</div>
</div>
<div>
</div>
<div>
<p name="reserved_20km_2022_nationalite" id="reserved_20km_2022_nationalite_id_624a50ff6e373" data-type="short">
<label for="reserved_20km_2022_nationalite" style="display: none;">
<span class="reserved_title">Wat is jouw nationaliteit?</span>
<span class="required">*</span>
<span id="nameHelp_reserved_20km_2022_nationalite" class="help"></span>
</label>
<input id="reserved_20km_2022_nationalite" type="text" aria-describedby="nameHelp_reserved_20km_2022_nationalite" name="reserved_20km_2022_nationalite" data-scope="step1" data-required="1" value="BEL, FR, LUX, UK..."
placeholder="Wat is jouw nationaliteit? *">
</p>
<p name="reserved_20km_2022_marcheur_coureur" id="reserved_20km_2022_marcheur_coureur_id_624a50ff6e3d2" data-type="select">
<label for="reserved_20km_2022_marcheur_coureur" style="display: none;">
<span class="reserved_title">Ga je lopen of wandelen?</span>
<span class="required">*</span>
<span id="nameHelp_reserved_20km_2022_marcheur_coureur" class="help"></span>
</label>
<select id="reserved_20km_2022_marcheur_coureur" aria-describedby="nameHelp_reserved_20km_2022_marcheur_coureur" name="reserved_20km_2022_marcheur_coureur" data-scope="step1" data-required="1" tabindex="-1"
class="select2-hidden-accessible" aria-hidden="true">
<option value="" selected="">Ga je lopen of wandelen?*</option>
<option name="reserved_20km_2022_marcheur_coureur" value="Marcher">Wandelen</option>
<option name="reserved_20km_2022_marcheur_coureur" value="Courir">Lopen</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 340px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-autocomplete="list"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-reserved_20km_2022_marcheur_coureur-container"><span class="select2-selection__rendered" id="select2-reserved_20km_2022_marcheur_coureur-container"
title="Ga je lopen of wandelen?*">Ga je lopen of wandelen?*</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
aria-hidden="true"></span></span>
</p>
<p name="reserved_20km_2022_handisport" id="reserved_20km_2022_handisport_id_624a50ff6e43a" data-type="checkbox">
<label for="reserved_20km_2022_handisport">
<input type="hidden" name="reserved_20km_2022_handisport" value="0">
<input id="reserved_20km_2022_handisport" type="checkbox" aria-describedby="nameHelp_reserved_20km_2022_handisport" name="reserved_20km_2022_handisport" data-scope="step1" data-required="" value="1"><span></span>
<span class="reserved_title">Loop je in de handisport categorie?</span>
<span id="nameHelp_reserved_20km_2022_handisport" class="help"></span>
</label>
</p>
<p name="reserved_20km_2022_temps" id="reserved_20km_2022_temps_id_624a50ff6e58b" data-type="short">
<label for="reserved_20km_2022_temps" style="display: none;">
<span class="reserved_title">In hoe veel tijd verwacht je de 20km te lopen? <br><span>Met deze informatie, kan de team van de organisatie jouw startbox bepalen. <br>Voor wandelaars gelieve 03:00 in te vullen: </span></span>
<span class="required">*</span>
<span id="nameHelp_reserved_20km_2022_temps" class="help"></span>
</label>
<input id="reserved_20km_2022_temps" type="text" aria-describedby="nameHelp_reserved_20km_2022_temps" name="reserved_20km_2022_temps" data-scope="step1" data-required="1" value="hh:mm"
placeholder="In hoe veel tijd verwacht je de 20km t... *">
</p>
<p name="reserved_20km_2022_tshirt" id="reserved_20km_2022_tshirt_id_624a50ff6e5e6" data-type="select">
<label for="reserved_20km_2022_tshirt" style="display: none;">
<span class="reserved_title">Wat is je t-shirt maat?</span>
<span class="required">*</span>
<span id="nameHelp_reserved_20km_2022_tshirt" class="help"></span>
</label>
<select id="reserved_20km_2022_tshirt" aria-describedby="nameHelp_reserved_20km_2022_tshirt" name="reserved_20km_2022_tshirt" data-scope="step1" data-required="1" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option value="" selected="">Wat is je t-shirt maat?*</option>
<option name="reserved_20km_2022_tshirt" value="S">S</option>
<option name="reserved_20km_2022_tshirt" value="M">M</option>
<option name="reserved_20km_2022_tshirt" value="L">L</option>
<option name="reserved_20km_2022_tshirt" value="XL">XL</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 340px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-autocomplete="list"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-reserved_20km_2022_tshirt-container"><span class="select2-selection__rendered" id="select2-reserved_20km_2022_tshirt-container"
title="Wat is je t-shirt maat?*">Wat is je t-shirt maat?*</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
aria-hidden="true"></span></span>
</p>
<p name="reserved_20km_2022_tshirt_reception" id="reserved_20km_2022_tshirt_reception_id_624a50ff6e647" data-type="radio">
<label for="reserved_20km_2022_tshirt_reception">
<span class="reserved_title">Hoe wil je jouw t-shirt ontvangen?</span>
<span class="required">*</span>
<span id="nameHelp_reserved_20km_2022_tshirt_reception" class="help"></span>
</label>
<label for="reserved_20km_2022_tshirt_reception_Poste" class="table">
<input id="reserved_20km_2022_tshirt_reception_Poste" type="radio" name="reserved_20km_2022_tshirt_reception" value="Poste" class="column" data-scope="step1" data-required="1">
<span class="column">Ik zou het graag via de post ontvangen</span>
</label>
<label for="reserved_20km_2022_tshirt_reception_MSF" class="table">
<input id="reserved_20km_2022_tshirt_reception_MSF" type="radio" name="reserved_20km_2022_tshirt_reception" value="MSF" class="column" data-scope="step1" data-required="1">
<span class="column">Ik kom het liever ophalen tussen 6 en 9 mei in de kantoren van Artsen zonder Grenzen, Gewijde Boomstraat 46, 1050 Elsene</span>
</label>
</p>
</div>
<div class="clearfix"></div>
</div>
</div> <!-- End Step-content -->
<!-- End Step-info -->
</div> <!-- End Step-container -->
</div> <!-- End Step-1 -->
<div id="step-2" class="unit size1of3">
<div class="step-container">
<div class="step-title light-text" style="font-family: "Source Sans Pro";">
<h2 style="height: 51px;">2. Mijn gegevens</h2>
</div>
<div class="step-content" style="height: 1223px;">
<div class="height_adaptor">
<fieldset id="fieldset-step2">
<p id="c-email">
<label for="email"><svg role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" class="">
<path fill="#969696"
d="M464 64H48C21.49 64 0 85.49 0 112v288c0 26.51 21.49 48 48 48h416c26.51 0 48-21.49 48-48V112c0-26.51-21.49-48-48-48zm0 48v40.805c-22.422 18.259-58.168 46.651-134.587 106.49-16.841 13.247-50.201 45.072-73.413 44.701-23.208.375-56.579-31.459-73.413-44.701C106.18 199.465 70.425 171.067 48 152.805V112h416zM48 400V214.398c22.914 18.251 55.409 43.862 104.938 82.646 21.857 17.205 60.134 55.186 103.062 54.955 42.717.231 80.509-37.199 103.053-54.947 49.528-38.783 82.032-64.401 104.947-82.653V400H48z"
class=""></path>
</svg></label>
<input type="text" name="email" id="email" placeholder="E-mail *">
</p>
<fieldset id="fielset-name">
<p id="c-civ">
<label for="civility" style="display: none;">Aanspreking <span class="required">*</span></label>
<select name="civility" id="civility" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option value="">Aanspreking *</option>
<option value="1">Dhr</option>
<option value="2">Mevr</option>
<option value="5">Mevr en Dhr</option>
<option value="22">Dhr en Dhr</option>
<option value="23">Mevr en Mevr</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 136px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-autocomplete="list"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-civility-container"><span class="select2-selection__rendered" id="select2-civility-container" title="Aanspreking *">Aanspreking *</span><span
class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</p>
<p id="c-fname">
<label for="firstname" style="display: none;">Voornaam <span class="required">*</span> <span class="help">bv. Jan</span></label>
<input type="text" name="firstname" id="firstname" placeholder="Voornaam *">
</p>
<p id="c-lname">
<label for="lastname" style="display: none;">Naam <span class="required">*</span> <span class="help">bv. Janssens</span></label>
<input type="text" name="lastname" id="lastname" placeholder="Naam *">
</p>
</fieldset>
<p name="reserved_rue" id="reserved_rue_id_624a50ff7123f" data-type="short">
<label for="reserved_rue" style="display: none;">
<span class="reserved_title">Adres</span>
<span class="required">*</span>
<span id="nameHelp_reserved_rue" class="help"></span>
</label>
<input id="reserved_rue" type="text" aria-describedby="nameHelp_reserved_rue" name="reserved_rue" data-scope="step2" data-required="1" value="" placeholder="Adres *">
</p>
<p name="reserved_numero_de_boite" id="reserved_numero_de_boite_id_624a50ff7129f" data-type="short">
<label for="reserved_numero_de_boite" style="display: none;">
<span class="reserved_title">Huisnummer</span>
<span class="required">*</span>
<span id="nameHelp_reserved_numero_de_boite" class="help"></span>
</label>
<input id="reserved_numero_de_boite" type="text" aria-describedby="nameHelp_reserved_numero_de_boite" name="reserved_numero_de_boite" data-scope="step2" data-required="1" value="" placeholder="Huisnummer *">
</p>
<fieldset id="fielset-address">
<p id="c-addr1">
<label for="address1" style="display: none;">Adres <span class="required">*</span> <span class="help">bv. Molenstraat 15</span></label>
<input type="text" name="address1" id="address1" placeholder="Adres *">
</p>
<p id="c-addr2">
<label for="address2" style="display: none;">Bus <span class="help">bv. Gebouw B</span></label>
<input type="text" name="address2" id="address2" placeholder="Bus">
</p>
<div class="line">
<p id="c-pcode" class="unit size1of2">
<label for="postcode" style="display: none;">Postcode <span class="required">*</span><!--<span class="help">bv. 9000</span>--></label>
<input type="text" name="postcode" id="postcode" placeholder="Postcode *">
</p>
<p id="c-city" class="unit size2of2 lastUnit">
<label for="city" style="display: none;">Gemeente <span class="required">*</span> <span class="help">bv. Gent</span></label>
<input type="text" name="city" id="city" placeholder="Gemeente *">
</p>
</div>
<p id="c-country">
<label for="country" style="display: none;">Land <span class="required">*</span> <span class="help">bv. België</span></label>
<select name="country" id="country" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option value="BE" selected="selected">België</option>
<option value="FR">Frankrijk</option>
<option value="LU">Luxemburg</option>
<option value="NL">Nederland</option>
<option value="ES">Spanje</option>
<option value="">----------------------------------</option>
<option value="AF">Afghanistan</option>
<option value="AX">Alandeilanden</option>
<option value="AL">Albanië</option>
<option value="DZ">Algerije</option>
<option value="AS">Amerikaans Samoa</option>
<option value="UM">Amerikaanse kleinere afgelegen eilanden</option>
<option value="VI">Amerikaanse Maagdeneilanden</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">Argentinië</option>
<option value="AM">Armenië</option>
<option value="AW">Aruba</option>
<option value="AC">Ascension</option>
<option value="AU">Australië</option>
<option value="AZ">Azerbeidzjan</option>
<option value="BS">Bahama’s</option>
<option value="BH">Bahrein</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BE">België</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</option>
<option value="BA">Bosnië en Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouveteiland</option>
<option value="BR">Brazilië</option>
<option value="IO">Britse Gebieden in de Indische Oceaan</option>
<option value="VG">Britse Maagdeneilanden</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgarije</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodja</option>
<option value="CA">Canada</option>
<option value="IC">Canarische Eilanden</option>
<option value="KY">Caymaneilanden</option>
<option value="CF">Centraal-Afrikaanse Republiek</option>
<option value="EA">Ceuta en Melilla</option>
<option value="CL">Chili</option>
<option value="CN">China</option>
<option value="CX">Christmaseiland</option>
<option value="CP">Clipperton</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-Kinshasa</option>
<option value="CK">Cookeilanden</option>
<option value="CR">Costa Rica</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</option>
<option value="DK">Denemarken</option>
<option value="DG">Diego Garcia</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominicaanse Republiek</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">Equatoriaal-Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estland</option>
<option value="ET">Ethiopië</option>
<option value="FX">Europese Frankrijk</option>
<option value="EU">Europese Unie</option>
<option value="FO">Faeröer</option>
<option value="FK">Falklandeilanden</option>
<option value="FJ">Fiji</option>
<option value="PH">Filipijnen</option>
<option value="FI">Finland</option>
<option value="FR">Frankrijk</option>
<option value="GF">Frans-Guyana</option>
<option value="PF">Frans-Polynesië</option>
<option value="TF">Franse Gebieden in de zuidelijke Indische Oceaan</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgië</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">Guinee</option>
<option value="GW">Guinee-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haïti</option>
<option value="HM">Heard- en McDonaldeilanden</option>
<option value="IM">Het Eiland Man</option>
<option value="HN">Honduras</option>
<option value="HU">Hongarije</option>
<option value="HK">Hongkong SAR van China</option>
<option value="IE">Ierland</option>
<option value="IS">IJsland</option>
<option value="IN">India</option>
<option value="ID">Indonesië</option>
<option value="IQ">Irak</option>
<option value="IR">Iran</option>
<option value="IL">Israël</option>
<option value="IT">Italië</option>
<option value="CI">Ivoorkust</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="YE">Jemen</option>
<option value="JE">Jersey</option>
<option value="JO">Jordanië</option>
<option value="CV">Kaapverdië</option>
<option value="CM">Kameroen</option>
<option value="KZ">Kazachstan</option>
<option value="KE">Kenia</option>
<option value="KG">Kirgizië</option>
<option value="KI">Kiribati</option>
<option value="KW">Koeweit</option>
<option value="HR">Kroatië</option>
<option value="LA">Laos</option>
<option value="LS">Lesotho</option>
<option value="LV">Letland</option>
<option value="LB">Libanon</option>
<option value="LR">Liberia</option>
<option value="LY">Libië</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Litouwen</option>
<option value="LU">Luxemburg</option>
<option value="MO">Macao SAR van China</option>
<option value="MK">Macedonië</option>
<option value="MG">Madagaskar</option>
<option value="MW">Malawi</option>
<option value="MV">Malediven</option>
<option value="MY">Maleisië</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MA">Marokko</option>
<option value="MH">Marshalleilanden</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritanië</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesië</option>
<option value="MD">Moldavië</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolië</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibië</option>
<option value="NR">Nauru</option>
<option value="NL">Nederland</option>
<option value="AN">Nederlandse Antillen</option>
<option value="NP">Nepal</option>
<option value="NI">Nicaragua</option>
<option value="NC">Nieuw-Caledonië</option>
<option value="NZ">Nieuw-Zeeland</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="KP">Noord-Korea</option>
<option value="MP">Noordelijke Marianeneilanden</option>
<option value="NO">Noorwegen</option>
<option value="NF">Norfolkeiland</option>
<option value="QO">Oceanië (overige)</option>
<option value="UG">Oeganda</option>
<option value="UA">Oekraïne</option>
<option value="UZ">Oezbekistan</option>
<option value="OM">Oman</option>
<option value="ZZ">Onbekend of onjuist gebied</option>
<option value="TL">Oost-Timor</option>
<option value="AT">Oostenrijk</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestijns Gebied</option>
<option value="PA">Panama</option>
<option value="PG">Papoea-Nieuw-Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</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="RE">Réunion</option>
<option value="RO">Roemenië</option>
<option value="RU">Rusland</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="KN">Saint Kitts en Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="PM">Saint Pierre en Miquelon</option>
<option value="VC">Saint Vincent en de Grenadines</option>
<option value="SB">Salomoneilanden</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tomé en Principe</option>
<option value="SA">Saoedi-Arabië</option>
<option value="SN">Senegal</option>
<option value="RS">Servië</option>
<option value="CS">Servië en Montenegro</option>
<option value="SC">Seychellen</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SH">Sint-Helena</option>
<option value="MF">Sint-Maarten</option>
<option value="SI">Slovenië</option>
<option value="SK">Slowakije</option>
<option value="SD">Soedan</option>
<option value="SO">Somalië</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="SZ">Swaziland</option>
<option value="SY">Syrië</option>
<option value="TJ">Tadzjikistan</option>
<option value="TW">Taiwan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad en Tobago</option>
<option value="TA">Tristan da Cunha</option>
<option value="TD">Tsjaad</option>
<option value="CZ">Tsjechië</option>
<option value="TN">Tunesië</option>
<option value="TR">Turkije</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks- en Caicoseilanden</option>
<option value="TV">Tuvalu</option>
<option value="UY">Uruguay</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vaticaanstad</option>
<option value="VE">Venezuela</option>
<option value="GB">Verenigd Koninkrijk</option>
<option value="AE">Verenigde Arabische Emiraten</option>
<option value="US">Verenigde Staten</option>
<option value="VN">Vietnam</option>
<option value="WF">Wallis en Futuna</option>
<option value="EH">Westelijke Sahara</option>
<option value="BY">Wit-Rusland</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
<option value="ZA">Zuid-Afrika</option>
<option value="GS">Zuid-Georgië en Zuidelijke Sandwicheilanden</option>
<option value="KR">Zuid-Korea</option>
<option value="SE">Zweden</option>
<option value="CH">Zwitserland</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 340px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-autocomplete="list"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-country-container"><span class="select2-selection__rendered flag_country flag_BE" id="select2-country-container" title="België">België</span><span
class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</p>
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<p id="required-info"><span class="required">*</span> <span class="help">Verplichte velden </span></p>
</fieldset>
</div>
</div> <!-- End Bloc -->
<!-- End Step-info -->
</div> <!-- End Step-container -->
</div> <!-- End Step-2 -->
<div id="step-3" class="unit size1of3 lastUnit">
<div class="step-container">
<div class="step-title light-text" style="font-family: "Source Sans Pro";">
<h2 style="height: 51px;">3. Mijn betaling</h2>
</div>
<div class="step-content" style="height: 1223px;">
<div class="height_adaptor">
<div id="security-info">
<p><img src="/medias/app/plateformesecuriseenl.png" alt="100% beveiligd betalingsplatform"></p>
</div>
<div class="payment">
<div id="payment_modes_once">
<div class="payment_titles has_1_child">
<h4 class="payment_head payment_mode-card-ingenico active light-text" data-paymentid="payment_mode-card-ingenico">
<span class="payment_mode_title">Bankkaart</span>
</h4>
</div>
<fieldset id="payment_mode-card-ingenico" class="payment_mode" style="display: block;">
<h4 class="payment_head active light-text">
<span class="payment_mode_title">Bankkaart</span>
</h4>
<div class="payment_body payment_mode-card-ingenico" id="creditcard-list" data-paymentid="payment_mode-card-ingenico">
<ul id="card-type">
<li data-value="amex"><label><input name="cardtype_ingenico" type="radio" value="amex"><span class="radio-type"></span> American Express</label></li>
<li data-value="mastercard"><label><input name="cardtype_ingenico" type="radio" value="mastercard"><span class="radio-type"></span> Mastercard</label></li>
<li data-value="visa"><label><input name="cardtype_ingenico" type="radio" value="visa"><span class="radio-type"></span> Visa</label></li>
<li data-value="bancontact"><label><input name="cardtype_ingenico" type="radio" value="bancontact"><span class="radio-type"></span> Bancontact / Mister Cash</label></li>
<div class="clearfix"></div>
</ul>
<p id="card_ingenico-submit" class="payment-submit">
<input name="card_ingenico_submit" type="submit" id="card_ingenico_submit" class="button" data-scope="card_ingenico" value="Bevestigen">
</p>
</div>
</fieldset>
</div>
</div>
</div>
<!-- End Payment -->
<div class="clearfix"></div>
</div> <!-- End Bloc -->
<!-- End Step-info -->
</div> <!-- End Step-container -->
</div> <!-- End Step 3 -->
<input type="hidden" name="private_stats_capture"><input type="hidden" name="private_stats_version"><input type="hidden" name="private_stats_config"
value="{"visitor_resolution_width":1600,"visitor_resolution_height":1200,"visitor_color":24,"visitor_java_enabled":false,"visitor_langage":"en-US","visitor_screen_height":1200,"visitor_screen_width":1600,"user_agent":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/100.0.4896.60 Safari/537.36","visitor_timezone":0,"window_width":1600,"window_height":1200}">
</form>Text Content
Cookie Notice We gebruiken cookies om inhoud en advertenties te personaliseren, sociale mediafuncties aan te bieden en ons verkeer te analyseren. We delen ook informatie over uw gebruik van onze site met onze partners voor sociale media, reclame en analytics.Cookie beleid Sluiten Cookies accepteren Cookie-instellingen * Uw privacy * Strikt noodzakelijke cookies * Statistiekencookies * Functionele cookies * Doelgroepgerichte en sociale mediacookies * Meer informatie Voorkeurenmenu Actief Altijd actief Instellingen opslaan Alle toestaan Taal: Français Nederlands English 1. UW INSCHRIJVING * 20KM DOOR BRUSSEL 2022 * €35 Inschrijfgeld bedraagt Wat is jouw nationaliteit? * Ga je lopen of wandelen? * Ga je lopen of wandelen?* Wandelen Lopen Ga je lopen of wandelen?* Loop je in de handisport categorie? In hoe veel tijd verwacht je de 20km te lopen? Met deze informatie, kan de team van de organisatie jouw startbox bepalen. Voor wandelaars gelieve 03:00 in te vullen: * Wat is je t-shirt maat? * Wat is je t-shirt maat?* S M L XL Wat is je t-shirt maat?* Hoe wil je jouw t-shirt ontvangen? * Ik zou het graag via de post ontvangen Ik kom het liever ophalen tussen 6 en 9 mei in de kantoren van Artsen zonder Grenzen, Gewijde Boomstraat 46, 1050 Elsene 2. MIJN GEGEVENS Aanspreking * Aanspreking * Dhr Mevr Mevr en Dhr Dhr en Dhr Mevr en Mevr Aanspreking * Voornaam * bv. Jan Naam * bv. Janssens Adres * Huisnummer * Adres * bv. Molenstraat 15 Bus bv. Gebouw B Postcode * Gemeente * bv. Gent Land * bv. België België Frankrijk Luxemburg Nederland Spanje ---------------------------------- Afghanistan Alandeilanden Albanië Algerije Amerikaans Samoa Amerikaanse kleinere afgelegen eilanden Amerikaanse Maagdeneilanden Andorra Angola Anguilla Antarctica Antigua en Barbuda Argentinië Armenië Aruba Ascension Australië Azerbeidzjan Bahama’s Bahrein Bangladesh Barbados België Belize Benin Bermuda Bhutan Bolivia Bosnië en Herzegovina Botswana Bouveteiland Brazilië Britse Gebieden in de Indische Oceaan Britse Maagdeneilanden Brunei Bulgarije Burkina Faso Burundi Cambodja Canada Canarische Eilanden Caymaneilanden Centraal-Afrikaanse Republiek Ceuta en Melilla Chili China Christmaseiland Clipperton Cocoseilanden Colombia Comoren Congo Congo-Kinshasa Cookeilanden Costa Rica Cuba Cyprus Denemarken Diego Garcia Djibouti Dominica Dominicaanse Republiek Duitsland Ecuador Egypte El Salvador Equatoriaal-Guinea Eritrea Estland Ethiopië Europese Frankrijk Europese Unie Faeröer Falklandeilanden Fiji Filipijnen Finland Frankrijk Frans-Guyana Frans-Polynesië Franse Gebieden in de zuidelijke Indische Oceaan Gabon Gambia Georgië Ghana Gibraltar Grenada Griekenland Groenland Guadeloupe Guam Guatemala Guernsey Guinee Guinee-Bissau Guyana Haïti Heard- en McDonaldeilanden Het Eiland Man Honduras Hongarije Hongkong SAR van China Ierland IJsland India Indonesië Irak Iran Israël Italië Ivoorkust Jamaica Japan Jemen Jersey Jordanië Kaapverdië Kameroen Kazachstan Kenia Kirgizië Kiribati Koeweit Kroatië Laos Lesotho Letland Libanon Liberia Libië Liechtenstein Litouwen Luxemburg Macao SAR van China Macedonië Madagaskar Malawi Malediven Maleisië Mali Malta Marokko Marshalleilanden Martinique Mauritanië Mauritius Mayotte Mexico Micronesië Moldavië Monaco Mongolië Montenegro Montserrat Mozambique Myanmar Namibië Nauru Nederland Nederlandse Antillen Nepal Nicaragua Nieuw-Caledonië Nieuw-Zeeland Niger Nigeria Niue Noord-Korea Noordelijke Marianeneilanden Noorwegen Norfolkeiland Oceanië (overige) Oeganda Oekraïne Oezbekistan Oman Onbekend of onjuist gebied Oost-Timor Oostenrijk Pakistan Palau Palestijns Gebied Panama Papoea-Nieuw-Guinea Paraguay Peru Pitcairn Polen Portugal Puerto Rico Qatar Réunion Roemenië Rusland Rwanda Saint Barthélemy Saint Kitts en Nevis Saint Lucia Saint Pierre en Miquelon Saint Vincent en de Grenadines Salomoneilanden Samoa San Marino Sao Tomé en Principe Saoedi-Arabië Senegal Servië Servië en Montenegro Seychellen Sierra Leone Singapore Sint-Helena Sint-Maarten Slovenië Slowakije Soedan Somalië Spanje Sri Lanka Suriname Svalbard en Jan Mayen Swaziland Syrië Tadzjikistan Taiwan Tanzania Thailand Togo Tokelau Tonga Trinidad en Tobago Tristan da Cunha Tsjaad Tsjechië Tunesië Turkije Turkmenistan Turks- en Caicoseilanden Tuvalu Uruguay Vanuatu Vaticaanstad Venezuela Verenigd Koninkrijk Verenigde Arabische Emiraten Verenigde Staten Vietnam Wallis en Futuna Westelijke Sahara Wit-Rusland Zambia Zimbabwe Zuid-Afrika Zuid-Georgië en Zuidelijke Sandwicheilanden Zuid-Korea Zweden Zwitserland België * Verplichte velden 3. MIJN BETALING BANKKAART BANKKAART * American Express * Mastercard * Visa * Bancontact / Mister Cash 20KM DOOR BRUSSEL 2022 PRAKTISCHE INFO Datum en uur: Zondag 29 mei 2022 9u opent Artsen Zonder Grenzen haar tent. Om 10 uur starten de eerste renners. Onthaal: de tent van Artsen Zonder Grenzen staat in het Jubelpark, tegenover de fontein. Inschrijven: 35 euro. Daarin zit ook een T-shirt, de inschrijving, dranken, snacks, vestiaire. Masseurs zullen aanwezig zijn na de race. WAAROM LOPEN VOOR ARTSEN ZONDER GRENZEN? LOOP MEE MET ARTSEN ZONDER GRENZEN EN ZAMEL €50 IN VOOR DE BOUW VAN EEN KRAAMAFDELING IN BANGUI Met het ingezamelde geld bouwt Artsen Zonder Grenzen een nieuwe kraamafdeling in Bangui, Centraal-Afrikaanse Republiek. Het moeder- en kindersterftecijfer is er het op drie na hoogste ter wereld. Door met Artsen Zonder Grenzen deel te nemen aan de 20 km door Brussel maakt u de bouw van deze nieuwe kraamafdeling mogelijk en maakt u de verloskundige zorg toegankelijker voor de bevolking van Bangui. VOLLEDIG VEILIGE BETALING Alle bankgegevens voor verwerking van de betaling worden versleuteld met het SSL-protocol. De gegevens worden in geen geval opgeslagen in onze informaticasystemen. Hebt u vragen over Artsen Zonder Grenzen, neem dan contact op met: Miek Monsieur Afdelingshoofd Donateurs tel.: +32 2 474 74 77 E-mail: miek.monsieur@brussels.msf.org Copyright | Wettelijke bepalingen | Contact