{"id":6509,"date":"2023-06-21T07:45:34","date_gmt":"2023-06-21T05:45:34","guid":{"rendered":"https:\/\/member.phoodfarm.org\/shopper-trial-box-form\/"},"modified":"2024-04-03T09:28:01","modified_gmt":"2024-04-03T07:28:01","slug":"shopper-trial-box-form","status":"publish","type":"page","link":"https:\/\/member.phoodfarm.org\/en\/shopper-trial-box-form\/","title":{"rendered":"Shopper Trial Box Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6509\" class=\"elementor elementor-6509 elementor-5562\">\n\t\t\t\t<input type=\"hidden\" id=\"security\" name=\"security\" value=\"12e0e931c1\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6509\" \/>\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-71453761 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"71453761\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e827ed0\" data-id=\"e827ed0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-4991ba1e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4991ba1e\" data-element_type=\"section\" data-e-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-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-7fd6e0a8\" data-id=\"7fd6e0a8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-ba1a0f7 background-right\" data-id=\"ba1a0f7\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-1b20ff65 page-icon elementor-widget elementor-widget-image\" data-id=\"1b20ff65\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"160\" height=\"125\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/uploads\/2023\/06\/community-farmer-abonnement.png\" class=\"attachment-large size-large wp-image-6200\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e4a699f page-title elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"7e4a699f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><div class=\"elementor-image-box-content\"><h2 class=\"elementor-image-box-title\">Shopper Trial Box<\/h2><p class=\"elementor-image-box-description\">Pick up a Phood Farm Shopper Trial Box once or have it delivered. Choose the number of people and select your desired date below.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6c9d5606 elementor-widget elementor-widget-html\" data-id=\"6c9d5606\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"community_shopper_proefbox\" subpage-title=\"Shopper Proefbox\" class=\"phoodbox-membership-registration-form proefbox\">\n    <div class=\"progressbar\">\n        <div class=\"row\">\n            <div class=\"col-4\">\n                <div id=\"subscription_details_progress\" class=\"registration-progress-bar progress-active\">\n                    <h6>1. Order details<\/h6>\n                    <div class=\"progress-bar-tab\"><\/div>\n                <\/div>\n            <\/div>\n            <div class=\"col-4\">\n                <div id=\"account_details_progress\" class=\"registration-progress-bar\">\n                    <h6>2. Account information<\/h6>\n                    <div class=\"progress-bar-tab\"><\/div>\n                <\/div>\n            <\/div>\n            <div class=\"col-4\">\n                <div id=\"checkout_details_progress\" class=\"registration-progress-bar\">\n                    <h6>3. Checkout<\/h6>\n                    <div class=\"progress-bar-tab\"><\/div>\n                <\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n    <div id=\"subscription_details_tab\" class=\"registration-details-tab active\">\n        <div class=\"subscription-details-form\">\n            <div class=\"persons-field\">\n                <h4>Number of persons:<\/h4>\n                <p>How many people will the Phood box be for?<\/p>\n                <div class=\"person-fieldset\">\n                    <button id=\"selected_persons\" class=\"selected-persons\" data-value=\"1\">1<\/button>\n                    <button id=\"selected_persons\" class=\"selected-persons\" data-value=\"2\">2<\/button>\n                    <button id=\"selected_persons\" class=\"selected-persons\" data-value=\"3\">3<\/button>\n                    <button id=\"selected_persons\" class=\"selected-persons\" data-value=\"4\">4<\/button>\n                    <button id=\"selected_persons\" class=\"selected-persons\" data-value=\"5\">5<\/button>\n                    <button id=\"selected_persons\" class=\"selected-persons\" data-value=\"6\">6<\/button>\n                <\/div>\n            <\/div>\n            <div class=\"phoodbox-field\">\n                <div class=\"phoodbox-delivery-fieldset\">\n                    <h4>Phoodbox pickup or delivery:<\/h4>\n                    <p>Do you live within a 4km radius? Then we can also have the Phoodbox delivered to you for \u20ac2.99!<\/p>\n                    <div class=\"btn-wrapper\">\n                        <button id=\"delivery_method\" class=\"delivery-method\" data-value=\"ophalen\">Retrieved from<\/button>\n                        <button id=\"delivery_method\" class=\"delivery-method\" data-value=\"bezorgen\">Delivery<\/button>\n                    <\/div>\n\n                <\/div>\n                <div class=\"phoodbox-timeslot-fieldset\" style=\"display: none;\">\n                    <h4>Available pick-up times:<\/h4>\n                    <p>  Choose which day you would like to pick up the Phoodbox. This can also be adjusted later in your\n  profile.  <\/p>                    \n                <\/div>\n                <div class=\"delivery-postcode\" style=\"display: none;\">\n                    <h4>Available delivery times:<\/h4>\n                    <p>Based on your zip code, we can show you what delivery times are available.<\/p>\n                    <div class=\"Postcode-box\">\n                        <input id=\"delivery_postcode\" class=\"phoodbox-delivery-postcode\" type=\"text\" placeholder=\"zip code\">\n                        <button id=\"check_postcode\" class=\"delivery-check-postcode\"><i class=\"_mi _before bb-icon-l buddyboss bb-icon-arrow-right\" aria-hidden=\"true\"><\/i><\/button>\n                        <span id=\"postcode_error\" class=\"cc-error\"><\/span>\n                    <\/div>\n                <\/div>\n\t\t\t\t<div class=\"phoodbox-calendar-fieldset\" style=\"display:none;\">\n\t\t\t\t\t<input type=\"text\" id=\"phoodfarm_calender\" placeholder=\"choose delivery date\">\n\t\t\t\t\t<span id=\"phoodfarm_calender_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n                <div class=\"phoodbox-frequency-fieldset\" style=\"display:none;\">\n                    <div class=\"btn-wrapper\">\n                        <button id=\"phoodbox_frequency\" class=\"phoodbox-frequency active_phood_frequency\" data-value=\"wekelijks\">Weekly<\/button>\n                    <\/div>\n                <\/div>\n            <\/div>\n            <div class=\"payment-method-field\">\n                <div class=\"payment-method-fieldset\" style=\"display:none;\">\n                    <div class=\"btn-wrapper\">\n                        <button id=\"payment_method\" class=\"payment-method wekelijks active_payment_method\" disabled data-value=\"wekelijks\">Weekly<\/button>\n                    <\/div>\n                <\/div>\n                <div class=\"subscription-price\" id=\"subscription-price-proefbox\" style=\"display: none;\">\n  You pay\n                    <div id=\"mepr_subscription_price\" class=\"mepr-subscription-price\">\n\t\t\t\t\t\t<p class=\"1_wekelijks_ophalen\" total-price=\"23.50\" delivery-charge=\"0\" subscription-price=\"23.50\"><span class=\"subcription-price-num\">\u20ac 23,50<\/span><\/p>\n\t\t\t\t\t\t<p class=\"2_wekelijks_ophalen\" total-price=\"47\" delivery-charge=\"0\" subscription-price=\"47\"><span class=\"subcription-price-num\">\u20ac 47<\/span><\/p>\n\t\t\t\t\t\t<p class=\"3_wekelijks_ophalen\" total-price=\"70.50\" delivery-charge=\"0\" subscription-price=\"70.50\"><span class=\"subcription-price-num\">\u20ac 70,50<\/span><\/p>\n\t\t\t\t\t\t<p class=\"4_wekelijks_ophalen\" total-price=\"94\" delivery-charge=\"0\" subscription-price=\"94\"><span class=\"subcription-price-num\">\u20ac 94<\/span><\/p>\n\t\t\t\t\t\t<p class=\"5_wekelijks_ophalen\" total-price=\"117.50\" delivery-charge=\"0\" subscription-price=\"117.50\"><span class=\"subcription-price-num\">\u20ac 117,50<\/span><\/p>\n\t\t\t\t\t\t<p class=\"6_wekelijks_ophalen\" total-price=\"141\" delivery-charge=\"0\" subscription-price=\"141\"><span class=\"subcription-price-num\">\u20ac 141<\/span><\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<p class=\"1_wekelijks_bezorgen\" total-price=\"26.49\" delivery-charge=\"2.99\" subscription-price=\"23.50\"><span class=\"subcription-price-num\">\u20ac 26,49<\/span><\/p>\n\t\t\t\t\t\t<p class=\"2_wekelijks_bezorgen\" total-price=\"49.99\" delivery-charge=\"2.99\" subscription-price=\"47\"><span class=\"subcription-price-num\">\u20ac 49,99<\/span><\/p>\n\t\t\t\t\t\t<p class=\"3_wekelijks_bezorgen\" total-price=\"73.49\" delivery-charge=\"2.99\" subscription-price=\"70.50\"><span class=\"subcription-price-num\">\u20ac 73,49<\/span><\/p>\n\t\t\t\t\t\t<p class=\"4_wekelijks_bezorgen\" total-price=\"96.99\" delivery-charge=\"2.99\" subscription-price=\"94\"><span class=\"subcription-price-num\">\u20ac 96,99<\/span><\/p>\n\t\t\t\t\t\t<p class=\"5_wekelijks_bezorgen\" total-price=\"120.49\" delivery-charge=\"2.99\" subscription-price=\"117.50\"><span class=\"subcription-price-num\">\u20ac 120,49<\/span><\/p>\n\t\t\t\t\t\t<p class=\"6_wekelijks_bezorgen\" total-price=\"143.99\" delivery-charge=\"2.99\" subscription-price=\"141\"><span class=\"subcription-price-num\">\u20ac 143,99<\/span><\/p>\n\t\t\t\t\t<\/div>\n                <\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n    <div id=\"account_details_tab\" class=\"registration-details-tab\" style=\"display: none;\">\n        <div class=\"account-details-form\">\n\t\t\t\n\t\t\t<div class=\"row\" id=\"pf_login_form\">\n\t\t\t\t<div class=\"col-6\">\n\t\t\t\t\t<h6>Ik ben een nieuwe gebruiker en heb nog geen account:<\/h6>\n\t\t\t\t\t<p>Voer je e-mail in om je te aan te melden.<\/p>\n\t\t\t\t\t<form class=\"registration-form\">\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<input type=\"email\" class=\"form-control\" id=\"register_email\" name=\"email\" placeholder=\"e-mailadres\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<span id=\"pf_register_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class=\"registre-btn next-btn-div\">\n\t\t\t\t\t\t\t<button id=\"pf_registre_btn\" class=\"btn btn-registre community_farmer_abonnement custom-icon\">Aanmelden<\/button>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"col-6\">\n\t\t\t\t\t<h6>Ik heb al een account \/ Ik heb ooit een proefbox besteld:<\/h6>\n\t\t\t\t\t<p>Voer je e-mail en wachtwoord in om in te loggen.<\/p>\n\t\t\t\t\t<form class=\"login-form\" id=\"phoodfarm_login\" method=\"post\" data-url=\"https:\/\/member.phoodfarm.org\/wp-admin\/admin-ajax.php\">\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_login_email\" name=\"username\" placeholder=\"e-mailadres\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<input type=\"password\" class=\"form-control\" id=\"pf_login_password\" name=\"password\" placeholder=\"wachtwoord\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<span id=\"pf_login_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<input type=\"hidden\" name=\"action\" value=\"phoodfarm_login\">\n\t\t\t\t\t\n\t\t\t\t\t\t<input type=\"hidden\" id=\"security\" name=\"security\" value=\"12e0e931c1\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6509\" \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<div class=\"login-btn next-btn-div\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<a href=https:\/\/member.phoodfarm.org\/en\/wp-login.php?action=lostpassword>Wachtwoord vergeten?<\/a>\n\t\t\t\t\t\t\t<button id=\"login_btn\" value=\"Login\" name=\"submit\" class=\"btn btn-login community_farmer_abonnement custom-icon\">Inloggen<\/button>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"full-details-form not_login\" id=\"full_details_form\" style=\"display:none;\">\n\t\t\t<div class=\"personal-info-fieldset\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"email\">E-mail<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"email\" class=\"form-control\" id=\"pf_email\" name=\"email\" placeholder=\"test@phoodfarm.org\" value=\"\">\n\t\t\t\t\t<span id=\"pf_email_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"telefoon\">Telefoon<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_telefoon\" name=\"telefoon\" placeholder=\"Telefoon\" value=\"\">\n\t\t\t\t\t<span id=\"pf_telefoon_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"first_name\">Voornaam<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_first_name\" name=\"first_name\" placeholder=\"Voornaam\" value=\"\">\n\t\t\t\t\t<span id=\"pf_first_name_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"last_name\">Achternaam<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_last_name\" name=\"last_name\" placeholder=\"Achternaam\"  value=\"\">\n\t\t\t\t\t<span id=\"pf_last_name_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"password-fieldset\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"password\">Wachtwoord<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"password\" class=\"form-control\" id=\"pf_password\">\t\t\t\t\t\n\t\t\t\t\t<a href=\"#\" class=\"pf-pass-hide\"><span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\" id=\"pf_pass_visibility\"><\/span><\/a>\n\t\t\t\t\t<span id=\"pf_password_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"confirm_password\">Herhaal wachtwoord<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"password\" class=\"form-control\" id=\"pf_confirm_password\">\t\t\t\t\t\n\t\t\t\t\t<a href=\"#\" class=\"pf-repass-hide\"><span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\" id=\"pf_repass_visibility\"><\/span><\/a>\n\t\t\t\t\t<span id=\"pf_confirm_password_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"address-fieldset\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"straat\">Straat<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_straat\" name=\"straat\" placeholder=\"Straat\" value=\"\">\n\t\t\t\t\t<span id=\"pf_straat_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"huisnummer\">Huisnummer<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_huisnummer\" name=\"huisnummer\" placeholder=\"Huisnummer\"  value=\"\">\n\t\t\t\t\t<span id=\"pf_huisnummer_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"toevoeging\">Toevoeging<\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_toevoeging\" name=\"toevoeging\" placeholder=\"Toevoeging\" value=\"\">\n\t\t\t\t\t<span id=\"pf_toevoeging_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"postcode\">Postcode<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_postcode\" name=\"postcode\" placeholder=\"Postcode\"  value=\"\">\n\t\t\t\t\t<span id=\"pf_postcode_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"woonplaats\">Woonplaats<span>*<\/span><\/label>\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"pf_woonplaats\" name=\"woonplaats\" placeholder=\"Woonplaats\"  value=\"\">\n\t\t\t\t\t<span id=\"pf_woonplaats_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<label for=\"comment\">Opmerking<\/label>\n\t\t\t\t\t<textarea class=\"comment_field\" id=\"comment\" name=\"comment\" rows=\"3\"><\/textarea>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<div class=\"bottom_pickup\">\n\t\t\t\t\t\n\t\t\t\t<!--\n\t\t\t\t<div id=\"someone_pickup_field\" class=\"pickup_field\">\n\t\t\t\t\t<input id=\"someone_pickup\" class=\"someone-pickup-checkbox\" name=\"someone_pickup\" type=\"checkbox\" value=\"someone_pickup\" \/>Ik wil de Phoodbox door iemand anders laten ophalen (ook later aan te passen in profiel)\n\t\t\t\t<\/div>\n\t\t\t\t-->\n\t\t\t\t\n\t\t\t\t<div class=\"someone-pickup-fieldset\" id=\"someone_pickup_fieldset\" style=\"display:none\">\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"telefoon\">Telefoon<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"someone_pickup_telefoon\" name=\"someone_pickup_telefoon\" placeholder=\"Telefoon\">\n\t\t\t\t\t\t<span id=\"pf_someone_pickup_telefoon_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"first_name\">Voornaam<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"someone_pickup_first_name\" name=\"someone_pickup_first_name\" placeholder=\"Voornaam\">\n\t\t\t\t\t\t<span id=\"pf_someone_pickup_first_name_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"last_name\">Achternaam<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"someone_pickup_last_name\" name=\"someone_pickup_last_name\" placeholder=\"Achternaam\">\n\t\t\t\t\t\t<span id=\"pf_someone_pickup_last_name_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\t\t\t\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<!--\n\t\t\t\t<div id=\"different_delivery_address_field\" class=\"pickup_field\">\n\t\t\t\t\t<input id=\"different_delivery_address_checkbox\" class=\"different-delivery-address-checkbox\" name=\"different_delivery_address\" type=\"checkbox\" value=\"yes\" \/>Gebruik een ander bezorgadres\n\t\t\t\t<\/div>\n\t\t\t\t-->\n\t\t\t\t\n\t\t\t\t<div class=\"different-delivery-address-fieldset\" id=\"different_delivery_address_fieldset\" style=\"display:none\">\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"ddfa_straat\">Straat<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"ddfa_pf_straat\" name=\"ddfa_straat\" placeholder=\"Straat\">\n\t\t\t\t\t\t<span id=\"ddfa_pf_straat_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"ddfa_huisnummer\">Huisnummer<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"ddfa_pf_huisnummer\" name=\"ddfa_huisnummer\" placeholder=\"Huisnummer\">\n\t\t\t\t\t\t<span id=\"ddfa_pf_huisnummer_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"ddfa_toevoeging\">Toevoeging<\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"ddfa_pf_toevoeging\" name=\"ddfa_toevoeging\" placeholder=\"Toevoeging\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"ddfa_postcode\">Postcode<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"ddfa_pf_postcode\" name=\"ddfa_postcode\" placeholder=\"Postcode\">\n\t\t\t\t\t\t<span id=\"ddfa_pf_postcode_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<label for=\"ddfa_woonplaats\">Woonplaats<span>*<\/span><\/label>\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"ddfa_pf_woonplaats\" name=\"ddfa_woonplaats\" placeholder=\"Woonplaats\">\n\t\t\t\t\t\t<span id=\"ddfa_pf_woonplaats_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\t\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<span id=\"ddfa_payment_method\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"pickup_field\">\n\t\t\t\t\t<input id=\"agree_tc\" class=\"agree-with-tc\" name=\"agree_tc\" type=\"checkbox\" value=\"agree_tc\" \/>Ik ga akkoord met de <a href=\"gebruikersvoorwaarden\/\" target=\"_blank\">Algemene Voorwaarden<\/a>\n\t\t\t\t\t<span id=\"agree_tc_error\" class=\"cc-error\"><\/span>\n\t\t\t\t<\/div>\t\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t<\/div>\n    <\/div>\n    <div id=\"checkout_details_tab\" class=\"registration-details-tab\" style=\"display: none;\">\n    \t<div class=\"checkout-details-info\">\n\t\t\t<div class=\"checkout-subscription-details\">\n\t\t\t\t<h5 id=\"checkout_info_title\"><\/h5>\n\t\t\t\t<div class=\"checkout-info check_persons\">Aantal personen <span class=\"info-right\" id=\"check_persons\"><\/span><\/div>\n\t\t\t\t<div class=\"checkout-info check_delivery_timesolt\"><span id=\"check_delivery_timesolt_text\">Timeslot ophalen<\/span> <span class=\"info-right\" id=\"check_delivery_timesolt\"><\/span><\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-info check_phoodbox_frequency\">Frequentie Phoodbox <span class=\"info-right\" id=\"check_phoodbox_frequency\"><\/span><\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-info paymentmethod-text-info\"><span id=\"check_payment_method_text\">Betalingswijze<\/span> <span class=\"info-right\" id=\"check_payment_method\"><\/span><\/div>\n\t\t\t\t\n\t\t\t\t<!--\n\t\t\t\t<div class=\"checkout-info check_delivery_method\">Phoodbox ophalen of bezorgen <span class=\"info-right\" id=\"check_delivery_method\"><\/span><\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-info check_delivery_timesolt\"><span id=\"check_delivery_timesolt_text\">Timeslot ophalen<\/span> <span class=\"info-right\" id=\"check_delivery_timesolt\"><\/span><\/div>\n\t\t\t\t<div class=\"checkout-info check_phoodbox_delivery_costs\">Bezorgkosten Phoodbox <span class=\"info-right\" id=\"check_phoodbox_delivery_costs\"><\/span><\/div>\n\t\t\t\t-->\n\t\t\t\t<div class=\"checkout-info\">Totaal nu te betalen <span class=\"info-right\" id=\"check_total_price\"><\/span><\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<div class=\"checkout-personal-info\">\n\t\t\t\t<div class=\"checkout-info\"><h5>Controleer je gegevens<\/h5><span class=\"info-right\"><a href=\"#\" id=\"go_back\">Ga terug om aan te passen<\/a><\/span><\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-contact-details\">\n\t\t\t\t\t<h6>Contactgegevens<\/h6>\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"checkout-info\">E-mail: <span class=\"info-right\" id=\"check_contact_email\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Telefoon: <span class=\"info-right\" id=\"check_contact_telefoon\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Voornaam: <span class=\"info-right\" id=\"check_phoodbox_voornaam\"><\/span><\/div> \n\t\t\t\t\t<div class=\"checkout-info\">Achternaam: <span class=\"info-right\" id=\"check_phoodbox_achternaam\"><\/span><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-billing-address-details\">\n\t\t\t\t\t<h6>Factuuradres<\/h6>\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"checkout-info\">Straat: <span class=\"info-right\" id=\"check_address_straat\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Huisnummer: <span class=\"info-right\" id=\"check_address_huisnummer\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Toevoeging: <span class=\"info-right\" id=\"check_address_toevoeging\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Postcode: <span class=\"info-right\"id=\"check_address_postcode\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Woonplaats: <span class=\"info-right\" id=\"check_address_woonplaats\"><\/span><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-delivery-address-details\" id=\"ph_che_bezorgadres\" style=\"display:none\">\n\t\t\t\t\t<h6>Bezorgadres<\/h6>\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"checkout-info\">Straat: <span class=\"info-right\" id=\"check_delivery_address_straat\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Huisnummer: <span class=\"info-right\" id=\"check_delivery_address_huisnummer\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Toevoeging: <span class=\"info-right\" id=\"check_delivery_address_toevoeging\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Postcode: <span class=\"info-right\" id=\"check_delivery_address_postcode\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Woonplaats: <span class=\"info-right\" id=\"check_delivery_address_woonplaats\"><\/span><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-delivery-address-details\" id=\"ph_pick_phoodbox_someone\" style=\"display:none\">\n\t\t\t\t\t<h6>Ik wil de Phoodbox door iemand anders laten ophalen<\/h6>\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"checkout-info\">Telefoon: <span class=\"info-right\" id=\"check_pf_someone_telephone\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Voornaam: <span class=\"info-right\" id=\"check_pf_someone_voornaam\"><\/span><\/div>\n\t\t\t\t\t<div class=\"checkout-info\">Achternaam: <span class=\"info-right\" id=\"check_pf_someone_achternaam\"><\/span><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"checkout-billing-address-details\">\n\t\t\t\t\t<h6>Opmerking<\/h6>\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"checkout-info\">Opmerking: <span class=\"info-right\" id=\"check_pf_user_comment\"><\/span><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<div class=\"checkout-payment-method\">\n\t\t\t\t<h5>Betaalmethode:<\/h5>\n\t\t\t\t\n\t\t\t\t<div class=\"payment-method-stripe cards\">\n\t\t\t\t\t<img decoding=\"async\" src=\"\/wp-content\/uploads\/2024\/10\/international-bank-account-number-iban-logo-BD7E53E238-seeklogo.com_.png\" class=\"iban-logo\">\n\t\t\t\t\t<img decoding=\"async\" src=\"\/wp-content\/uploads\/2024\/10\/sepa-2.svg\" class=\"sepa-logo\">\n\t\t\t\t\t<img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/05\/cards.png\" class=\"all-cards-logo\">\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"payment-method-stripe\">\n\t\t\t\t\t<input type=\"radio\" class=\"payment-method\" id=\"checkout_payment_method\" name=\"checkout_payment_method\" value=\"stripe_payment\">Betaal veilig met je IBAN rekeningnummer of Credit card via Stripe Checkout\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"payment-method-stripe\" id=\"ideal_payment_method\">\n\t\t\t\t\t<img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/05\/payment-img-1.png\">\n\t\t\t\t\t<input type=\"radio\" class=\"payment-method\" id=\"checkout_payment_method\" name=\"checkout_payment_method\" value=\"bank_card_payment\">Betaal met je bankpas via Ideal\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<h5 class=\"debit-agreement-title\">Akkoord automatische incasso:<\/h5>\n\t\t\t\t<div class=\"debit-agreement\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"direct-debit-agreement\" id=\"direct_debit_agreement\" value=\"yes\" name=\"direct_debit_agreement\">Hierbij geef ik akkoord om mijn abonnement per automatische incasso te incasseren.\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\t\n\t\t\n\t\t<div class=\"subscribe-now\" style=\"display:none;\">\n\t\t\t<button type=\"submit\" name=\"subscribe_now\" id=\"subscribe_now\" class=\"btn btn-primary custom-icon\">Abonneer nu<\/button>\n\t\t<\/div>\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t<div id=\"phoodfarm_membership_form\">\n\t\t\t<div id=\"phoodfarm_membership_form_5480\" class=\"1_wekelijks_ophalen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"5480\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac23.50 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name1\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name1\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name1\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name1\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one1\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two1\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city1\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country1\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country1\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state1\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"1\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"1\"\n               id=\"mepr-address-state1\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip1\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen1\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen1\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot1\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot1\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen1\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen1\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox1\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox1\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone1\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone1\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon1\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam1\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam1\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode1\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address1\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street1\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber1\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional1\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance1\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date1\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional1\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable1\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable1\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon1\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon1\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment1\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment1\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email1\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email1\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password1\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password1\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm1\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm1\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos1\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos1\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_5481\" class=\"2_wekelijks_ophalen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"5481\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac47 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name2\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name2\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name2\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name2\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one2\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two2\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city2\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country2\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country2\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state2\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"2\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"2\"\n               id=\"mepr-address-state2\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip2\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen2\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen2\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot2\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot2\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen2\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen2\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox2\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox2\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone2\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone2\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon2\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam2\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam2\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode2\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address2\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street2\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber2\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional2\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance2\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date2\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional2\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable2\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable2\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon2\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon2\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment2\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment2\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email2\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email2\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password2\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password2\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm2\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm2\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos2\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos2\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_5482\" class=\"3_wekelijks_ophalen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"5482\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac70.50 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name3\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name3\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name3\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name3\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one3\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two3\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city3\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country3\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country3\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state3\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"3\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"3\"\n               id=\"mepr-address-state3\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip3\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen3\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen3\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot3\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot3\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen3\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen3\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox3\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox3\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone3\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone3\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon3\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam3\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam3\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode3\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address3\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street3\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber3\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional3\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance3\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date3\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional3\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable3\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable3\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon3\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon3\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment3\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment3\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email3\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email3\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password3\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password3\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm3\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm3\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos3\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos3\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_5483\" class=\"4_wekelijks_ophalen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"5483\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac94 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name4\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name4\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name4\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name4\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one4\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two4\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city4\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country4\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country4\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state4\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"4\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"4\"\n               id=\"mepr-address-state4\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip4\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen4\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen4\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot4\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot4\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen4\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen4\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox4\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox4\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone4\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone4\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon4\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam4\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam4\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode4\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address4\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street4\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber4\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional4\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance4\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date4\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional4\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable4\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable4\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon4\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon4\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment4\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment4\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email4\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email4\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password4\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password4\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm4\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm4\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos4\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos4\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_5484\" class=\"5_wekelijks_ophalen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"5484\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac117.50 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name5\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name5\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name5\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name5\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one5\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two5\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city5\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country5\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country5\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state5\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"5\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"5\"\n               id=\"mepr-address-state5\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip5\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen5\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen5\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot5\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot5\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen5\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen5\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox5\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox5\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone5\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone5\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon5\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam5\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam5\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode5\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address5\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street5\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber5\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional5\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance5\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date5\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional5\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable5\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable5\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon5\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon5\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment5\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment5\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email5\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email5\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password5\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password5\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm5\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm5\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos5\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos5\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_5485\" class=\"6_wekelijks_ophalen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"5485\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac141 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name6\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name6\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name6\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name6\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one6\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two6\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city6\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country6\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country6\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state6\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"6\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"6\"\n               id=\"mepr-address-state6\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip6\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen6\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen6\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot6\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot6\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen6\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen6\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox6\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox6\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone6\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone6\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon6\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam6\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam6\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode6\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address6\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street6\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber6\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional6\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance6\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date6\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional6\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable6\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable6\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon6\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon6\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment6\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment6\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email6\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email6\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password6\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password6\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm6\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm6\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos6\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos6\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<div id=\"phoodfarm_membership_form_6283\" class=\"1_wekelijks_bezorgen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"6283\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac26.49 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name7\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name7\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name7\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name7\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one7\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two7\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city7\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country7\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country7\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state7\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"7\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"7\"\n               id=\"mepr-address-state7\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip7\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen7\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen7\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot7\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot7\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen7\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen7\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox7\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox7\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone7\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone7\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon7\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam7\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam7\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode7\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address7\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street7\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber7\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional7\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance7\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date7\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional7\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable7\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable7\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon7\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon7\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment7\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment7\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email7\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email7\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password7\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password7\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm7\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm7\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos7\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos7\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_6284\" class=\"2_wekelijks_bezorgen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"6284\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac49.99 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name8\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name8\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name8\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name8\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one8\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two8\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city8\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country8\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country8\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state8\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"8\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"8\"\n               id=\"mepr-address-state8\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip8\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen8\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen8\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot8\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot8\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen8\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen8\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox8\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox8\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone8\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone8\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon8\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam8\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam8\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode8\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address8\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street8\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber8\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional8\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance8\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date8\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional8\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable8\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable8\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon8\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon8\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment8\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment8\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email8\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email8\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password8\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password8\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm8\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm8\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos8\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos8\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_6285\" class=\"3_wekelijks_bezorgen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"6285\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac73.49 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name9\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name9\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name9\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name9\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one9\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two9\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city9\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country9\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country9\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state9\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"9\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"9\"\n               id=\"mepr-address-state9\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip9\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen9\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen9\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot9\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot9\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen9\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen9\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox9\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox9\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone9\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone9\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon9\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam9\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam9\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode9\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address9\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street9\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber9\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional9\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance9\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date9\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional9\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable9\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable9\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon9\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon9\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment9\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment9\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email9\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email9\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password9\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password9\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm9\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm9\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos9\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos9\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_6287\" class=\"4_wekelijks_bezorgen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"6287\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac96.99 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name10\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name10\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name10\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name10\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one10\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two10\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city10\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country10\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country10\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state10\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"10\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"10\"\n               id=\"mepr-address-state10\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip10\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen10\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen10\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot10\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot10\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen10\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen10\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox10\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox10\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone10\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone10\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon10\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam10\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam10\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode10\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address10\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street10\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber10\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional10\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance10\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date10\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional10\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable10\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable10\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon10\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon10\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment10\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment10\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email10\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email10\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password10\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password10\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm10\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm10\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos10\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos10\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_6286\" class=\"5_wekelijks_bezorgen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"6286\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac120.49 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name11\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name11\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name11\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name11\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one11\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two11\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city11\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country11\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country11\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state11\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"11\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"11\"\n               id=\"mepr-address-state11\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip11\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen11\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen11\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot11\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot11\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen11\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen11\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox11\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox11\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone11\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone11\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon11\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam11\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam11\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode11\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address11\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street11\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber11\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional11\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance11\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date11\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional11\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable11\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable11\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon11\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon11\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment11\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment11\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email11\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email11\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password11\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password11\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm11\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm11\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos11\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos11\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t<div id=\"phoodfarm_membership_form_6288\" class=\"6_wekelijks_bezorgen pf_mp_form\">\n\t\t\t\t\n\n\n<div class=\"mp_wrapper\">\n  <form name=\"mepr_signup_form\" id=\"mepr_signup_form\" class=\"mepr-signup-form mepr-form\" method=\"post\" action=\"\/en\/wp-json\/wp\/v2\/pages\/6509#mepr_jump\" enctype=\"multipart\/form-data\" novalidate>\n    <input type=\"hidden\" name=\"mepr_process_signup_form\" value=\"1\" \/>\n    <input type=\"hidden\" name=\"mepr_product_id\" value=\"6288\" \/>\n    <input type=\"hidden\" name=\"mepr_transaction_id\" value=\"\" \/>\n\n    \n    \n          <div class=\"mp-form-row mepr_bold mepr_price\">\n\t\t\t\t\t\t        <div class=\"mepr_price_cell_label\">Price:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac143.99 for 1 Day        <\/div>\n      <\/div>\n    \n    \n    \n          <div class=\"mp-form-row mepr_first_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_first_name12\">\n\t\t\t\t\t\tFirst Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tFirst Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_first_name\" id=\"user_first_name12\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_last_name\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_last_name12\">\n\t\t\t\t\t\tLast Name:\t\t\t\t\t  <\/label>\n          <span class=\"cc-error\">\n\t\t\t\t\t\tLast Name Required\t\t\t\t\t  <\/span>\n        <\/div>\n        <input type=\"text\" name=\"user_last_name\" id=\"user_last_name12\" class=\"mepr-form-input\" value=\"\"  \/>\n      <\/div>\n    \n    \n    \n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-one mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-one12\">\n          Address Line 1:*      <\/label>\n              <span id=\"mepr-address-one_error\" class=\"cc-error\">\n          Address Line 1 is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-one\" id=\"mepr-address-one12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-one_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-two\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-two12\">\n          Address Line 2:      <\/label>\n              <span id=\"mepr-address-two_error\" class=\"cc-error\">\n          Address Line 2 is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-two\" id=\"mepr-address-two12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-two_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-city mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-city12\">\n          City:*      <\/label>\n              <span id=\"mepr-address-city_error\" class=\"cc-error\">\n          City is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-city\" id=\"mepr-address-city12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-city_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-country mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-country12\">\n          Country:*      <\/label>\n              <span id=\"mepr-address-country_error\" class=\"cc-error\">\n          Country is Required      <\/span>\n    <\/div>\n            <select name=\"mepr-address-country\" id=\"mepr-address-country12\"\n                class=\" mepr-countries-dropdown mepr-form-input mepr-select-field\"  required>\n            <option value=\"\">-- Select Country --<\/option>\n                            <option\n                    value=\"NL\" >Netherlands<\/option>\n                            <option\n                    value=\"AF\" >Afghanistan<\/option>\n                            <option\n                    value=\"AX\" >&#197;land Islands<\/option>\n                            <option\n                    value=\"AL\" >Albania<\/option>\n                            <option\n                    value=\"DZ\" >Algeria<\/option>\n                            <option\n                    value=\"AD\" >Andorra<\/option>\n                            <option\n                    value=\"AO\" >Angola<\/option>\n                            <option\n                    value=\"AI\" >Anguilla<\/option>\n                            <option\n                    value=\"AQ\" >Antarctica<\/option>\n                            <option\n                    value=\"AG\" >Antigua and Barbuda<\/option>\n                            <option\n                    value=\"AR\" >Argentina<\/option>\n                            <option\n                    value=\"AM\" >Armenia<\/option>\n                            <option\n                    value=\"AW\" >Aruba<\/option>\n                            <option\n                    value=\"AU\" >Australia<\/option>\n                            <option\n                    value=\"AT\" >Austria<\/option>\n                            <option\n                    value=\"AZ\" >Azerbaijan<\/option>\n                            <option\n                    value=\"BS\" >Bahamas<\/option>\n                            <option\n                    value=\"BH\" >Bahrain<\/option>\n                            <option\n                    value=\"BD\" >Bangladesh<\/option>\n                            <option\n                    value=\"BB\" >Barbados<\/option>\n                            <option\n                    value=\"BY\" >Belarus<\/option>\n                            <option\n                    value=\"BE\" >Belgium<\/option>\n                            <option\n                    value=\"PW\" >Belau<\/option>\n                            <option\n                    value=\"BZ\" >Belize<\/option>\n                            <option\n                    value=\"BJ\" >Benin<\/option>\n                            <option\n                    value=\"BM\" >Bermuda<\/option>\n                            <option\n                    value=\"BT\" >Bhutan<\/option>\n                            <option\n                    value=\"BO\" >Bolivia<\/option>\n                            <option\n                    value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option>\n                            <option\n                    value=\"BA\" >Bosnia and Herzegovina<\/option>\n                            <option\n                    value=\"BW\" >Botswana<\/option>\n                            <option\n                    value=\"BV\" >Bouvet Island<\/option>\n                            <option\n                    value=\"BR\" >Brazil<\/option>\n                            <option\n                    value=\"IO\" >British Indian Ocean Territory<\/option>\n                            <option\n                    value=\"VG\" >British Virgin Islands<\/option>\n                            <option\n                    value=\"BN\" >Brunei<\/option>\n                            <option\n                    value=\"BG\" >Bulgaria<\/option>\n                            <option\n                    value=\"BF\" >Burkina Faso<\/option>\n                            <option\n                    value=\"BI\" >Burundi<\/option>\n                            <option\n                    value=\"KH\" >Cambodia<\/option>\n                            <option\n                    value=\"CM\" >Cameroon<\/option>\n                            <option\n                    value=\"CA\" >Canada<\/option>\n                            <option\n                    value=\"CV\" >Cape Verde<\/option>\n                            <option\n                    value=\"KY\" >Cayman Islands<\/option>\n                            <option\n                    value=\"CF\" >Central African Republic<\/option>\n                            <option\n                    value=\"TD\" >Chad<\/option>\n                            <option\n                    value=\"CL\" >Chile<\/option>\n                            <option\n                    value=\"CN\" >China<\/option>\n                            <option\n                    value=\"CX\" >Christmas Island<\/option>\n                            <option\n                    value=\"CC\" >Cocos (Keeling) Islands<\/option>\n                            <option\n                    value=\"CO\" >Colombia<\/option>\n                            <option\n                    value=\"KM\" >Comoros<\/option>\n                            <option\n                    value=\"CG\" >Congo (Brazzaville)<\/option>\n                            <option\n                    value=\"CD\" >Congo (Kinshasa)<\/option>\n                            <option\n                    value=\"CK\" >Cook Islands<\/option>\n                            <option\n                    value=\"CR\" >Costa Rica<\/option>\n                            <option\n                    value=\"HR\" >Croatia<\/option>\n                            <option\n                    value=\"CU\" >Cuba<\/option>\n                            <option\n                    value=\"CW\" >Cura&Ccedil;ao<\/option>\n                            <option\n                    value=\"CY\" >Cyprus<\/option>\n                            <option\n                    value=\"CZ\" >Czech Republic<\/option>\n                            <option\n                    value=\"DK\" >Denmark<\/option>\n                            <option\n                    value=\"DJ\" >Djibouti<\/option>\n                            <option\n                    value=\"DM\" >Dominica<\/option>\n                            <option\n                    value=\"DO\" >Dominican Republic<\/option>\n                            <option\n                    value=\"EC\" >Ecuador<\/option>\n                            <option\n                    value=\"EG\" >Egypt<\/option>\n                            <option\n                    value=\"SV\" >El Salvador<\/option>\n                            <option\n                    value=\"GQ\" >Equatorial Guinea<\/option>\n                            <option\n                    value=\"ER\" >Eritrea<\/option>\n                            <option\n                    value=\"EE\" >Estonia<\/option>\n                            <option\n                    value=\"ET\" >Ethiopia<\/option>\n                            <option\n                    value=\"FK\" >Falkland Islands<\/option>\n                            <option\n                    value=\"FO\" >Faroe Islands<\/option>\n                            <option\n                    value=\"FJ\" >Fiji<\/option>\n                            <option\n                    value=\"FI\" >Finland<\/option>\n                            <option\n                    value=\"FR\" >France<\/option>\n                            <option\n                    value=\"GF\" >French Guiana<\/option>\n                            <option\n                    value=\"PF\" >French Polynesia<\/option>\n                            <option\n                    value=\"TF\" >French Southern Territories<\/option>\n                            <option\n                    value=\"GA\" >Gabon<\/option>\n                            <option\n                    value=\"GM\" >Gambia<\/option>\n                            <option\n                    value=\"GE\" >Georgia<\/option>\n                            <option\n                    value=\"DE\" >Germany<\/option>\n                            <option\n                    value=\"GH\" >Ghana<\/option>\n                            <option\n                    value=\"GI\" >Gibraltar<\/option>\n                            <option\n                    value=\"GR\" >Greece<\/option>\n                            <option\n                    value=\"GL\" >Greenland<\/option>\n                            <option\n                    value=\"GD\" >Grenada<\/option>\n                            <option\n                    value=\"GP\" >Guadeloupe<\/option>\n                            <option\n                    value=\"GT\" >Guatemala<\/option>\n                            <option\n                    value=\"GG\" >Guernsey<\/option>\n                            <option\n                    value=\"GN\" >Guinea<\/option>\n                            <option\n                    value=\"GW\" >Guinea-Bissau<\/option>\n                            <option\n                    value=\"GY\" >Guyana<\/option>\n                            <option\n                    value=\"HT\" >Haiti<\/option>\n                            <option\n                    value=\"HM\" >Heard Island and McDonald Islands<\/option>\n                            <option\n                    value=\"HN\" >Honduras<\/option>\n                            <option\n                    value=\"HK\" >Hong Kong<\/option>\n                            <option\n                    value=\"HU\" >Hungary<\/option>\n                            <option\n                    value=\"IS\" >Iceland<\/option>\n                            <option\n                    value=\"IN\" >India<\/option>\n                            <option\n                    value=\"ID\" >Indonesia<\/option>\n                            <option\n                    value=\"IR\" >Iran<\/option>\n                            <option\n                    value=\"IQ\" >Iraq<\/option>\n                            <option\n                    value=\"IE\" >Republic of Ireland<\/option>\n                            <option\n                    value=\"IM\" >Isle of Man<\/option>\n                            <option\n                    value=\"IL\" >Israel<\/option>\n                            <option\n                    value=\"IT\" >Italy<\/option>\n                            <option\n                    value=\"CI\" >Ivory Coast<\/option>\n                            <option\n                    value=\"JM\" >Jamaica<\/option>\n                            <option\n                    value=\"JP\" >Japan<\/option>\n                            <option\n                    value=\"JE\" >Jersey<\/option>\n                            <option\n                    value=\"JO\" >Jordan<\/option>\n                            <option\n                    value=\"KZ\" >Kazakhstan<\/option>\n                            <option\n                    value=\"KE\" >Kenya<\/option>\n                            <option\n                    value=\"KI\" >Kiribati<\/option>\n                            <option\n                    value=\"KW\" >Kuwait<\/option>\n                            <option\n                    value=\"KG\" >Kyrgyzstan<\/option>\n                            <option\n                    value=\"LA\" >Laos<\/option>\n                            <option\n                    value=\"LV\" >Latvia<\/option>\n                            <option\n                    value=\"LB\" >Lebanon<\/option>\n                            <option\n                    value=\"LS\" >Lesotho<\/option>\n                            <option\n                    value=\"LR\" >Liberia<\/option>\n                            <option\n                    value=\"LY\" >Libya<\/option>\n                            <option\n                    value=\"LI\" >Liechtenstein<\/option>\n                            <option\n                    value=\"LT\" >Lithuania<\/option>\n                            <option\n                    value=\"LU\" >Luxembourg<\/option>\n                            <option\n                    value=\"MO\" >Macao S.A.R., China<\/option>\n                            <option\n                    value=\"MK\" >Macedonia<\/option>\n                            <option\n                    value=\"MG\" >Madagascar<\/option>\n                            <option\n                    value=\"MW\" >Malawi<\/option>\n                            <option\n                    value=\"MY\" >Malaysia<\/option>\n                            <option\n                    value=\"MV\" >Maldives<\/option>\n                            <option\n                    value=\"ML\" >Mali<\/option>\n                            <option\n                    value=\"MT\" >Malta<\/option>\n                            <option\n                    value=\"MH\" >Marshall Islands<\/option>\n                            <option\n                    value=\"MQ\" >Martinique<\/option>\n                            <option\n                    value=\"MR\" >Mauritania<\/option>\n                            <option\n                    value=\"MU\" >Mauritius<\/option>\n                            <option\n                    value=\"YT\" >Mayotte<\/option>\n                            <option\n                    value=\"MX\" >Mexico<\/option>\n                            <option\n                    value=\"FM\" >Micronesia<\/option>\n                            <option\n                    value=\"MD\" >Moldova<\/option>\n                            <option\n                    value=\"MC\" >Monaco<\/option>\n                            <option\n                    value=\"MN\" >Mongolia<\/option>\n                            <option\n                    value=\"ME\" >Montenegro<\/option>\n                            <option\n                    value=\"MS\" >Montserrat<\/option>\n                            <option\n                    value=\"MA\" >Morocco<\/option>\n                            <option\n                    value=\"MZ\" >Mozambique<\/option>\n                            <option\n                    value=\"MM\" >Myanmar<\/option>\n                            <option\n                    value=\"NA\" >Namibia<\/option>\n                            <option\n                    value=\"NR\" >Nauru<\/option>\n                            <option\n                    value=\"NP\" >Nepal<\/option>\n                            <option\n                    value=\"AN\" >Netherlands Antilles<\/option>\n                            <option\n                    value=\"NC\" >New Caledonia<\/option>\n                            <option\n                    value=\"NZ\" >New Zealand<\/option>\n                            <option\n                    value=\"NI\" >Nicaragua<\/option>\n                            <option\n                    value=\"NE\" >Niger<\/option>\n                            <option\n                    value=\"NG\" >Nigeria<\/option>\n                            <option\n                    value=\"NU\" >Niue<\/option>\n                            <option\n                    value=\"NF\" >Norfolk Island<\/option>\n                            <option\n                    value=\"KP\" >North Korea<\/option>\n                            <option\n                    value=\"NO\" >Norway<\/option>\n                            <option\n                    value=\"OM\" >Oman<\/option>\n                            <option\n                    value=\"PK\" >Pakistan<\/option>\n                            <option\n                    value=\"PS\" >Palestinian Territory<\/option>\n                            <option\n                    value=\"PA\" >Panama<\/option>\n                            <option\n                    value=\"PG\" >Papua New Guinea<\/option>\n                            <option\n                    value=\"PY\" >Paraguay<\/option>\n                            <option\n                    value=\"PE\" >Peru<\/option>\n                            <option\n                    value=\"PH\" >Philippines<\/option>\n                            <option\n                    value=\"PN\" >Pitcairn<\/option>\n                            <option\n                    value=\"PL\" >Poland<\/option>\n                            <option\n                    value=\"PT\" >Portugal<\/option>\n                            <option\n                    value=\"PR\" >Puerto Rico<\/option>\n                            <option\n                    value=\"QA\" >Qatar<\/option>\n                            <option\n                    value=\"RE\" >Reunion<\/option>\n                            <option\n                    value=\"RO\" >Romania<\/option>\n                            <option\n                    value=\"RU\" >Russia<\/option>\n                            <option\n                    value=\"RW\" >Rwanda<\/option>\n                            <option\n                    value=\"BL\" >Saint Barth&eacute;lemy<\/option>\n                            <option\n                    value=\"SH\" >Saint Helena<\/option>\n                            <option\n                    value=\"KN\" >Saint Kitts and Nevis<\/option>\n                            <option\n                    value=\"LC\" >Saint Lucia<\/option>\n                            <option\n                    value=\"MF\" >Saint Martin (French part)<\/option>\n                            <option\n                    value=\"SX\" >Saint Martin (Dutch part)<\/option>\n                            <option\n                    value=\"PM\" >Saint Pierre and Miquelon<\/option>\n                            <option\n                    value=\"VC\" >Saint Vincent and the Grenadines<\/option>\n                            <option\n                    value=\"SM\" >San Marino<\/option>\n                            <option\n                    value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option>\n                            <option\n                    value=\"SA\" >Saudi Arabia<\/option>\n                            <option\n                    value=\"SN\" >Senegal<\/option>\n                            <option\n                    value=\"RS\" >Serbia<\/option>\n                            <option\n                    value=\"SC\" >Seychelles<\/option>\n                            <option\n                    value=\"SL\" >Sierra Leone<\/option>\n                            <option\n                    value=\"SG\" >Singapore<\/option>\n                            <option\n                    value=\"SK\" >Slovakia<\/option>\n                            <option\n                    value=\"SI\" >Slovenia<\/option>\n                            <option\n                    value=\"SB\" >Solomon Islands<\/option>\n                            <option\n                    value=\"SO\" >Somalia<\/option>\n                            <option\n                    value=\"ZA\" >South Africa<\/option>\n                            <option\n                    value=\"GS\" >South Georgia\/Sandwich Islands<\/option>\n                            <option\n                    value=\"KR\" >South Korea<\/option>\n                            <option\n                    value=\"SS\" >South Sudan<\/option>\n                            <option\n                    value=\"ES\" >Spain<\/option>\n                            <option\n                    value=\"LK\" >Sri Lanka<\/option>\n                            <option\n                    value=\"SD\" >Sudan<\/option>\n                            <option\n                    value=\"SR\" >Suriname<\/option>\n                            <option\n                    value=\"SJ\" >Svalbard and Jan Mayen<\/option>\n                            <option\n                    value=\"SZ\" >Swaziland<\/option>\n                            <option\n                    value=\"SE\" >Sweden<\/option>\n                            <option\n                    value=\"CH\" >Switzerland<\/option>\n                            <option\n                    value=\"SY\" >Syria<\/option>\n                            <option\n                    value=\"TW\" >Taiwan<\/option>\n                            <option\n                    value=\"TJ\" >Tajikistan<\/option>\n                            <option\n                    value=\"TZ\" >Tanzania<\/option>\n                            <option\n                    value=\"TH\" >Thailand<\/option>\n                            <option\n                    value=\"TL\" >Timor-Leste<\/option>\n                            <option\n                    value=\"TG\" >Togo<\/option>\n                            <option\n                    value=\"TK\" >Tokelau<\/option>\n                            <option\n                    value=\"TO\" >Tonga<\/option>\n                            <option\n                    value=\"TT\" >Trinidad and Tobago<\/option>\n                            <option\n                    value=\"TN\" >Tunisia<\/option>\n                            <option\n                    value=\"TR\" >Turkey<\/option>\n                            <option\n                    value=\"TM\" >Turkmenistan<\/option>\n                            <option\n                    value=\"TC\" >Turks and Caicos Islands<\/option>\n                            <option\n                    value=\"TV\" >Tuvalu<\/option>\n                            <option\n                    value=\"UG\" >Uganda<\/option>\n                            <option\n                    value=\"UA\" >Ukraine<\/option>\n                            <option\n                    value=\"AE\" >United Arab Emirates<\/option>\n                            <option\n                    value=\"GB\" >United Kingdom (UK)<\/option>\n                            <option\n                    value=\"US\" >United States (US)<\/option>\n                            <option\n                    value=\"UY\" >Uruguay<\/option>\n                            <option\n                    value=\"UZ\" >Uzbekistan<\/option>\n                            <option\n                    value=\"VU\" >Vanuatu<\/option>\n                            <option\n                    value=\"VA\" >Vatican<\/option>\n                            <option\n                    value=\"VE\" >Venezuela<\/option>\n                            <option\n                    value=\"VN\" >Vietnam<\/option>\n                            <option\n                    value=\"WF\" >Wallis and Futuna<\/option>\n                            <option\n                    value=\"EH\" >Western Sahara<\/option>\n                            <option\n                    value=\"WS\" >Western Samoa<\/option>\n                            <option\n                    value=\"YE\" >Yemen<\/option>\n                            <option\n                    value=\"ZM\" >Zambia<\/option>\n                            <option\n                    value=\"ZW\" >Zimbabwe<\/option>\n                    <\/select>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-state mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-state12\">\n          State\/Province:*      <\/label>\n              <span id=\"mepr-address-state_error\" class=\"cc-error\">\n          State\/Province is Required      <\/span>\n    <\/div>\n            <select name=\"\" data-fieldname=\"mepr-address-state\" data-value=\"\"\n                data-unique-suffix=\"12\"\n                class=\" mepr-hidden mepr-states-dropdown mepr-form-input mepr-select-field\"\n                aria-label=\"State\/Province\"\n                style=\"display: none;\"  required>\n        <\/select>\n                <input type=\"text\" name=\"mepr-address-state\" data-fieldname=\"mepr-address-state\"\n               data-value=\"\" data-unique-suffix=\"12\"\n               id=\"mepr-address-state12\"\n               class=\" mepr-states-text mepr-form-input\"\n               aria-label=\"State\/Province\"\n               value=\"\"  required\/>\n          <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr-address-zip mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr-address-zip12\">\n          Zip\/Postal Code:*      <\/label>\n              <span id=\"mepr-address-zip_error\" class=\"cc-error\">\n          Zip\/Postal Code is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr-address-zip\" id=\"mepr-address-zip12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr-address-zip_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_ophalen_of_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_ophalen_of_bezorgen12\">\n          Phoodbox ophalen of bezorgen:      <\/label>\n              <span id=\"mepr_phoodbox_ophalen_of_bezorgen_error\" class=\"cc-error\">\n          Phoodbox ophalen of bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_ophalen_of_bezorgen\" id=\"mepr_phoodbox_ophalen_of_bezorgen12\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_ophalen_of_bezorgen_error\"   >\n                <option value=\"ophalen\" >Ophalen<\/option><option value=\"bezorgen\" >Bezorgen<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot12\">\n          Timeslot for Ophalen:      <\/label>\n              <span id=\"mepr_timeslot_error\" class=\"cc-error\">\n          Timeslot for Ophalen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot\" id=\"mepr_timeslot12\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_vrijdag\" >Vrijdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_zaterdag\" >Zaterdag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_maandag\" >Maandag tussen 12:30 \u2013 15:00<\/option><option value=\"12_00_15_00_dinsdag\" >Dinsdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_timeslot_for_bezorgen\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_timeslot_for_bezorgen12\">\n          Timeslot for Bezorgen:      <\/label>\n              <span id=\"mepr_timeslot_for_bezorgen_error\" class=\"cc-error\">\n          Timeslot for Bezorgen is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_timeslot_for_bezorgen\" id=\"mepr_timeslot_for_bezorgen12\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_timeslot_for_bezorgen_error\"   >\n                <option value=\"12_00_15_00_donderdag\" >Donderdag tussen 12:30 \u2013 15:00<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_frequentie_phoodbox\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_frequentie_phoodbox12\">\n          Frequentie Phoodbox:      <\/label>\n              <span id=\"mepr_frequentie_phoodbox_error\" class=\"cc-error\">\n          Frequentie Phoodbox is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_frequentie_phoodbox\" id=\"mepr_frequentie_phoodbox12\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_frequentie_phoodbox_error\"   >\n                <option value=\"wekelijks\" >Wekelijks<\/option><option value=\"omde_week\" >Om de week<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_pickup_by_someone\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_pickup_by_someone12\">\n          Phoodbox pickup by someone:      <\/label>\n              <span id=\"mepr_phoodbox_pickup_by_someone_error\" class=\"cc-error\">\n          Phoodbox pickup by someone is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_pickup_by_someone\" id=\"mepr_phoodbox_pickup_by_someone12\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_pickup_by_someone_error\"   >\n                <option value=\"yes\" >ja<\/option><option value=\"no\" >nee<\/option>        <\/select>\n                  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_telefoon\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_telefoon12\">\n          Telefoon:      <\/label>\n              <span id=\"mepr_telefoon_error\" class=\"cc-error\">\n          Telefoon is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_telefoon\" id=\"mepr_telefoon12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_telefoon_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_voornaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_voornaam12\">\n          Voornaam:      <\/label>\n              <span id=\"mepr_voornaam_error\" class=\"cc-error\">\n          Voornaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_voornaam\" id=\"mepr_voornaam12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_voornaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_achternaam\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_achternaam12\">\n          Achternaam:      <\/label>\n              <span id=\"mepr_achternaam_error\" class=\"cc-error\">\n          Achternaam is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_achternaam\" id=\"mepr_achternaam12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_achternaam_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_postcode\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_postcode12\">\n          Postcode:      <\/label>\n              <span id=\"mepr_postcode_error\" class=\"cc-error\">\n          Postcode is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_postcode\" id=\"mepr_postcode12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_postcode_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_different_delivery_address\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_different_delivery_address12\">\n          Different delivery address:      <\/label>\n              <span id=\"mepr_different_delivery_address_error\" class=\"cc-error\">\n          Different delivery address is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_different_delivery_address\" id=\"mepr_different_delivery_address12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_different_delivery_address_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_street\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_street12\">\n          Phoodbox address street:      <\/label>\n              <span id=\"mepr_phoodbox_address_street_error\" class=\"cc-error\">\n          Phoodbox address street is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_street\" id=\"mepr_phoodbox_address_street12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_street_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_housenumber\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_housenumber12\">\n          Phoodbox address housenumber:      <\/label>\n              <span id=\"mepr_phoodbox_address_housenumber_error\" class=\"cc-error\">\n          Phoodbox address housenumber is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_housenumber\" id=\"mepr_phoodbox_address_housenumber12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_housenumber_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_additional12\">\n          Phoodbox address additional:      <\/label>\n              <span id=\"mepr_phoodbox_address_additional_error\" class=\"cc-error\">\n          Phoodbox address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_additional\" id=\"mepr_phoodbox_address_additional12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_address_residance\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_address_residance12\">\n          Phoodbox address residance:      <\/label>\n              <span id=\"mepr_phoodbox_address_residance_error\" class=\"cc-error\">\n          Phoodbox address residance is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_address_residance\" id=\"mepr_phoodbox_address_residance12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_address_residance_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_phoodbox_delivery_date\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_delivery_date12\">\n          Phoodbox delivery date:      <\/label>\n              <span id=\"mepr_phoodbox_delivery_date_error\" class=\"cc-error\">\n          Phoodbox delivery date is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_phoodbox_delivery_date\" id=\"mepr_phoodbox_delivery_date12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_phoodbox_delivery_date_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_address_additional\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_address_additional12\">\n          Address additional:      <\/label>\n              <span id=\"mepr_address_additional_error\" class=\"cc-error\">\n          Address additional is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_address_additional\" id=\"mepr_address_additional12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_address_additional_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_recurring_payment_enable\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_recurring_payment_enable12\">\n          Recurring payment enable:      <\/label>\n              <span id=\"mepr_recurring_payment_enable_error\" class=\"cc-error\">\n          Recurring payment enable is not valid      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_recurring_payment_enable\" id=\"mepr_recurring_payment_enable12\" class=\"mepr-form-input \" value=\"no\" aria-describedby=\"mepr_recurring_payment_enable_error\"   \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_telefoon mepr-field-required\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_telefoon12\">\n          User Telefoon:*      <\/label>\n              <span id=\"mepr_user_telefoon_error\" class=\"cc-error\">\n          User Telefoon is Required      <\/span>\n    <\/div>\n    <input type=\"text\" name=\"mepr_user_telefoon\" id=\"mepr_user_telefoon12\" class=\"mepr-form-input \" value=\"\" aria-describedby=\"mepr_user_telefoon_error\"  required \/>  <\/div>\n\n<div class=\"mp-form-row mepr_custom_field mepr_mepr_user_comment\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_user_comment12\">\n          User Comment:      <\/label>\n              <span id=\"mepr_user_comment_error\" class=\"cc-error\">\n          User Comment is not valid      <\/span>\n    <\/div>\n    <textarea name=\"mepr_user_comment\" id=\"mepr_user_comment12\" class=\"mepr-form-textarea mepr-form-input \" aria-describedby=\"mepr_user_comment_error\"  ><\/textarea>  <\/div>\n\n    \n          <input type=\"hidden\" class=\"mepr-geo-country\" name=\"mepr-geo-country\" value=\"\" \/>\n\n            <div class=\"mp-form-row mepr_email mepr-field-required\">\n        <div class=\"mp-form-label\">\n          <label for=\"user_email12\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email12\" class=\"mepr-form-input\" value=\"\" required \/>\n      <\/div>\n      <div class=\"mp-form-row mepr_email_stripe mepr-field-required mepr-hidden\">\n      <\/div>\n                          <div class=\"mp-form-row mepr_password mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password12\">\n\t\t\t\t\t\t\t\tPassword:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\n\t\t\t\t\t\t\t\tInvalid Password\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password\" id=\"mepr_user_password12\" class=\"mepr-form-input mepr-password\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n        <div class=\"mp-form-row mepr_password_confirm mepr-field-required\">\n          <div class=\"mp-form-label\">\n            <label for=\"mepr_user_password_confirm12\">\t\t\t\t\n\t\t\t\t\t\t\t\tPassword Confirmation:*\t\t\t\t\t\t\t<\/label>\n            <span class=\"cc-error\">\t\t\t\t\n\t\t\t\t\t\t\t\tWachtwoordbevestiging komt niet overeen\t\t\t\t\t\t\t<\/span>\n          <\/div>\n          <div class=\"mp-hide-pw\">\n            <input type=\"password\" name=\"mepr_user_password_confirm\" id=\"mepr_user_password_confirm12\" class=\"mepr-form-input mepr-password-confirm\" value=\"\" required \/>\n            <button type=\"button\" class=\"button mp-hide-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\">\n              <span class=\"dashicons dashicons-visibility\" aria-hidden=\"true\"><\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n                          \n        \n    \n                  <input type=\"hidden\" name=\"mepr_coupon_code\" value=\"\" \/>\n      \n      \n      \n      \n      <div class=\"mepr-payment-methods-wrapper\">\n                <div class=\"mepr-payment-methods-icons\">\n          <span class=\"mepr-payment-method-icon\"><img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-content\/plugins\/memberpress\/images\/checkout\/cards.png\" alt=\"Stripe\" height=\"32px\" \/><\/span>        <\/div>\n        <div class=\"mepr-payment-methods-radios mepr-hidden\">\n                      <label class=\"mepr-payment-option-label payment-option-stripe\">\n                <input\n                    type=\"radio\"\n                    name=\"mepr_payment_method\"\n                    class=\"mepr-form-radio mepr-can-order-bumps mepr-can-multiple-subscriptions\"\n                    value=\"s97eqp-6a9\"\n                    data-payment-method-type=\"Stripe\"\n                         checked='checked'                \/>\n                <span class=\"mepr-payment-method-label-text\">Stripe Payments<\/span>            <\/label>\n                    <\/div>\n                                <div class=\"mepr-payment-method mepr_payment_method-s97eqp-6a9 mepr-payment-method-stripe\">\n                    <div class=\"mepr-payment-method-desc-text mp-pm-desc-s97eqp-6a9 spc \">\n                                    <div class=\"mepr-stripe-gateway-description\">Pay with your Credit Card via Stripe Checkout<\/div>\n    <noscript><p class=\"mepr_nojs\">JavaScript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it.<\/p><\/noscript>\n                    <\/div>\n                <\/div>\n                      <\/div>\n    \n    \n          <div class=\"mp-form-row mepr_tos\">\n        <label for=\"mepr_agree_to_tos12\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos12\"  \/>\n          <a href=\"https:\/\/phoodfarm.org\/gebruikersvoorwaarden\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ik heb de <u>gebruikersvoorwaarden<\/u> en het <u>privacy-beleid<\/u> gelezen en ga hiermee akkoord.<\/a>*\n        <\/label>\n      <\/div>\n    \n    \n        \n    <div class=\"mepr_spacer\">&nbsp;<\/div>\n\n    <div class=\"mp-form-submit\">\n            <label for=\"mepr_no_val\" class=\"mepr-visuallyhidden\">No val<\/label>\n      <input type=\"text\" id=\"mepr_no_val\" name=\"mepr_no_val\" class=\"mepr-form-input mepr-visuallyhidden mepr_no_val mepr-hidden\" autocomplete=\"off\" \/>\n\n              <input type=\"submit\" class=\"mepr-submit\" value=\"Bestel nu\" \/>\n            <img decoding=\"async\" src=\"https:\/\/member.phoodfarm.org\/wp-admin\/images\/loading.gif\" alt=\"Loading...\" style=\"display: none;\" class=\"mepr-loading-gif\" title=\"Loading icon\" \/>\n      <span class=\"mepr-form-has-errors\">Please fix the errors above<\/span>\n\n    <\/div>\n  <\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t\n\t<\/div>\n    <div class=\"next-btn-div\">\n\t\t<button id=\"go_back2\" class=\"btn btn-next custom-icon go-back2\" style=\"display:none\">go back<\/button>\n\t\t<button id=\"next_btn\" class=\"btn btn-next community_farmer_abonnement custom-icon\" disabled>Next Step<\/button>\n\t\t<p id=\"phoodfarm_privecy_text\" class=\"phoodfarm_privecy_text\" style=\"display:none\">Phood Farm is responsible for processing your<\/br>personal data. Please visit our <a href=\"privacy-beleid\" target=\"_blank\">Privacy Policy<\/a> for more information.<\/br><\/p>\n    <\/div>\n<\/div>\n\n<style>\n.pf_mp_form {\n\tdisplay: none;\n}\n\n.mp-form-row {\n\tdisplay: none;\n}\n\n\n.mp-form-row.mepr_bold.mepr_price {\n    display: none;\n}\n\np.subscription_price {\n\tdisplay: none;\n}\n\n#community_shopper_proefbox .debit-agreement {\n\tdisplay: none;\n}\n\n#community_shopper_proefbox .debit-agreement-title {\n\tdisplay: none;\n}\n\n.mepr-payment-method-desc-text::before{\n    content:\" \";\n}\n.mepr-payment-methods-icons img {\n    display: none;\n}\n<\/style>\n\n<script>\n(function($) {\n\t$(document).ready(function() {\n\t\t$(\".ophalen_caldendar\").datepicker({\t\t\t\n\t\t\tbeforeShowDay: function (date) {\n\t\t\t\tvar day = date.getDay(), Sunday = 0, Monday = 1, Tuesday = 2, Wednesday = 3, Thursday = 4, Friday = 5, Saturday = 6;\n\t\t\t\tvar today = new Date();\n\t\t\t\tvar closedDays = [[Wednesday], [Sunday]];\n\t\t\t\t\n\t\t\t\tfor (var i = 0; i < closedDays.length; i++) {\n\t\t\t\t\tif (day == closedDays[i][0]) {\n\t\t\t\t\t\treturn [false];\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\t\n\t\t\t\tvar closedDates = new Date();\n\t\t\t\tclosedDates = closedDates.setDate(today.getDate() + 30);\n\n\t\t\t\treturn [date >= today && date <= closedDates];\n\t\t\t}\n\t\t});\n\t\t\n\t\t$(\".bezorgen_caldendar\").datepicker({\t\t\t\n\t\t\tbeforeShowDay: function (date) {\n\t\t\t\tvar today = new Date();\n\t\t\t\t\/\/ var today = new Date('2023-07-23T12:00:00');\n\t\t\t\tvar nextSaturday = new Date();\n\t\t\t\t\n\t\t\t\tvar todayday = today.getDay();\n\t\t\t\tvar hours = today.getHours();\n\t\t\t\tvar minutes = today.getMinutes();\n\n\t\t\t\twhile (nextSaturday.getDay() !== 4) {\n\t\t\t\t\tnextSaturday.setDate(nextSaturday.getDate() + 1);\n\t\t\t\t}\n\t\t\t\t\n\t\t\t\tif( todayday == 5 && hours >= 12 ) {\n\t\t\t\t\ttoday.setDate(today.getDate() + 2);\n\t\t\t\t} else if( todayday == 4 ) {\n\t\t\t\t\ttoday.setDate(today.getDate() + 1);\n\t\t\t\t} else {\n\t\t\t\t\tvar today = new Date();\n\t\t\t\t}\n\t\t\t\t\n\t\t\t\tnextSaturday.setDate(today.getDate() + 28);\n\t\t\t\tvar day = date.getDay();\n\n\t\t\t\treturn [day === 4 && date >= today && date <= nextSaturday];\n\t\t\t}\n\t\t});\n\t\t\n\t});\n\t\n})(jQuery);\n\n<\/script>\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\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Shopper Trial Box Pick up a Phood Farm Shopper Trial Box once or have it delivered. 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