{"id":6537,"date":"2023-06-21T07:21:14","date_gmt":"2023-06-21T05:21:14","guid":{"rendered":"https:\/\/member.phoodfarm.org\/community-farmer-subscription-form\/"},"modified":"2024-10-04T14:35:30","modified_gmt":"2024-10-04T12:35:30","slug":"community-farmer-subscription-form","status":"publish","type":"page","link":"https:\/\/member.phoodfarm.org\/en\/community-farmer-subscription-form\/","title":{"rendered":"Community Farmer subscription form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6537\" class=\"elementor elementor-6537 elementor-5498\">\n\t\t\t\t<input type=\"hidden\" id=\"security\" name=\"security\" value=\"ac4938703d\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6537\" \/>\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-622e5c0c elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"622e5c0c\" 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-23c68849\" data-id=\"23c68849\" 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-2ddc6ecd elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2ddc6ecd\" 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-890bb36\" data-id=\"890bb36\" 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-702fe0c0 background-right\" data-id=\"702fe0c0\" 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-692da197 page-icon elementor-widget elementor-widget-image\" data-id=\"692da197\" 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-677246a9 page-title elementor-vertical-align-top elementor-widget elementor-widget-image-box\" data-id=\"677246a9\" 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\">Community Farmer Picking Garden Subscription  <\/h2><p class=\"elementor-image-box-description\">Helping out in the fields, learning how to grow your own vegetables and harvesting them fresh at your own time. Choose your subscription.<\/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-7baa3c5a elementor-widget elementor-widget-html\" data-id=\"7baa3c5a\" 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_farmer_abonnement\" subpage-title=\"Community Farmer abonnement\" class=\"phoodbox-membership-registration-form\">\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. Subscription 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\">Collection<\/button><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\t\t\t\t\t<p>Choose which day you would like to pick up the Phoodbox. This can also be modified later in your profile.  <\/p>\n                    <ul><li><input id=\"phoodbox_timeslot\" class=\"phoodbox-timeslot\" name=\"phoodbox_timeslot\" type=\"radio\" value=\"12_00_15_00_donderdag\"  \/>Donderdag tussen 12:30 \u2013 15:00<\/li><li><input id=\"phoodbox_timeslot\" class=\"phoodbox-timeslot\" name=\"phoodbox_timeslot\" type=\"radio\" value=\"12_00_15_00_vrijdag\"  \/>Vrijdag tussen 12:30 \u2013 15:00<\/li><li><input id=\"phoodbox_timeslot\" class=\"phoodbox-timeslot\" name=\"phoodbox_timeslot\" type=\"radio\" value=\"12_00_15_00_zaterdag\"  \/>Zaterdag tussen 12:30 \u2013 15:00<\/li><li><input id=\"phoodbox_timeslot\" class=\"phoodbox-timeslot\" name=\"phoodbox_timeslot\" type=\"radio\" value=\"12_00_15_00_maandag\"  \/>Maandag tussen 12:30 \u2013 15:00<\/li><li><input id=\"phoodbox_timeslot\" class=\"phoodbox-timeslot\" name=\"phoodbox_timeslot\" type=\"radio\" value=\"12_00_15_00_dinsdag\"  \/>Dinsdag tussen 12:30 \u2013 15:00<\/li><\/ul>\n\t\t\t\t\t<span id=\"phoodbox_timeslot_error\" class=\"cc-error\"><\/span>\n                    \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\t\t\t\t\t<div class=\"phoodbox-delivery-time-fieldset\" style=\"display:none\">\n\t\t\t\t\t\t<ul><li><input id=\"phoodbox_delivery_time\" class=\"phhodbox-delivery-time\" name=\"phoodbox_timeslot\" type=\"radio\" value=\"12_00_15_00_donderdag\" \/>Donderdag tussen 12:30 \u2013 15:00<\/li><\/ul>\n\t\t\t\t\t\t<span id=\"phoodbox_delivery_time_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n                <\/div>\n                <div class=\"phoodbox-frequency-fieldset\">\n                    <h4>Frequency Phoodbox:<\/h4>\n                    <p>How often would you like to receive the Phoodbox? This can also be modified later in your profile.<\/p>\n                    <div class=\"btn-wrapper\">\n                        <button id=\"phoodbox_frequency\" class=\"phoodbox-frequency\" data-value=\"wekelijks\">Weekly<\/button><button id=\"phoodbox_frequency\" class=\"phoodbox-frequency\" data-value=\"omde_week\">Every other week<\/button>\n                    <\/div>\n                <\/div>\n\t\t\t\t<div class=\"phoodbox-week-frequency-fieldset\" style=\"display:none\">\n\t\t\t\t\t<p>In which weeks do you want your Phood Farm Box?<\/p>\n\t\t\t\t\t<div class=\"btn-wrapper\">\n\t\t\t\t\t\t<button id=\"phoodbox_week_frequency\" class=\"phoodbox-week-frequency\" data-value=\"even_week\">Even<\/button><button id=\"phoodbox_week_frequency\" class=\"phoodbox-week-frequency\" data-value=\"oneven_week\">Odd<\/button>\n\t\t\t\t\t\t<span id=\"phoodbox_week_frequency_error\" class=\"cc-error\"><\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n            <\/div>\n            <div class=\"payment-method-field\">\n                <div class=\"payment-method-fieldset\">\n                    <h4>Payment method:<\/h4>\n                    <p>Choose the payment method that suits you best. This is also let you modify it in your profile.<\/p>\n                    <div class=\"btn-wrapper\">\n                        <button id=\"payment_method\" class=\"payment-method wekelijks\" disabled data-value=\"wekelijks\">Weekly<\/button><button id=\"payment_method\" class=\"payment-method omde_week\" disabled data-value=\"omde_week\">Every other week<\/button><button id=\"payment_method\" class=\"payment-method jaarlijks\" disabled data-value=\"jaarlijks\">Annually<\/button>\n                    <\/div>\n                <\/div>\n                <div class=\"subscription-price\" style=\"display: none;\">  You pay  <div id=\"mepr_subscription_price\" class=\"mepr-subscription-price\">\n\t\t\t\t\t\t<p class=\"1_ophalen_wekelijks_wekelijks\" total-price=\"15\" delivery-charge=\"0\" subscription-price=\"15\"><span class=\"subcription-price-num\">\u20ac 15<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"1_ophalen_omde_week_omde_week\" total-price=\"15\" delivery-charge=\"0\" subscription-price=\"15\"><span class=\"subcription-price-num\">\u20ac 15<\/span> \/ every other week<\/p>\n\t\t\t\t\t\t<p class=\"1_ophalen_wekelijks_jaarlijks\" total-price=\"660\" delivery-charge=\"0\" subscription-price=\"660\"><span class=\"subcription-price-num\">\u20ac 660<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"1_ophalen_omde_week_jaarlijks\" total-price=\"330\" delivery-charge=\"0\" subscription-price=\"330\"><span class=\"subcription-price-num\">\u20ac 330<\/span> \/ year<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<p class=\"1_bezorgen_wekelijks_wekelijks\" total-price=\"17.99\" delivery-charge=\"2.99\" subscription-price=\"15\"><span class=\"subcription-price-num\">\u20ac 17.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"1_bezorgen_omde_week_omde_week\" total-price=\"17.99\" delivery-charge=\"2.99\" subscription-price=\"15\"><span class=\"subcription-price-num\">\u20ac 17.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"1_bezorgen_wekelijks_jaarlijks\" total-price=\"791.56\" delivery-charge=\"131.56\" subscription-price=\"660\"><span class=\"subcription-price-num\">\u20ac 791.56<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"1_bezorgen_omde_week_jaarlijks\" total-price=\"395.78\" delivery-charge=\"65.78\" subscription-price=\"330\"><span class=\"subcription-price-num\">\u20ac 395.78<\/span> \/ year<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<p class=\"2_ophalen_wekelijks_wekelijks\" total-price=\"30\" delivery-charge=\"0\" subscription-price=\"30\"><span class=\"subcription-price-num\">\u20ac 30<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"2_ophalen_omde_week_omde_week\" total-price=\"30\" delivery-charge=\"0\" subscription-price=\"30\"><span class=\"subcription-price-num\">\u20ac 30<\/span> \/ every other week<\/p>\n\t\t\t\t\t\t<p class=\"2_ophalen_wekelijks_jaarlijks\" total-price=\"1320\" delivery-charge=\"0\" subscription-price=\"1320\"><span class=\"subcription-price-num\">\u20ac 1320<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"2_ophalen_omde_week_jaarlijks\" total-price=\"660\" delivery-charge=\"0\" subscription-price=\"660\"><span class=\"subcription-price-num\">\u20ac 660<\/span> \/ year<\/p>\n\n\t\t\t\t\t\t<p class=\"2_bezorgen_wekelijks_wekelijks\" total-price=\"32.99\" delivery-charge=\"2.99\" subscription-price=\"30\"><span class=\"subcription-price-num\">\u20ac 32.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"2_bezorgen_omde_week_omde_week\" total-price=\"32.99  \" delivery-charge=\"2.99\" subscription-price=\"30\"><span class=\"subcription-price-num\">\u20ac 32.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"2_bezorgen_wekelijks_jaarlijks\" total-price=\"1451.56\" delivery-charge=\"131.56\" subscription-price=\"1320\"><span class=\"subcription-price-num\">\u20ac 1451.56<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"2_bezorgen_omde_week_jaarlijks\" total-price=\"725.78\" delivery-charge=\"65.78\" subscription-price=\"660\"><span class=\"subcription-price-num\">\u20ac 725.78<\/span> \/ year<\/p>\n\n\t\t\t\t\t\t<p class=\"3_ophalen_wekelijks_wekelijks\" total-price=\"45\" delivery-charge=\"0\" subscription-price=\"45\"><span class=\"subcription-price-num\">\u20ac 45<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"3_ophalen_omde_week_omde_week\" total-price=\"45\" delivery-charge=\"0\" subscription-price=\"45\"><span class=\"subcription-price-num\">\u20ac 45<\/span> \/ every other week<\/p>\n\t\t\t\t\t\t<p class=\"3_ophalen_wekelijks_jaarlijks\" total-price=\"1980\" delivery-charge=\"0\" subscription-price=\"1980\"><span class=\"subcription-price-num\">\u20ac 1980<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"3_ophalen_omde_week_jaarlijks\" total-price=\"990\" delivery-charge=\"0\" subscription-price=\"990\"><span class=\"subcription-price-num\">\u20ac 990<\/span> \/ year<\/p>\n\n\t\t\t\t\t\t<p class=\"3_bezorgen_wekelijks_wekelijks\" total-price=\"47.99\" delivery-charge=\"2.99\" subscription-price=\"45\"><span class=\"subcription-price-num\">\u20ac 47.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"3_bezorgen_omde_week_omde_week\" total-price=\"47.99  \" delivery-charge=\"2.99\" subscription-price=\"45\"><span class=\"subcription-price-num\">\u20ac 47.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"3_bezorgen_wekelijks_jaarlijks\" total-price=\"2111.56\" delivery-charge=\"131.56\" subscription-price=\"1980\"><span class=\"subcription-price-num\">\u20ac 2111.56<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"3_bezorgen_omde_week_jaarlijks\" total-price=\"1055.78\" delivery-charge=\"65.78\" subscription-price=\"990\"><span class=\"subcription-price-num\">\u20ac 1055.78<\/span> \/ year<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<p class=\"4_ophalen_wekelijks_wekelijks\" total-price=\"60\" delivery-charge=\"0\" subscription-price=\"60\"><span class=\"subcription-price-num\">\u20ac 60<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"4_ophalen_omde_week_omde_week\" total-price=\"60\" delivery-charge=\"0\" subscription-price=\"60\"><span class=\"subcription-price-num\">\u20ac 60<\/span> \/ every other week<\/p>\n\t\t\t\t\t\t<p class=\"4_ophalen_wekelijks_jaarlijks\" total-price=\"2640\" delivery-charge=\"0\" subscription-price=\"2640\"><span class=\"subcription-price-num\">\u20ac2640<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"4_ophalen_omde_week_jaarlijks\" total-price=\"1320\" delivery-charge=\"0\" subscription-price=\"1320\"><span class=\"subcription-price-num\">\u20ac 1320<\/span> \/ year<\/p>\n\n\t\t\t\t\t\t<p class=\"4_bezorgen_wekelijks_wekelijks\" total-price=\"62.99\" delivery-charge=\"2.99\" subscription-price=\"60\"><span class=\"subcription-price-num\">\u20ac62.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"4_bezorgen_omde_week_omde_week\" total-price=\"62.99  \" delivery-charge=\"2.99\" subscription-price=\"60\"><span class=\"subcription-price-num\">\u20ac62.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"4_bezorgen_wekelijks_jaarlijks\" total-price=\"2771.56\" delivery-charge=\"131.56\" subscription-price=\"2640\"><span class=\"subcription-price-num\">\u20ac 2771.56<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"4_bezorgen_omde_week_jaarlijks\" total-price=\"1385.78\" delivery-charge=\"65.78\" subscription-price=\"1320\"><span class=\"subcription-price-num\">\u20ac 1385.78<\/span> \/ year<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<p class=\"5_ophalen_wekelijks_wekelijks\" total-price=\"75\" delivery-charge=\"0\" subscription-price=\"75\"><span class=\"subcription-price-num\">\u20ac 75<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"5_ophalen_omde_week_omde_week\" total-price=\"75\" delivery-charge=\"0\" subscription-price=\"75\"><span class=\"subcription-price-num\">\u20ac 75<\/span> \/ every other week<\/p>\n\t\t\t\t\t\t<p class=\"5_ophalen_wekelijks_jaarlijks\" total-price=\"3300\" delivery-charge=\"0\" subscription-price=\"3300\"><span class=\"subcription-price-num\">\u20ac 3300<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"5_ophalen_omde_week_jaarlijks\" total-price=\"1800\" delivery-charge=\"0\" subscription-price=\"1650\"><span class=\"subcription-price-num\">\u20ac 1650<\/span> \/ year<\/p>\n\n\t\t\t\t\t\t<p class=\"5_bezorgen_wekelijks_wekelijks\" total-price=\"77.99\" delivery-charge=\"2.99\" subscription-price=\"75\"><span class=\"subcription-price-num\">\u20ac 77.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"5_bezorgen_omde_week_omde_week\" total-price=\"77.99  \" delivery-charge=\"2.99\" subscription-price=\"75\"><span class=\"subcription-price-num\">\u20ac 77.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"5_bezorgen_wekelijks_jaarlijks\" total-price=\"3431.56\" delivery-charge=\"131.56\" subscription-price=\"3300\"><span class=\"subcription-price-num\">\u20ac 3431.56<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"5_bezorgen_omde_week_jaarlijks\" total-price=\"1715.78\" delivery-charge=\"65.78\" subscription-price=\"1650\"><span class=\"subcription-price-num\">\u20ac 1715.78<\/span> \/ year<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<p class=\"6_ophalen_wekelijks_wekelijks\" total-price=\"90\" delivery-charge=\"0\" subscription-price=\"90\"><span class=\"subcription-price-num\">\u20ac 90<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"6_ophalen_omde_week_omde_week\" total-price=\"90\" delivery-charge=\"0\" subscription-price=\"90\"><span class=\"subcription-price-num\">\u20ac 90<\/span> \/ every other week<\/p>\n\t\t\t\t\t\t<p class=\"6_ophalen_wekelijks_jaarlijks\" total-price=\"3960\" delivery-charge=\"0\" subscription-price=\"3960\"><span class=\"subcription-price-num\">\u20ac 3960<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"6_ophalen_omde_week_jaarlijks\" total-price=\"1980\" delivery-charge=\"0\" subscription-price=\"1980\"><span class=\"subcription-price-num\">\u20ac 1980<\/span> \/ year<\/p>\n\n\t\t\t\t\t\t<p class=\"6_bezorgen_wekelijks_wekelijks\" total-price=\"92.99\" delivery-charge=\"2.99\" subscription-price=\"90\"><span class=\"subcription-price-num\">\u20ac 92.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"6_bezorgen_omde_week_omde_week\" total-price=\"92.99  \" delivery-charge=\"2.99\" subscription-price=\"90\"><span class=\"subcription-price-num\">\u20ac 92.99<\/span> \/ week<\/p>\n\t\t\t\t\t\t<p class=\"6_bezorgen_wekelijks_jaarlijks\" total-price=\"4091.56\" delivery-charge=\"131.56\" subscription-price=\"3960\"><span class=\"subcription-price-num\">\u20ac 4091.56<\/span> \/ year<\/p>\n\t\t\t\t\t\t<p class=\"6_bezorgen_omde_week_jaarlijks\" total-price=\"2045.78\" delivery-charge=\"65.78\" subscription-price=\"1980\"><span class=\"subcription-price-num\">\u20ac 2045.78<\/span> \/ year<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n                \n\t\t\t\t<\/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=\"ac4938703d\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6537\" \/>\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<div id=\"phoodfarm_membership_form\">\n\t\t\n\t\t\t<div id=\"phoodfarm_membership_form_1407\" class=\"1_ophalen_wekelijks_wekelijks 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\/6537#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=\"1407\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac15 \/ Week        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week1\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week1\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_2044\" class=\"1_ophalen_wekelijks_jaarlijks 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\/6537#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=\"2044\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac660 \/ Year        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week2\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week2\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_5462\" class=\"1_ophalen_omde_week_omde_week 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\/6537#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=\"5462\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac15 \/ 2 Weeks        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week3\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week3\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_6601\" class=\"1_ophalen_omde_week_jaarlijks 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\/6537#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=\"6601\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac330 \/ Year        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week4\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week4\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Sign Up\" \/>\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_6292\" class=\"1_bezorgen_wekelijks_wekelijks 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\/6537#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=\"6292\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac17.99 \/ Week        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week5\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week5\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_6325\" class=\"1_bezorgen_wekelijks_jaarlijks 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\/6537#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=\"6325\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac791.56 \/ Year        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week6\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week6\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_6298\" class=\"1_bezorgen_omde_week_omde_week 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\/6537#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=\"6298\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac17.99 \/ 2 Weeks        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week7\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week7\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_6600\" class=\"1_bezorgen_omde_week_jaarlijks 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\/6537#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=\"6600\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac395.78 \/ Year        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week8\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week8\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Sign Up\" \/>\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_2305\" class=\"2_ophalen_wekelijks_wekelijks 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\/6537#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=\"2305\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac30 \/ Week        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week9\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week9\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_2306\" class=\"2_ophalen_wekelijks_jaarlijks 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\/6537#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=\"2306\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,320 \/ Year        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week10\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week10\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_5463\" class=\"2_ophalen_omde_week_omde_week 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\/6537#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=\"5463\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac30 \/ 2 Weeks        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week11\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week11\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Aanmelden\" \/>\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_6602\" class=\"2_ophalen_omde_week_jaarlijks 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\/6537#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=\"6602\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac660 \/ Year        <\/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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week12\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week12\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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=\"Sign Up\" \/>\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_6293\" class=\"2_bezorgen_wekelijks_wekelijks 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\/6537#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=\"6293\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac32.99 \/ Week        <\/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_name13\">\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_name13\" 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_name13\">\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_name13\" 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-one13\">\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-one13\" 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-two13\">\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-two13\" 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-city13\">\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-city13\" 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-country13\">\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-country13\"\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-state13\">\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=\"13\"\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=\"13\"\n               id=\"mepr-address-state13\"\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-zip13\">\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-zip13\" 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_bezorgen13\">\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_bezorgen13\" 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_timeslot13\">\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_timeslot13\" 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_bezorgen13\">\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_bezorgen13\" 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_phoodbox13\">\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_phoodbox13\" 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_someone13\">\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_someone13\" 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_telefoon13\">\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_telefoon13\" 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_voornaam13\">\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_voornaam13\" 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_achternaam13\">\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_achternaam13\" 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_postcode13\">\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_postcode13\" 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_address13\">\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_address13\" 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_street13\">\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_street13\" 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_housenumber13\">\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_housenumber13\" 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_additional13\">\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_additional13\" 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_residance13\">\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_residance13\" 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_date13\">\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_date13\" 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_additional13\">\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_additional13\" 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_enable13\">\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_enable13\" 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_telefoon13\">\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_telefoon13\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week13\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week13\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment13\">\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_comment13\" 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_email13\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email13\" 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_password13\">\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_password13\" 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_confirm13\">\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_confirm13\" 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_tos13\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos13\"  \/>\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=\"Aanmelden\" \/>\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_6326\" class=\"2_bezorgen_wekelijks_jaarlijks 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\/6537#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=\"6326\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,451.56 \/ Year        <\/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_name14\">\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_name14\" 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_name14\">\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_name14\" 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-one14\">\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-one14\" 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-two14\">\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-two14\" 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-city14\">\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-city14\" 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-country14\">\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-country14\"\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-state14\">\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=\"14\"\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=\"14\"\n               id=\"mepr-address-state14\"\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-zip14\">\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-zip14\" 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_bezorgen14\">\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_bezorgen14\" 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_timeslot14\">\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_timeslot14\" 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_bezorgen14\">\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_bezorgen14\" 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_phoodbox14\">\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_phoodbox14\" 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_someone14\">\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_someone14\" 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_telefoon14\">\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_telefoon14\" 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_voornaam14\">\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_voornaam14\" 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_achternaam14\">\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_achternaam14\" 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_postcode14\">\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_postcode14\" 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_address14\">\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_address14\" 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_street14\">\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_street14\" 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_housenumber14\">\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_housenumber14\" 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_additional14\">\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_additional14\" 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_residance14\">\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_residance14\" 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_date14\">\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_date14\" 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_additional14\">\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_additional14\" 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_enable14\">\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_enable14\" 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_telefoon14\">\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_telefoon14\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week14\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week14\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment14\">\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_comment14\" 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_email14\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email14\" 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_password14\">\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_password14\" 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_confirm14\">\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_confirm14\" 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_tos14\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos14\"  \/>\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=\"Aanmelden\" \/>\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_6299\" class=\"2_bezorgen_omde_week_omde_week 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\/6537#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=\"6299\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac32.99 \/ 2 Weeks        <\/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_name15\">\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_name15\" 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_name15\">\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_name15\" 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-one15\">\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-one15\" 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-two15\">\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-two15\" 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-city15\">\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-city15\" 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-country15\">\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-country15\"\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-state15\">\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=\"15\"\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=\"15\"\n               id=\"mepr-address-state15\"\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-zip15\">\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-zip15\" 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_bezorgen15\">\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_bezorgen15\" 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_timeslot15\">\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_timeslot15\" 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_bezorgen15\">\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_bezorgen15\" 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_phoodbox15\">\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_phoodbox15\" 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_someone15\">\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_someone15\" 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_telefoon15\">\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_telefoon15\" 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_voornaam15\">\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_voornaam15\" 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_achternaam15\">\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_achternaam15\" 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_postcode15\">\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_postcode15\" 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_address15\">\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_address15\" 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_street15\">\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_street15\" 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_housenumber15\">\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_housenumber15\" 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_additional15\">\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_additional15\" 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_residance15\">\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_residance15\" 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_date15\">\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_date15\" 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_additional15\">\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_additional15\" 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_enable15\">\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_enable15\" 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_telefoon15\">\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_telefoon15\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week15\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week15\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment15\">\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_comment15\" 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_email15\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email15\" 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_password15\">\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_password15\" 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_confirm15\">\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_confirm15\" 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_tos15\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos15\"  \/>\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=\"Aanmelden\" \/>\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_6603\" class=\"2_bezorgen_omde_week_jaarlijks 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\/6537#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=\"6603\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac725.78 \/ Year        <\/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_name16\">\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_name16\" 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_name16\">\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_name16\" 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-one16\">\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-one16\" 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-two16\">\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-two16\" 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-city16\">\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-city16\" 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-country16\">\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-country16\"\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-state16\">\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=\"16\"\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=\"16\"\n               id=\"mepr-address-state16\"\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-zip16\">\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-zip16\" 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_bezorgen16\">\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_bezorgen16\" 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_timeslot16\">\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_timeslot16\" 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_bezorgen16\">\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_bezorgen16\" 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_phoodbox16\">\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_phoodbox16\" 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_someone16\">\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_someone16\" 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_telefoon16\">\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_telefoon16\" 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_voornaam16\">\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_voornaam16\" 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_achternaam16\">\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_achternaam16\" 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_postcode16\">\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_postcode16\" 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_address16\">\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_address16\" 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_street16\">\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_street16\" 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_housenumber16\">\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_housenumber16\" 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_additional16\">\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_additional16\" 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_residance16\">\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_residance16\" 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_date16\">\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_date16\" 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_additional16\">\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_additional16\" 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_enable16\">\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_enable16\" 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_telefoon16\">\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_telefoon16\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week16\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week16\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment16\">\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_comment16\" 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_email16\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email16\" 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_password16\">\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_password16\" 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_confirm16\">\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_confirm16\" 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_tos16\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos16\"  \/>\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=\"Sign Up\" \/>\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>\t\t\t\n\t\t\t\n\t\t\t<div id=\"phoodfarm_membership_form_2400\" class=\"3_ophalen_wekelijks_wekelijks 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\/6537#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=\"2400\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac45 \/ Week        <\/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_name17\">\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_name17\" 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_name17\">\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_name17\" 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-one17\">\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-one17\" 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-two17\">\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-two17\" 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-city17\">\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-city17\" 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-country17\">\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-country17\"\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-state17\">\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=\"17\"\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=\"17\"\n               id=\"mepr-address-state17\"\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-zip17\">\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-zip17\" 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_bezorgen17\">\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_bezorgen17\" 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_timeslot17\">\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_timeslot17\" 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_bezorgen17\">\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_bezorgen17\" 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_phoodbox17\">\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_phoodbox17\" 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_someone17\">\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_someone17\" 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_telefoon17\">\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_telefoon17\" 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_voornaam17\">\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_voornaam17\" 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_achternaam17\">\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_achternaam17\" 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_postcode17\">\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_postcode17\" 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_address17\">\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_address17\" 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_street17\">\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_street17\" 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_housenumber17\">\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_housenumber17\" 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_additional17\">\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_additional17\" 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_residance17\">\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_residance17\" 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_date17\">\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_date17\" 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_additional17\">\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_additional17\" 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_enable17\">\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_enable17\" 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_telefoon17\">\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_telefoon17\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week17\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week17\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment17\">\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_comment17\" 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_email17\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email17\" 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_password17\">\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_password17\" 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_confirm17\">\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_confirm17\" 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_tos17\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos17\"  \/>\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=\"Aanmelden\" \/>\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_2401\" class=\"3_ophalen_wekelijks_jaarlijks 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\/6537#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=\"2401\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,980 \/ Year        <\/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_name18\">\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_name18\" 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_name18\">\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_name18\" 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-one18\">\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-one18\" 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-two18\">\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-two18\" 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-city18\">\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-city18\" 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-country18\">\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-country18\"\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-state18\">\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=\"18\"\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=\"18\"\n               id=\"mepr-address-state18\"\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-zip18\">\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-zip18\" 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_bezorgen18\">\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_bezorgen18\" 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_timeslot18\">\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_timeslot18\" 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_bezorgen18\">\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_bezorgen18\" 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_phoodbox18\">\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_phoodbox18\" 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_someone18\">\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_someone18\" 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_telefoon18\">\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_telefoon18\" 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_voornaam18\">\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_voornaam18\" 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_achternaam18\">\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_achternaam18\" 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_postcode18\">\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_postcode18\" 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_address18\">\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_address18\" 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_street18\">\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_street18\" 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_housenumber18\">\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_housenumber18\" 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_additional18\">\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_additional18\" 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_residance18\">\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_residance18\" 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_date18\">\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_date18\" 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_additional18\">\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_additional18\" 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_enable18\">\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_enable18\" 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_telefoon18\">\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_telefoon18\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week18\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week18\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment18\">\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_comment18\" 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_email18\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email18\" 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_password18\">\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_password18\" 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_confirm18\">\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_confirm18\" 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_tos18\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos18\"  \/>\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=\"Aanmelden\" \/>\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_5464\" class=\"3_ophalen_omde_week_omde_week 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\/6537#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=\"5464\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac45 \/ 2 Weeks        <\/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_name19\">\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_name19\" 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_name19\">\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_name19\" 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-one19\">\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-one19\" 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-two19\">\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-two19\" 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-city19\">\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-city19\" 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-country19\">\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-country19\"\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-state19\">\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=\"19\"\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=\"19\"\n               id=\"mepr-address-state19\"\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-zip19\">\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-zip19\" 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_bezorgen19\">\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_bezorgen19\" 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_timeslot19\">\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_timeslot19\" 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_bezorgen19\">\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_bezorgen19\" 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_phoodbox19\">\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_phoodbox19\" 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_someone19\">\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_someone19\" 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_telefoon19\">\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_telefoon19\" 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_voornaam19\">\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_voornaam19\" 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_achternaam19\">\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_achternaam19\" 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_postcode19\">\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_postcode19\" 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_address19\">\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_address19\" 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_street19\">\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_street19\" 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_housenumber19\">\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_housenumber19\" 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_additional19\">\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_additional19\" 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_residance19\">\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_residance19\" 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_date19\">\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_date19\" 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_additional19\">\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_additional19\" 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_enable19\">\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_enable19\" 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_telefoon19\">\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_telefoon19\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week19\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week19\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment19\">\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_comment19\" 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_email19\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email19\" 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_password19\">\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_password19\" 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_confirm19\">\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_confirm19\" 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_tos19\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos19\"  \/>\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=\"Aanmelden\" \/>\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_6604\" class=\"3_ophalen_omde_week_jaarlijks 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\/6537#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=\"6604\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac990 \/ Year        <\/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_name20\">\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_name20\" 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_name20\">\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_name20\" 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-one20\">\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-one20\" 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-two20\">\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-two20\" 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-city20\">\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-city20\" 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-country20\">\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-country20\"\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-state20\">\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=\"20\"\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=\"20\"\n               id=\"mepr-address-state20\"\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-zip20\">\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-zip20\" 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_bezorgen20\">\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_bezorgen20\" 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_timeslot20\">\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_timeslot20\" 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_bezorgen20\">\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_bezorgen20\" 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_phoodbox20\">\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_phoodbox20\" 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_someone20\">\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_someone20\" 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_telefoon20\">\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_telefoon20\" 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_voornaam20\">\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_voornaam20\" 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_achternaam20\">\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_achternaam20\" 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_postcode20\">\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_postcode20\" 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_address20\">\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_address20\" 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_street20\">\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_street20\" 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_housenumber20\">\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_housenumber20\" 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_additional20\">\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_additional20\" 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_residance20\">\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_residance20\" 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_date20\">\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_date20\" 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_additional20\">\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_additional20\" 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_enable20\">\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_enable20\" 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_telefoon20\">\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_telefoon20\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week20\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week20\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment20\">\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_comment20\" 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_email20\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email20\" 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_password20\">\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_password20\" 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_confirm20\">\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_confirm20\" 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_tos20\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos20\"  \/>\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=\"Sign Up\" \/>\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_6294\" class=\"3_bezorgen_wekelijks_wekelijks 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\/6537#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=\"6294\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac47.99 \/ Week        <\/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_name21\">\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_name21\" 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_name21\">\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_name21\" 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-one21\">\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-one21\" 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-two21\">\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-two21\" 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-city21\">\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-city21\" 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-country21\">\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-country21\"\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-state21\">\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=\"21\"\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=\"21\"\n               id=\"mepr-address-state21\"\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-zip21\">\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-zip21\" 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_bezorgen21\">\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_bezorgen21\" 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_timeslot21\">\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_timeslot21\" 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_bezorgen21\">\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_bezorgen21\" 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_phoodbox21\">\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_phoodbox21\" 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_someone21\">\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_someone21\" 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_telefoon21\">\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_telefoon21\" 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_voornaam21\">\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_voornaam21\" 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_achternaam21\">\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_achternaam21\" 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_postcode21\">\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_postcode21\" 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_address21\">\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_address21\" 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_street21\">\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_street21\" 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_housenumber21\">\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_housenumber21\" 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_additional21\">\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_additional21\" 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_residance21\">\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_residance21\" 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_date21\">\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_date21\" 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_additional21\">\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_additional21\" 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_enable21\">\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_enable21\" 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_telefoon21\">\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_telefoon21\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week21\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week21\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment21\">\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_comment21\" 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_email21\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email21\" 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_password21\">\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_password21\" 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_confirm21\">\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_confirm21\" 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_tos21\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos21\"  \/>\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=\"Aanmelden\" \/>\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_6327\" class=\"3_bezorgen_wekelijks_jaarlijks 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\/6537#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=\"6327\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac2,111.56 \/ Year        <\/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_name22\">\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_name22\" 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_name22\">\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_name22\" 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-one22\">\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-one22\" 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-two22\">\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-two22\" 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-city22\">\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-city22\" 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-country22\">\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-country22\"\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-state22\">\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=\"22\"\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=\"22\"\n               id=\"mepr-address-state22\"\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-zip22\">\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-zip22\" 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_bezorgen22\">\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_bezorgen22\" 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_timeslot22\">\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_timeslot22\" 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_bezorgen22\">\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_bezorgen22\" 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_phoodbox22\">\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_phoodbox22\" 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_someone22\">\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_someone22\" 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_telefoon22\">\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_telefoon22\" 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_voornaam22\">\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_voornaam22\" 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_achternaam22\">\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_achternaam22\" 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_postcode22\">\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_postcode22\" 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_address22\">\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_address22\" 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_street22\">\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_street22\" 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_housenumber22\">\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_housenumber22\" 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_additional22\">\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_additional22\" 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_residance22\">\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_residance22\" 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_date22\">\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_date22\" 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_additional22\">\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_additional22\" 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_enable22\">\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_enable22\" 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_telefoon22\">\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_telefoon22\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week22\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week22\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment22\">\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_comment22\" 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_email22\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email22\" 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_password22\">\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_password22\" 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_confirm22\">\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_confirm22\" 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_tos22\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos22\"  \/>\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=\"Aanmelden\" \/>\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_6300\" class=\"3_bezorgen_omde_week_omde_week 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\/6537#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=\"6300\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac47.99 \/ 2 Weeks        <\/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_name23\">\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_name23\" 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_name23\">\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_name23\" 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-one23\">\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-one23\" 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-two23\">\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-two23\" 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-city23\">\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-city23\" 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-country23\">\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-country23\"\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-state23\">\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=\"23\"\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=\"23\"\n               id=\"mepr-address-state23\"\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-zip23\">\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-zip23\" 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_bezorgen23\">\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_bezorgen23\" 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_timeslot23\">\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_timeslot23\" 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_bezorgen23\">\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_bezorgen23\" 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_phoodbox23\">\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_phoodbox23\" 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_someone23\">\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_someone23\" 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_telefoon23\">\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_telefoon23\" 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_voornaam23\">\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_voornaam23\" 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_achternaam23\">\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_achternaam23\" 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_postcode23\">\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_postcode23\" 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_address23\">\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_address23\" 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_street23\">\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_street23\" 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_housenumber23\">\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_housenumber23\" 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_additional23\">\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_additional23\" 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_residance23\">\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_residance23\" 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_date23\">\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_date23\" 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_additional23\">\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_additional23\" 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_enable23\">\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_enable23\" 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_telefoon23\">\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_telefoon23\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week23\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week23\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment23\">\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_comment23\" 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_email23\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email23\" 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_password23\">\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_password23\" 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_confirm23\">\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_confirm23\" 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_tos23\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos23\"  \/>\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=\"Aanmelden\" \/>\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_6605\" class=\"3_bezorgen_omde_week_jaarlijks 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\/6537#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=\"6605\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,055.78 \/ Year        <\/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_name24\">\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_name24\" 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_name24\">\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_name24\" 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-one24\">\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-one24\" 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-two24\">\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-two24\" 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-city24\">\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-city24\" 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-country24\">\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-country24\"\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-state24\">\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=\"24\"\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=\"24\"\n               id=\"mepr-address-state24\"\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-zip24\">\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-zip24\" 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_bezorgen24\">\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_bezorgen24\" 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_timeslot24\">\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_timeslot24\" 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_bezorgen24\">\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_bezorgen24\" 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_phoodbox24\">\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_phoodbox24\" 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_someone24\">\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_someone24\" 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_telefoon24\">\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_telefoon24\" 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_voornaam24\">\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_voornaam24\" 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_achternaam24\">\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_achternaam24\" 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_postcode24\">\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_postcode24\" 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_address24\">\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_address24\" 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_street24\">\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_street24\" 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_housenumber24\">\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_housenumber24\" 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_additional24\">\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_additional24\" 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_residance24\">\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_residance24\" 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_date24\">\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_date24\" 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_additional24\">\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_additional24\" 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_enable24\">\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_enable24\" 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_telefoon24\">\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_telefoon24\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week24\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week24\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment24\">\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_comment24\" 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_email24\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email24\" 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_password24\">\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_password24\" 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_confirm24\">\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_confirm24\" 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_tos24\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos24\"  \/>\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=\"Sign Up\" \/>\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_2416\" class=\"4_ophalen_wekelijks_wekelijks 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\/6537#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=\"2416\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac60 \/ Week        <\/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_name25\">\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_name25\" 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_name25\">\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_name25\" 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-one25\">\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-one25\" 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-two25\">\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-two25\" 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-city25\">\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-city25\" 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-country25\">\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-country25\"\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-state25\">\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=\"25\"\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=\"25\"\n               id=\"mepr-address-state25\"\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-zip25\">\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-zip25\" 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_bezorgen25\">\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_bezorgen25\" 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_timeslot25\">\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_timeslot25\" 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_bezorgen25\">\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_bezorgen25\" 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_phoodbox25\">\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_phoodbox25\" 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_someone25\">\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_someone25\" 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_telefoon25\">\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_telefoon25\" 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_voornaam25\">\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_voornaam25\" 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_achternaam25\">\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_achternaam25\" 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_postcode25\">\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_postcode25\" 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_address25\">\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_address25\" 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_street25\">\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_street25\" 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_housenumber25\">\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_housenumber25\" 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_additional25\">\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_additional25\" 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_residance25\">\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_residance25\" 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_date25\">\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_date25\" 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_additional25\">\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_additional25\" 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_enable25\">\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_enable25\" 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_telefoon25\">\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_telefoon25\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week25\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week25\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment25\">\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_comment25\" 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_email25\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email25\" 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_password25\">\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_password25\" 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_confirm25\">\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_confirm25\" 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_tos25\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos25\"  \/>\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=\"Aanmelden\" \/>\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_2417\" class=\"4_ophalen_wekelijks_jaarlijks 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\/6537#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=\"2417\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac2,640 \/ Year        <\/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_name26\">\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_name26\" 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_name26\">\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_name26\" 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-one26\">\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-one26\" 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-two26\">\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-two26\" 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-city26\">\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-city26\" 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-country26\">\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-country26\"\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-state26\">\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=\"26\"\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=\"26\"\n               id=\"mepr-address-state26\"\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-zip26\">\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-zip26\" 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_bezorgen26\">\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_bezorgen26\" 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_timeslot26\">\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_timeslot26\" 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_bezorgen26\">\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_bezorgen26\" 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_phoodbox26\">\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_phoodbox26\" 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_someone26\">\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_someone26\" 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_telefoon26\">\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_telefoon26\" 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_voornaam26\">\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_voornaam26\" 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_achternaam26\">\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_achternaam26\" 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_postcode26\">\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_postcode26\" 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_address26\">\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_address26\" 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_street26\">\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_street26\" 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_housenumber26\">\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_housenumber26\" 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_additional26\">\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_additional26\" 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_residance26\">\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_residance26\" 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_date26\">\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_date26\" 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_additional26\">\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_additional26\" 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_enable26\">\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_enable26\" 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_telefoon26\">\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_telefoon26\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week26\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week26\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment26\">\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_comment26\" 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_email26\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email26\" 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_password26\">\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_password26\" 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_confirm26\">\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_confirm26\" 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_tos26\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos26\"  \/>\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=\"Aanmelden\" \/>\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_5465\" class=\"4_ophalen_omde_week_omde_week 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\/6537#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=\"5465\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac60 \/ 2 Weeks        <\/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_name27\">\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_name27\" 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_name27\">\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_name27\" 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-one27\">\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-one27\" 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-two27\">\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-two27\" 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-city27\">\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-city27\" 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-country27\">\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-country27\"\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-state27\">\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=\"27\"\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=\"27\"\n               id=\"mepr-address-state27\"\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-zip27\">\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-zip27\" 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_bezorgen27\">\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_bezorgen27\" 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_timeslot27\">\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_timeslot27\" 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_bezorgen27\">\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_bezorgen27\" 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_phoodbox27\">\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_phoodbox27\" 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_someone27\">\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_someone27\" 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_telefoon27\">\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_telefoon27\" 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_voornaam27\">\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_voornaam27\" 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_achternaam27\">\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_achternaam27\" 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_postcode27\">\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_postcode27\" 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_address27\">\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_address27\" 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_street27\">\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_street27\" 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_housenumber27\">\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_housenumber27\" 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_additional27\">\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_additional27\" 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_residance27\">\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_residance27\" 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_date27\">\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_date27\" 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_additional27\">\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_additional27\" 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_enable27\">\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_enable27\" 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_telefoon27\">\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_telefoon27\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week27\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week27\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment27\">\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_comment27\" 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_email27\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email27\" 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_password27\">\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_password27\" 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_confirm27\">\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_confirm27\" 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_tos27\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos27\"  \/>\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=\"Aanmelden\" \/>\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_6606\" class=\"4_ophalen_omde_week_jaarlijks 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\/6537#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=\"6606\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,320 \/ Year        <\/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_name28\">\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_name28\" 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_name28\">\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_name28\" 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-one28\">\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-one28\" 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-two28\">\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-two28\" 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-city28\">\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-city28\" 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-country28\">\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-country28\"\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-state28\">\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=\"28\"\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=\"28\"\n               id=\"mepr-address-state28\"\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-zip28\">\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-zip28\" 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_bezorgen28\">\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_bezorgen28\" 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_timeslot28\">\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_timeslot28\" 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_bezorgen28\">\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_bezorgen28\" 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_phoodbox28\">\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_phoodbox28\" 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_someone28\">\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_someone28\" 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_telefoon28\">\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_telefoon28\" 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_voornaam28\">\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_voornaam28\" 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_achternaam28\">\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_achternaam28\" 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_postcode28\">\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_postcode28\" 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_address28\">\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_address28\" 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_street28\">\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_street28\" 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_housenumber28\">\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_housenumber28\" 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_additional28\">\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_additional28\" 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_residance28\">\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_residance28\" 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_date28\">\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_date28\" 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_additional28\">\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_additional28\" 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_enable28\">\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_enable28\" 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_telefoon28\">\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_telefoon28\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week28\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week28\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment28\">\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_comment28\" 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_email28\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email28\" 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_password28\">\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_password28\" 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_confirm28\">\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_confirm28\" 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_tos28\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos28\"  \/>\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=\"Sign Up\" \/>\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_6295\" class=\"4_bezorgen_wekelijks_wekelijks 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\/6537#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=\"6295\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac62.99 \/ Week        <\/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_name29\">\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_name29\" 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_name29\">\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_name29\" 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-one29\">\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-one29\" 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-two29\">\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-two29\" 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-city29\">\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-city29\" 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-country29\">\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-country29\"\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-state29\">\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=\"29\"\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=\"29\"\n               id=\"mepr-address-state29\"\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-zip29\">\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-zip29\" 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_bezorgen29\">\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_bezorgen29\" 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_timeslot29\">\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_timeslot29\" 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_bezorgen29\">\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_bezorgen29\" 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_phoodbox29\">\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_phoodbox29\" 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_someone29\">\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_someone29\" 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_telefoon29\">\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_telefoon29\" 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_voornaam29\">\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_voornaam29\" 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_achternaam29\">\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_achternaam29\" 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_postcode29\">\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_postcode29\" 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_address29\">\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_address29\" 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_street29\">\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_street29\" 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_housenumber29\">\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_housenumber29\" 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_additional29\">\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_additional29\" 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_residance29\">\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_residance29\" 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_date29\">\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_date29\" 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_additional29\">\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_additional29\" 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_enable29\">\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_enable29\" 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_telefoon29\">\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_telefoon29\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week29\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week29\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment29\">\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_comment29\" 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_email29\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email29\" 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_password29\">\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_password29\" 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_confirm29\">\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_confirm29\" 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_tos29\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos29\"  \/>\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=\"Aanmelden\" \/>\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_6329\" class=\"4_bezorgen_wekelijks_jaarlijks 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\/6537#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=\"6329\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac2,771.56 \/ Year        <\/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_name30\">\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_name30\" 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_name30\">\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_name30\" 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-one30\">\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-one30\" 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-two30\">\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-two30\" 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-city30\">\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-city30\" 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-country30\">\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-country30\"\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-state30\">\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=\"30\"\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=\"30\"\n               id=\"mepr-address-state30\"\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-zip30\">\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-zip30\" 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_bezorgen30\">\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_bezorgen30\" 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_timeslot30\">\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_timeslot30\" 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_bezorgen30\">\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_bezorgen30\" 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_phoodbox30\">\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_phoodbox30\" 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_someone30\">\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_someone30\" 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_telefoon30\">\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_telefoon30\" 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_voornaam30\">\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_voornaam30\" 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_achternaam30\">\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_achternaam30\" 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_postcode30\">\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_postcode30\" 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_address30\">\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_address30\" 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_street30\">\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_street30\" 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_housenumber30\">\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_housenumber30\" 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_additional30\">\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_additional30\" 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_residance30\">\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_residance30\" 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_date30\">\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_date30\" 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_additional30\">\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_additional30\" 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_enable30\">\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_enable30\" 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_telefoon30\">\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_telefoon30\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week30\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week30\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment30\">\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_comment30\" 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_email30\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email30\" 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_password30\">\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_password30\" 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_confirm30\">\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_confirm30\" 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_tos30\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos30\"  \/>\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=\"Aanmelden\" \/>\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_6301\" class=\"4_bezorgen_omde_week_omde_week 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\/6537#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=\"6301\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac62.99 \/ 2 Weeks        <\/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_name31\">\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_name31\" 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_name31\">\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_name31\" 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-one31\">\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-one31\" 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-two31\">\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-two31\" 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-city31\">\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-city31\" 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-country31\">\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-country31\"\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-state31\">\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=\"31\"\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=\"31\"\n               id=\"mepr-address-state31\"\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-zip31\">\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-zip31\" 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_bezorgen31\">\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_bezorgen31\" 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_timeslot31\">\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_timeslot31\" 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_bezorgen31\">\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_bezorgen31\" 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_phoodbox31\">\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_phoodbox31\" 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_someone31\">\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_someone31\" 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_telefoon31\">\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_telefoon31\" 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_voornaam31\">\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_voornaam31\" 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_achternaam31\">\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_achternaam31\" 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_postcode31\">\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_postcode31\" 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_address31\">\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_address31\" 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_street31\">\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_street31\" 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_housenumber31\">\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_housenumber31\" 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_additional31\">\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_additional31\" 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_residance31\">\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_residance31\" 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_date31\">\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_date31\" 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_additional31\">\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_additional31\" 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_enable31\">\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_enable31\" 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_telefoon31\">\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_telefoon31\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week31\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week31\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment31\">\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_comment31\" 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_email31\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email31\" 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_password31\">\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_password31\" 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_confirm31\">\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_confirm31\" 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_tos31\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos31\"  \/>\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=\"Aanmelden\" \/>\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_6607\" class=\"4_bezorgen_omde_week_jaarlijks 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\/6537#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=\"6607\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,385.78 \/ Year        <\/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_name32\">\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_name32\" 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_name32\">\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_name32\" 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-one32\">\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-one32\" 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-two32\">\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-two32\" 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-city32\">\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-city32\" 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-country32\">\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-country32\"\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-state32\">\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=\"32\"\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=\"32\"\n               id=\"mepr-address-state32\"\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-zip32\">\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-zip32\" 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_bezorgen32\">\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_bezorgen32\" 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_timeslot32\">\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_timeslot32\" 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_bezorgen32\">\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_bezorgen32\" 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_phoodbox32\">\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_phoodbox32\" 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_someone32\">\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_someone32\" 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_telefoon32\">\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_telefoon32\" 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_voornaam32\">\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_voornaam32\" 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_achternaam32\">\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_achternaam32\" 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_postcode32\">\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_postcode32\" 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_address32\">\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_address32\" 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_street32\">\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_street32\" 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_housenumber32\">\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_housenumber32\" 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_additional32\">\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_additional32\" 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_residance32\">\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_residance32\" 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_date32\">\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_date32\" 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_additional32\">\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_additional32\" 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_enable32\">\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_enable32\" 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_telefoon32\">\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_telefoon32\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week32\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week32\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment32\">\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_comment32\" 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_email32\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email32\" 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_password32\">\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_password32\" 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_confirm32\">\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_confirm32\" 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_tos32\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos32\"  \/>\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=\"Sign Up\" \/>\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_2422\" class=\"5_ophalen_wekelijks_wekelijks 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\/6537#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=\"2422\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac75 \/ Week        <\/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_name33\">\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_name33\" 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_name33\">\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_name33\" 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-one33\">\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-one33\" 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-two33\">\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-two33\" 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-city33\">\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-city33\" 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-country33\">\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-country33\"\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-state33\">\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=\"33\"\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=\"33\"\n               id=\"mepr-address-state33\"\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-zip33\">\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-zip33\" 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_bezorgen33\">\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_bezorgen33\" 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_timeslot33\">\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_timeslot33\" 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_bezorgen33\">\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_bezorgen33\" 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_phoodbox33\">\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_phoodbox33\" 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_someone33\">\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_someone33\" 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_telefoon33\">\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_telefoon33\" 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_voornaam33\">\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_voornaam33\" 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_achternaam33\">\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_achternaam33\" 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_postcode33\">\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_postcode33\" 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_address33\">\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_address33\" 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_street33\">\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_street33\" 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_housenumber33\">\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_housenumber33\" 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_additional33\">\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_additional33\" 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_residance33\">\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_residance33\" 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_date33\">\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_date33\" 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_additional33\">\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_additional33\" 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_enable33\">\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_enable33\" 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_telefoon33\">\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_telefoon33\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week33\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week33\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment33\">\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_comment33\" 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_email33\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email33\" 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_password33\">\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_password33\" 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_confirm33\">\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_confirm33\" 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_tos33\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos33\"  \/>\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=\"Aanmelden\" \/>\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_2423\" class=\"5_ophalen_wekelijks_jaarlijks 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\/6537#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=\"2423\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac3,300 \/ Year        <\/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_name34\">\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_name34\" 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_name34\">\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_name34\" 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-one34\">\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-one34\" 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-two34\">\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-two34\" 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-city34\">\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-city34\" 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-country34\">\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-country34\"\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-state34\">\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=\"34\"\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=\"34\"\n               id=\"mepr-address-state34\"\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-zip34\">\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-zip34\" 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_bezorgen34\">\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_bezorgen34\" 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_timeslot34\">\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_timeslot34\" 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_bezorgen34\">\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_bezorgen34\" 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_phoodbox34\">\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_phoodbox34\" 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_someone34\">\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_someone34\" 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_telefoon34\">\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_telefoon34\" 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_voornaam34\">\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_voornaam34\" 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_achternaam34\">\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_achternaam34\" 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_postcode34\">\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_postcode34\" 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_address34\">\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_address34\" 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_street34\">\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_street34\" 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_housenumber34\">\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_housenumber34\" 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_additional34\">\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_additional34\" 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_residance34\">\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_residance34\" 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_date34\">\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_date34\" 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_additional34\">\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_additional34\" 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_enable34\">\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_enable34\" 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_telefoon34\">\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_telefoon34\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week34\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week34\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment34\">\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_comment34\" 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_email34\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email34\" 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_password34\">\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_password34\" 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_confirm34\">\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_confirm34\" 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_tos34\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos34\"  \/>\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=\"Aanmelden\" \/>\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_5466\" class=\"5_ophalen_omde_week_omde_week 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\/6537#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=\"5466\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac75 \/ 2 Weeks        <\/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_name35\">\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_name35\" 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_name35\">\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_name35\" 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-one35\">\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-one35\" 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-two35\">\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-two35\" 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-city35\">\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-city35\" 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-country35\">\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-country35\"\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-state35\">\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=\"35\"\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=\"35\"\n               id=\"mepr-address-state35\"\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-zip35\">\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-zip35\" 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_bezorgen35\">\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_bezorgen35\" 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_timeslot35\">\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_timeslot35\" 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_bezorgen35\">\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_bezorgen35\" 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_phoodbox35\">\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_phoodbox35\" 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_someone35\">\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_someone35\" 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_telefoon35\">\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_telefoon35\" 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_voornaam35\">\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_voornaam35\" 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_achternaam35\">\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_achternaam35\" 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_postcode35\">\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_postcode35\" 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_address35\">\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_address35\" 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_street35\">\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_street35\" 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_housenumber35\">\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_housenumber35\" 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_additional35\">\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_additional35\" 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_residance35\">\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_residance35\" 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_date35\">\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_date35\" 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_additional35\">\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_additional35\" 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_enable35\">\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_enable35\" 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_telefoon35\">\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_telefoon35\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week35\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week35\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment35\">\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_comment35\" 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_email35\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email35\" 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_password35\">\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_password35\" 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_confirm35\">\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_confirm35\" 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_tos35\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos35\"  \/>\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=\"Aanmelden\" \/>\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_6608\" class=\"5_ophalen_omde_week_jaarlijks 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\/6537#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=\"6608\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,650 \/ Year        <\/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_name36\">\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_name36\" 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_name36\">\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_name36\" 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-one36\">\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-one36\" 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-two36\">\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-two36\" 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-city36\">\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-city36\" 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-country36\">\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-country36\"\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-state36\">\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=\"36\"\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=\"36\"\n               id=\"mepr-address-state36\"\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-zip36\">\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-zip36\" 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_bezorgen36\">\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_bezorgen36\" 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_timeslot36\">\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_timeslot36\" 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_bezorgen36\">\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_bezorgen36\" 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_phoodbox36\">\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_phoodbox36\" 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_someone36\">\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_someone36\" 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_telefoon36\">\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_telefoon36\" 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_voornaam36\">\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_voornaam36\" 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_achternaam36\">\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_achternaam36\" 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_postcode36\">\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_postcode36\" 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_address36\">\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_address36\" 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_street36\">\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_street36\" 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_housenumber36\">\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_housenumber36\" 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_additional36\">\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_additional36\" 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_residance36\">\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_residance36\" 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_date36\">\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_date36\" 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_additional36\">\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_additional36\" 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_enable36\">\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_enable36\" 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_telefoon36\">\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_telefoon36\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week36\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week36\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment36\">\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_comment36\" 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_email36\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email36\" 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_password36\">\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_password36\" 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_confirm36\">\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_confirm36\" 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_tos36\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos36\"  \/>\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=\"Sign Up\" \/>\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_6296\" class=\"5_bezorgen_wekelijks_wekelijks 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\/6537#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=\"6296\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac77.99 \/ Week        <\/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_name37\">\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_name37\" 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_name37\">\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_name37\" 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-one37\">\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-one37\" 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-two37\">\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-two37\" 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-city37\">\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-city37\" 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-country37\">\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-country37\"\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-state37\">\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=\"37\"\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=\"37\"\n               id=\"mepr-address-state37\"\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-zip37\">\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-zip37\" 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_bezorgen37\">\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_bezorgen37\" 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_timeslot37\">\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_timeslot37\" 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_bezorgen37\">\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_bezorgen37\" 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_phoodbox37\">\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_phoodbox37\" 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_someone37\">\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_someone37\" 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_telefoon37\">\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_telefoon37\" 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_voornaam37\">\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_voornaam37\" 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_achternaam37\">\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_achternaam37\" 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_postcode37\">\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_postcode37\" 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_address37\">\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_address37\" 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_street37\">\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_street37\" 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_housenumber37\">\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_housenumber37\" 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_additional37\">\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_additional37\" 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_residance37\">\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_residance37\" 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_date37\">\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_date37\" 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_additional37\">\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_additional37\" 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_enable37\">\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_enable37\" 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_telefoon37\">\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_telefoon37\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week37\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week37\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment37\">\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_comment37\" 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_email37\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email37\" 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_password37\">\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_password37\" 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_confirm37\">\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_confirm37\" 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_tos37\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos37\"  \/>\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=\"Aanmelden\" \/>\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_6330\" class=\"5_bezorgen_wekelijks_jaarlijks 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\/6537#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=\"6330\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac3,431.56 \/ Year        <\/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_name38\">\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_name38\" 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_name38\">\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_name38\" 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-one38\">\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-one38\" 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-two38\">\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-two38\" 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-city38\">\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-city38\" 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-country38\">\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-country38\"\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-state38\">\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=\"38\"\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=\"38\"\n               id=\"mepr-address-state38\"\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-zip38\">\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-zip38\" 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_bezorgen38\">\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_bezorgen38\" 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_timeslot38\">\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_timeslot38\" 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_bezorgen38\">\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_bezorgen38\" 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_phoodbox38\">\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_phoodbox38\" 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_someone38\">\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_someone38\" 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_telefoon38\">\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_telefoon38\" 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_voornaam38\">\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_voornaam38\" 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_achternaam38\">\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_achternaam38\" 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_postcode38\">\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_postcode38\" 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_address38\">\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_address38\" 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_street38\">\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_street38\" 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_housenumber38\">\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_housenumber38\" 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_additional38\">\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_additional38\" 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_residance38\">\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_residance38\" 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_date38\">\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_date38\" 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_additional38\">\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_additional38\" 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_enable38\">\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_enable38\" 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_telefoon38\">\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_telefoon38\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week38\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week38\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment38\">\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_comment38\" 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_email38\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email38\" 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_password38\">\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_password38\" 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_confirm38\">\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_confirm38\" 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_tos38\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos38\"  \/>\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=\"Aanmelden\" \/>\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_6303\" class=\"5_bezorgen_omde_week_omde_week 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\/6537#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=\"6303\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac77.99 \/ 2 Weeks        <\/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_name39\">\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_name39\" 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_name39\">\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_name39\" 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-one39\">\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-one39\" 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-two39\">\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-two39\" 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-city39\">\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-city39\" 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-country39\">\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-country39\"\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-state39\">\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=\"39\"\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=\"39\"\n               id=\"mepr-address-state39\"\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-zip39\">\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-zip39\" 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_bezorgen39\">\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_bezorgen39\" 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_timeslot39\">\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_timeslot39\" 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_bezorgen39\">\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_bezorgen39\" 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_phoodbox39\">\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_phoodbox39\" 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_someone39\">\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_someone39\" 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_telefoon39\">\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_telefoon39\" 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_voornaam39\">\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_voornaam39\" 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_achternaam39\">\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_achternaam39\" 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_postcode39\">\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_postcode39\" 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_address39\">\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_address39\" 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_street39\">\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_street39\" 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_housenumber39\">\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_housenumber39\" 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_additional39\">\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_additional39\" 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_residance39\">\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_residance39\" 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_date39\">\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_date39\" 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_additional39\">\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_additional39\" 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_enable39\">\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_enable39\" 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_telefoon39\">\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_telefoon39\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week39\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week39\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment39\">\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_comment39\" 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_email39\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email39\" 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_password39\">\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_password39\" 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_confirm39\">\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_confirm39\" 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_tos39\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos39\"  \/>\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=\"Aanmelden\" \/>\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_6609\" class=\"5_bezorgen_omde_week_jaarlijks 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\/6537#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=\"6609\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,715.78 \/ Year        <\/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_name40\">\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_name40\" 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_name40\">\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_name40\" 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-one40\">\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-one40\" 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-two40\">\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-two40\" 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-city40\">\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-city40\" 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-country40\">\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-country40\"\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-state40\">\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=\"40\"\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=\"40\"\n               id=\"mepr-address-state40\"\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-zip40\">\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-zip40\" 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_bezorgen40\">\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_bezorgen40\" 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_timeslot40\">\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_timeslot40\" 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_bezorgen40\">\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_bezorgen40\" 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_phoodbox40\">\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_phoodbox40\" 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_someone40\">\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_someone40\" 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_telefoon40\">\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_telefoon40\" 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_voornaam40\">\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_voornaam40\" 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_achternaam40\">\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_achternaam40\" 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_postcode40\">\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_postcode40\" 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_address40\">\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_address40\" 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_street40\">\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_street40\" 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_housenumber40\">\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_housenumber40\" 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_additional40\">\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_additional40\" 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_residance40\">\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_residance40\" 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_date40\">\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_date40\" 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_additional40\">\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_additional40\" 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_enable40\">\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_enable40\" 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_telefoon40\">\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_telefoon40\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week40\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week40\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment40\">\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_comment40\" 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_email40\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email40\" 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_password40\">\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_password40\" 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_confirm40\">\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_confirm40\" 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_tos40\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos40\"  \/>\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=\"Sign Up\" \/>\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_2428\" class=\"6_ophalen_wekelijks_wekelijks 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\/6537#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=\"2428\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac90 \/ Week        <\/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_name41\">\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_name41\" 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_name41\">\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_name41\" 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-one41\">\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-one41\" 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-two41\">\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-two41\" 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-city41\">\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-city41\" 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-country41\">\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-country41\"\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-state41\">\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=\"41\"\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=\"41\"\n               id=\"mepr-address-state41\"\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-zip41\">\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-zip41\" 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_bezorgen41\">\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_bezorgen41\" 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_timeslot41\">\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_timeslot41\" 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_bezorgen41\">\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_bezorgen41\" 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_phoodbox41\">\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_phoodbox41\" 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_someone41\">\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_someone41\" 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_telefoon41\">\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_telefoon41\" 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_voornaam41\">\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_voornaam41\" 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_achternaam41\">\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_achternaam41\" 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_postcode41\">\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_postcode41\" 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_address41\">\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_address41\" 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_street41\">\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_street41\" 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_housenumber41\">\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_housenumber41\" 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_additional41\">\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_additional41\" 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_residance41\">\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_residance41\" 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_date41\">\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_date41\" 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_additional41\">\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_additional41\" 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_enable41\">\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_enable41\" 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_telefoon41\">\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_telefoon41\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week41\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week41\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment41\">\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_comment41\" 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_email41\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email41\" 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_password41\">\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_password41\" 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_confirm41\">\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_confirm41\" 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_tos41\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos41\"  \/>\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=\"Aanmelden\" \/>\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_2429\" class=\"6_ophalen_wekelijks_jaarlijks 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\/6537#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=\"2429\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac3,960 \/ Year        <\/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_name42\">\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_name42\" 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_name42\">\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_name42\" 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-one42\">\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-one42\" 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-two42\">\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-two42\" 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-city42\">\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-city42\" 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-country42\">\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-country42\"\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-state42\">\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=\"42\"\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=\"42\"\n               id=\"mepr-address-state42\"\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-zip42\">\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-zip42\" 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_bezorgen42\">\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_bezorgen42\" 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_timeslot42\">\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_timeslot42\" 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_bezorgen42\">\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_bezorgen42\" 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_phoodbox42\">\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_phoodbox42\" 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_someone42\">\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_someone42\" 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_telefoon42\">\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_telefoon42\" 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_voornaam42\">\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_voornaam42\" 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_achternaam42\">\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_achternaam42\" 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_postcode42\">\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_postcode42\" 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_address42\">\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_address42\" 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_street42\">\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_street42\" 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_housenumber42\">\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_housenumber42\" 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_additional42\">\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_additional42\" 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_residance42\">\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_residance42\" 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_date42\">\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_date42\" 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_additional42\">\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_additional42\" 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_enable42\">\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_enable42\" 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_telefoon42\">\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_telefoon42\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week42\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week42\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment42\">\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_comment42\" 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_email42\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email42\" 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_password42\">\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_password42\" 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_confirm42\">\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_confirm42\" 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_tos42\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos42\"  \/>\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=\"Aanmelden\" \/>\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_5467\" class=\"6_ophalen_omde_week_omde_week 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\/6537#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=\"5467\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac90 \/ 2 Weeks        <\/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_name43\">\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_name43\" 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_name43\">\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_name43\" 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-one43\">\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-one43\" 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-two43\">\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-two43\" 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-city43\">\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-city43\" 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-country43\">\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-country43\"\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-state43\">\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=\"43\"\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=\"43\"\n               id=\"mepr-address-state43\"\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-zip43\">\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-zip43\" 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_bezorgen43\">\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_bezorgen43\" 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_timeslot43\">\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_timeslot43\" 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_bezorgen43\">\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_bezorgen43\" 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_phoodbox43\">\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_phoodbox43\" 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_someone43\">\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_someone43\" 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_telefoon43\">\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_telefoon43\" 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_voornaam43\">\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_voornaam43\" 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_achternaam43\">\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_achternaam43\" 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_postcode43\">\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_postcode43\" 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_address43\">\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_address43\" 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_street43\">\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_street43\" 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_housenumber43\">\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_housenumber43\" 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_additional43\">\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_additional43\" 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_residance43\">\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_residance43\" 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_date43\">\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_date43\" 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_additional43\">\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_additional43\" 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_enable43\">\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_enable43\" 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_telefoon43\">\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_telefoon43\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week43\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week43\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment43\">\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_comment43\" 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_email43\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email43\" 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_password43\">\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_password43\" 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_confirm43\">\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_confirm43\" 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_tos43\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos43\"  \/>\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=\"Aanmelden\" \/>\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_6610\" class=\"6_ophalen_omde_week_jaarlijks 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\/6537#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=\"6610\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac1,980 \/ Year        <\/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_name44\">\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_name44\" 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_name44\">\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_name44\" 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-one44\">\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-one44\" 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-two44\">\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-two44\" 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-city44\">\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-city44\" 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-country44\">\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-country44\"\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-state44\">\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=\"44\"\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=\"44\"\n               id=\"mepr-address-state44\"\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-zip44\">\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-zip44\" 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_bezorgen44\">\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_bezorgen44\" 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_timeslot44\">\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_timeslot44\" 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_bezorgen44\">\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_bezorgen44\" 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_phoodbox44\">\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_phoodbox44\" 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_someone44\">\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_someone44\" 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_telefoon44\">\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_telefoon44\" 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_voornaam44\">\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_voornaam44\" 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_achternaam44\">\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_achternaam44\" 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_postcode44\">\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_postcode44\" 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_address44\">\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_address44\" 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_street44\">\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_street44\" 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_housenumber44\">\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_housenumber44\" 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_additional44\">\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_additional44\" 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_residance44\">\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_residance44\" 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_date44\">\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_date44\" 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_additional44\">\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_additional44\" 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_enable44\">\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_enable44\" 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_telefoon44\">\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_telefoon44\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week44\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week44\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment44\">\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_comment44\" 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_email44\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email44\" 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_password44\">\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_password44\" 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_confirm44\">\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_confirm44\" 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_tos44\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos44\"  \/>\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=\"Sign Up\" \/>\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_6297\" class=\"6_bezorgen_wekelijks_wekelijks 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\/6537#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=\"6297\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac92.99 \/ Week        <\/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_name45\">\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_name45\" 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_name45\">\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_name45\" 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-one45\">\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-one45\" 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-two45\">\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-two45\" 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-city45\">\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-city45\" 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-country45\">\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-country45\"\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-state45\">\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=\"45\"\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=\"45\"\n               id=\"mepr-address-state45\"\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-zip45\">\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-zip45\" 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_bezorgen45\">\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_bezorgen45\" 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_timeslot45\">\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_timeslot45\" 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_bezorgen45\">\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_bezorgen45\" 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_phoodbox45\">\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_phoodbox45\" 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_someone45\">\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_someone45\" 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_telefoon45\">\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_telefoon45\" 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_voornaam45\">\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_voornaam45\" 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_achternaam45\">\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_achternaam45\" 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_postcode45\">\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_postcode45\" 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_address45\">\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_address45\" 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_street45\">\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_street45\" 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_housenumber45\">\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_housenumber45\" 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_additional45\">\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_additional45\" 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_residance45\">\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_residance45\" 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_date45\">\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_date45\" 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_additional45\">\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_additional45\" 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_enable45\">\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_enable45\" 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_telefoon45\">\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_telefoon45\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week45\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week45\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment45\">\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_comment45\" 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_email45\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email45\" 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_password45\">\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_password45\" 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_confirm45\">\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_confirm45\" 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_tos45\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos45\"  \/>\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=\"Aanmelden\" \/>\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_6328\" class=\"6_bezorgen_wekelijks_jaarlijks 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\/6537#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=\"6328\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac4,091.56 \/ Year        <\/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_name46\">\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_name46\" 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_name46\">\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_name46\" 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-one46\">\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-one46\" 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-two46\">\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-two46\" 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-city46\">\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-city46\" 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-country46\">\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-country46\"\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-state46\">\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=\"46\"\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=\"46\"\n               id=\"mepr-address-state46\"\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-zip46\">\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-zip46\" 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_bezorgen46\">\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_bezorgen46\" 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_timeslot46\">\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_timeslot46\" 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_bezorgen46\">\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_bezorgen46\" 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_phoodbox46\">\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_phoodbox46\" 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_someone46\">\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_someone46\" 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_telefoon46\">\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_telefoon46\" 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_voornaam46\">\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_voornaam46\" 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_achternaam46\">\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_achternaam46\" 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_postcode46\">\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_postcode46\" 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_address46\">\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_address46\" 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_street46\">\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_street46\" 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_housenumber46\">\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_housenumber46\" 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_additional46\">\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_additional46\" 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_residance46\">\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_residance46\" 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_date46\">\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_date46\" 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_additional46\">\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_additional46\" 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_enable46\">\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_enable46\" 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_telefoon46\">\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_telefoon46\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week46\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week46\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment46\">\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_comment46\" 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_email46\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email46\" 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_password46\">\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_password46\" 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_confirm46\">\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_confirm46\" 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_tos46\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos46\"  \/>\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=\"Aanmelden\" \/>\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_6302\" class=\"6_bezorgen_omde_week_omde_week 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\/6537#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=\"6302\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac92.99 \/ 2 Weeks        <\/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_name47\">\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_name47\" 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_name47\">\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_name47\" 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-one47\">\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-one47\" 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-two47\">\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-two47\" 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-city47\">\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-city47\" 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-country47\">\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-country47\"\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-state47\">\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=\"47\"\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=\"47\"\n               id=\"mepr-address-state47\"\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-zip47\">\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-zip47\" 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_bezorgen47\">\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_bezorgen47\" 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_timeslot47\">\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_timeslot47\" 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_bezorgen47\">\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_bezorgen47\" 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_phoodbox47\">\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_phoodbox47\" 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_someone47\">\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_someone47\" 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_telefoon47\">\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_telefoon47\" 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_voornaam47\">\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_voornaam47\" 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_achternaam47\">\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_achternaam47\" 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_postcode47\">\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_postcode47\" 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_address47\">\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_address47\" 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_street47\">\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_street47\" 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_housenumber47\">\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_housenumber47\" 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_additional47\">\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_additional47\" 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_residance47\">\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_residance47\" 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_date47\">\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_date47\" 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_additional47\">\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_additional47\" 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_enable47\">\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_enable47\" 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_telefoon47\">\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_telefoon47\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week47\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week47\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment47\">\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_comment47\" 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_email47\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email47\" 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_password47\">\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_password47\" 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_confirm47\">\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_confirm47\" 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_tos47\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos47\"  \/>\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=\"Aanmelden\" \/>\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_6611\" class=\"6_bezorgen_omde_week_jaarlijks 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\/6537#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=\"6611\" \/>\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\">Terms:<\/div>\n        <div class=\"mepr_price_cell\">\n          \u20ac2,045.78 \/ Year        <\/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_name48\">\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_name48\" 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_name48\">\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_name48\" 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-one48\">\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-one48\" 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-two48\">\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-two48\" 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-city48\">\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-city48\" 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-country48\">\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-country48\"\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-state48\">\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=\"48\"\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=\"48\"\n               id=\"mepr-address-state48\"\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-zip48\">\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-zip48\" 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_bezorgen48\">\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_bezorgen48\" 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_timeslot48\">\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_timeslot48\" 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_bezorgen48\">\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_bezorgen48\" 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_phoodbox48\">\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_phoodbox48\" 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_someone48\">\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_someone48\" 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_telefoon48\">\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_telefoon48\" 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_voornaam48\">\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_voornaam48\" 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_achternaam48\">\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_achternaam48\" 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_postcode48\">\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_postcode48\" 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_address48\">\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_address48\" 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_street48\">\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_street48\" 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_housenumber48\">\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_housenumber48\" 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_additional48\">\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_additional48\" 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_residance48\">\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_residance48\" 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_date48\">\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_date48\" 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_additional48\">\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_additional48\" 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_enable48\">\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_enable48\" 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_telefoon48\">\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_telefoon48\" 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_phoodbox_week\">\n        <div class=\"mp-form-label\">\n      <label class=\"placeholder-text\" for=\"mepr_phoodbox_week48\">\n          Phoodbox Week:      <\/label>\n              <span id=\"mepr_phoodbox_week_error\" class=\"cc-error\">\n          Phoodbox Week is not valid      <\/span>\n    <\/div>\n            <select name=\"mepr_phoodbox_week\" id=\"mepr_phoodbox_week48\" class=\"mepr-form-input mepr-select-field  \" aria-describedby=\"mepr_phoodbox_week_error\"   >\n                <option value=\"oneven_week\" >Oneven week<\/option><option value=\"even_week\" >Even week<\/option>        <\/select>\n                  <\/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_comment48\">\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_comment48\" 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_email48\">Email:*<\/label>\n          <span class=\"cc-error\">Invalid Email<\/span>\n        <\/div>\n        <input type=\"email\" name=\"user_email\" id=\"user_email48\" 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_password48\">\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_password48\" 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_confirm48\">\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_confirm48\" 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_tos48\" class=\"mepr-checkbox-field mepr-form-input\" required>\n          <input type=\"checkbox\" name=\"mepr_agree_to_tos\" id=\"mepr_agree_to_tos48\"  \/>\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=\"Sign Up\" \/>\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<\/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><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.\nPlease visit our <a href=\"privacy policy\" 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_farmer_abonnement .checkout-payment-method #ideal_payment_method {\n\tdisplay: none;\n}\n.mepr-payment-method-desc-text::before{\n    content:\" \";\n}\n.mepr-payment-methods-icons img {\n    display: none;\n}\n<\/style>\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>Community Farmer Picking Garden Subscription Helping out in the fields, learning how to grow your own vegetables and harvesting them fresh at your own time.&hellip;<\/p>\n","protected":false},"author":447,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-fullwidth-content.php","meta":{"_monsterinsights_skip_tracking":false,"_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"footnotes":"","_tec_slr_enabled":"","_tec_slr_layout":""},"class_list":["post-6537","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"ticketed":false,"_links":{"self":[{"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/pages\/6537","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/users\/447"}],"replies":[{"embeddable":true,"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/comments?post=6537"}],"version-history":[{"count":13,"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/pages\/6537\/revisions"}],"predecessor-version":[{"id":11964,"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/pages\/6537\/revisions\/11964"}],"wp:attachment":[{"href":"https:\/\/member.phoodfarm.org\/en\/wp-json\/wp\/v2\/media?parent=6537"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}