{"id":13599,"date":"2026-01-20T13:33:52","date_gmt":"2026-01-20T13:33:52","guid":{"rendered":"https:\/\/veinedagen.nl\/?page_id=13599"},"modified":"2026-02-11T20:43:25","modified_gmt":"2026-02-11T20:43:25","slug":"stemformulier","status":"publish","type":"page","link":"https:\/\/veinedagen.nl\/de\/stemformulier\/","title":{"rendered":"Stemformulier"},"content":{"rendered":"<div>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is 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innovatie verdient volgens jou de Publieksprijs? Stem op het product of de dienst waar jij het meest blij van wordt en help mee bepalen wie er met de prijs naar huis gaat!<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_11'  action='\/de\/wp-json\/wp\/v2\/pages\/13599' data-formid='11' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_11' class='gform_fields top_label form_sublabel_above description_below validation_below' data-column-layout='fill'><fieldset id=\"field_11_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c6d2ac55\" data-field-span=\"12\"><legend id='gfield_label_11_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Naam<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_1'>\n                            \n                            <span id='input_11_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_11_1_3' id='input_11_1_3_label' class='gform-field-label gform-field-label--type-sub '>Vorname<\/label>\n                                                    <input type='text' name='input_1.3' id='input_11_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" aria-labelledby=\"input_11_1_3_label gfield_label_11_1\"\/>\n                                                <\/span>\n                            \n                            <span id='input_11_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_11_1_6' id='input_11_1_6_label' class='gform-field-label gform-field-label--type-sub '>Nachname<\/label>\n                                                            <input type='text' name='input_1.6' id='input_11_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_11_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"df5bddbc\" data-field-span=\"12\"><legend id='gfield_label_11_2' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>E-mailadres<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_11_2_container'>\n                                <span id='input_11_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_11_2' id='input_11_2_label' class='gform-field-label gform-field-label--type-sub '>E-Mail eingeben<\/label>\n                                    <input class='' type='email' name='input_2' id='input_11_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  aria-labelledby=\"input_11_2_label gfield_label_11_2\" autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_11_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_11_2_2' id='input_11_2_2_label' class='gform-field-label gform-field-label--type-sub '>E-Mail best\u00e4tigen<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_11_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_11_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"00607be4\" data-field-span=\"12\"><legend id='gfield_label_11_7' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ik stem op:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_7'>\n\t\t\t<div class='gchoice gchoice_11_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='2KERR Mobility'  id='choice_11_7_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_11_7_0 gfield_label_11_7\"   \/>\n\t\t\t\t\t<label for='choice_11_7_0' id='label_11_7_0' class='gform-field-label gform-field-label--type-inline'>2KERR Mobility | De XSTO X12<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='A tot Z Reizen'  id='choice_11_7_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_1' id='label_11_7_1' class='gform-field-label gform-field-label--type-inline'>A tot Z Reizen | maatwerkreizen<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Able2'  id='choice_11_7_2' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_2' id='label_11_7_2' class='gform-field-label gform-field-label--type-inline'>Able2 | rolstoel en transportstoel gemaakt van magnesium<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Affect-us'  id='choice_11_7_3' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_3' id='label_11_7_3' class='gform-field-label gform-field-label--type-inline'>Affect-us | online game Broedels<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Alber service'  id='choice_11_7_4' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_4' id='label_11_7_4' class='gform-field-label gform-field-label--type-inline'>Alber service | De Alber scalamobil<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Beleefpaneel'  id='choice_11_7_5' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_5' id='label_11_7_5' class='gform-field-label gform-field-label--type-inline'>Beleefpaneel | Het beleef- en leerpaneel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Carepool'  id='choice_11_7_6' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_6' id='label_11_7_6' class='gform-field-label gform-field-label--type-inline'>Carepool | een slimme app<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='CoMoveIT'  id='choice_11_7_7' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_7' id='label_11_7_7' class='gform-field-label gform-field-label--type-inline'>CoMoveIT | CoMoveIT Flex<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Coperti'  id='choice_11_7_8' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_8' id='label_11_7_8' class='gform-field-label gform-field-label--type-inline'>Coperti | skelter met innovatieve aandrijving<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Decon Mobility'  id='choice_11_7_9' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_9' id='label_11_7_9' class='gform-field-label gform-field-label--type-inline'>Decon Mobility | SmootherWheel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='e-Ability'  id='choice_11_7_10' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_10' id='label_11_7_10' class='gform-field-label gform-field-label--type-inline'>e-Ability | De Strutt ev\u00b9<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Educadora'  id='choice_11_7_11' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_11' id='label_11_7_11' class='gform-field-label gform-field-label--type-inline'>Educadora | ZenWhale<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Elvea Low Vision'  id='choice_11_7_12' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_12' id='label_11_7_12' class='gform-field-label gform-field-label--type-inline'>Elvea Low Vision |  onderzoeken thuis<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Ergosolutions'  id='choice_11_7_13' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_13' id='label_11_7_13' class='gform-field-label gform-field-label--type-inline'>Ergosolutions | Cocoon<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Go-On loopfietsen'  id='choice_11_7_14' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_14' id='label_11_7_14' class='gform-field-label gform-field-label--type-inline'>Go-On | Go-On loopfiets<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='HappyTab'  id='choice_11_7_15' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_15' id='label_11_7_15' class='gform-field-label gform-field-label--type-inline'>HappyTab | grote gebruiksvriendelijke tablet<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Huka Bikes'  id='choice_11_7_16' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_16' id='label_11_7_16' class='gform-field-label gform-field-label--type-inline'>Huka Bikes |  de Cortes XS<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Iris Huys'  id='choice_11_7_17' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_17' id='label_11_7_17' class='gform-field-label gform-field-label--type-inline'>Iris Huys | IKONN hulpmiddelen<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_18'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Levare Cura'  id='choice_11_7_18' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_18' id='label_11_7_18' class='gform-field-label gform-field-label--type-inline'>Levare Cura | De Shine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_19'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Luna Glasses Angstone'  id='choice_11_7_19' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_19' id='label_11_7_19' class='gform-field-label gform-field-label--type-inline'>Luna Glass | een innovatieve bril<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_20'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='My Breath My Music'  id='choice_11_7_20' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_20' id='label_11_7_20' class='gform-field-label gform-field-label--type-inline'>My Breath My Music | Muziek zonder grenzen<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_21'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Nestl\u00e9 Health Science'  id='choice_11_7_21' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_21' id='label_11_7_21' class='gform-field-label gform-field-label--type-inline'>Nestl\u00e9 Health Science | Compleat\u00ae Paediatric Oral Blends<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_22'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='PGBeetje'  id='choice_11_7_22' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_22' id='label_11_7_22' class='gform-field-label gform-field-label--type-inline'>PGBeetje | D\u00e9 PGB-administratietool<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_23'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Pride Mobility Products Europe BV'  id='choice_11_7_23' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_23' id='label_11_7_23' class='gform-field-label gform-field-label--type-inline'>Pride Mobility | Baja Mobility Bandit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_24'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Q-Fog by NATER'  id='choice_11_7_24' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_24' id='label_11_7_24' class='gform-field-label gform-field-label--type-inline'>Q-Fog by NATER | Q-Fog<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice 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type='radio' value='Vahlkamp International B.V.'  id='choice_11_7_30' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_30' id='label_11_7_30' class='gform-field-label gform-field-label--type-inline'>Vahlkamp International B.V. | De Wetwatcher<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_31'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Vancilities'  id='choice_11_7_31' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_31' id='label_11_7_31' class='gform-field-label gform-field-label--type-inline'>Vancilities | serviceorganisatie  Costa Blanca<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_32'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Wheeleo'  id='choice_11_7_32' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_32' id='label_11_7_32' class='gform-field-label gform-field-label--type-inline'>Wheeleo | innovatieve \u00e9\u00e9nhandige rollator<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_33'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='De Eppur skeed wielen'  id='choice_11_7_33' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_33' id='label_11_7_33' class='gform-field-label gform-field-label--type-inline'>Decon Mobility | De Eppur skeed wielen<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_7_34'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='kookboek'  id='choice_11_7_34' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_11_7_34' id='label_11_7_34' class='gform-field-label gform-field-label--type-inline'>Nestl\u00e9 Health Science | kookboek ontwikkeld met recepten in aangepaste consistentie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_11' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Stem hier!<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_11' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_11' id='gform_theme_11' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_11' id='gform_style_settings_11' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='11' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' 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