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Medical website
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<script language="JavaScript">
function formulierTest(formulierVeld){
//Geef hier de naam in van de verplichte velden, zoals in je formulier:
var verplichtVeld = Array("vnaam", "anaam", "strt", "nr", "gmnte");
//Geef hier de naam in die moet verschijnen in het alert-venster:
var veldBeschrijving = Array("Voornaam", "Familienaam", "Straat", "Nummer", "Gemeente");
//Geef hier het bericht in:
var alertBoodschap = "Gelieve volgende velden in te vullen:\n";
//Hieronder niets wijzigen:
var Boodschap = alertBoodschap.length;
for (var i = 0; i < verplichtVeld.length; i++){var obj = formulierVeld.elements[verplichtVeld[i]];if (obj){switch(obj.type){case "select-one":
if (obj.selectedIndex == -1 || obj.options[obj.selectedIndex].text == ""){alertBoodschap += "-" + veldBeschrijving[i] + "\n";}break;case "select-multiple":
if (obj.selectedIndex == -1){alertBoodschap += " - " + veldBeschrijving[i] + "\n";}break;
case "text":case "textarea":if (obj.value == "" || obj.value == null){alertBoodschap += " - " + veldBeschrijving[i] + "\n";}break;default:
if (obj.value == "" || obj.value == null){alertBoodschap += " - " + veldBeschrijving[i] + "\n";}}}}
if (alertBoodschap.length == Boodschap){return true;}else{alert(alertBoodschap);return false;}}
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<font size="4" face="Alfredo's Dance">
EHBO Sport
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<td width="1" align="center" background="../images/menu_bg.gif" class="menu">
<a class="menu_lnk" href="../index.html">HOME</a>
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<a class="menu_lnk" href="http://www.du-feu.net/about%20us/index.html">Over ons</a>
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<a class="menu_lnk" href="http://www.du-feu.net/diensten/index.html">Diensten</a>
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<td width="1" align="center" background="../images/menu_bg.gif" class="menu">
<a href="#" class="menu_lnk">Aanvraagformulier</a>
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<a href="#" class="menu_lnk">CONTACT US</a>
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<a href="#" class="menu_lnk">Links</a>
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<table width="100%" height="100%" border="0" cellpadding="0" cellspacing="0">
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<td>
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</td>
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<td background="../images/sub_btn.gif" class="norepeat">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td class="submenu">
<p align="left">
<img border="0" src="../about%20us/emssymb_aqua3.gif" width="21" height="20">
<font size="3">
Fotos
</font>
</p>
</td>
<td width="40">
<img src="../images/sub_marker.gif" width="40" height="24">
</td>
</tr>
</table>
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<td background="../images/sub_btn.gif" class="norepeat">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
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<td class="submenu">
<p align="left">
<img border="0" src="../about%20us/emssymb_aqua3.gif" width="21" height="20">
<font size="3">
Wagenpark
</font>
</p>
</td>
<td width="20">
<img src="../images/sub_marker.gif" width="40" height="24">
</td>
</tr>
</table>
</td>
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<td background="../images/sub_btn.gif" class="norepeat">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
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<p align="left">
<img border="0" src="../about%20us/emssymb_aqua3.gif" width="21" height="20">
<font size="3">
Cursus
</font>
</p>
</td>
<td width="20">
<img src="../images/sub_marker.gif" width="40" height="24">
</td>
</tr>
</table>
</td>
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<td background="../images/sub_btn.gif" class="norepeat">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
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<td class="submenu">
<p align="left">
<img border="0" src="../about%20us/emssymb_aqua3.gif" width="21" height="20">
<font size="3">
EHBO weetjes
</font>
</p>
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<td width="20">
<img src="../images/sub_marker.gif" width="40" height="24">
</td>
</tr>
</table>
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<td height="100%" valign="top" background="../images/sub_bot_bg.jpg" class="bgx">
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<img src="../images/sub_angle.gif" width="12" height="34">
</td>
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<tr>
<td>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
<td valign="top">
<table width="608" border="0" cellspacing="0" cellpadding="0">
<tr>
<td class="welcome" width="591">
<p align="center">
<font size="4">
Info/Aanvraag formulier
</font>
</p>
</td>
</tr>
<tr>
<td height="1" background="../images/undertext_bg.gif" class="bgx" width="606">
<img src="../images/spacer.gif" width="1" height="1">
</td>
</tr>
<tr>
<td valign="top" class="base_txt" align="right" width="576">
<p align="center">
<script type="text/javascript"><!--
google_ad_client = "pub-0500162490295296";
google_ad_width = 468;
google_ad_height = 60;
google_ad_format = "468x60_as";
google_ad_type = "text";
//2006-11-21: Web templates - LAYOUTS
google_ad_channel = "0286771451";
google_color_border = "ffffff";
google_color_bg = "ffffff";
google_color_link = "9B1D13";
google_color_text = "000000";
google_color_url = "B3B3B3";
//-->
</script>
<img border="0" src="../uc_sign26.gif" width="216" height="81">
<b>
<font color="#FF0000" size="3">
Gelieve nog geen aanvragen te versturen
zolang het Under Construction bordje zichtbaar is
</font>
</b>
</p>
<form name="formulier" action="mailto:swat@du-feu.net?subject=formulier" enctype="text/plain" method="post">
<p align="left">
<font size="3">
Naam aanvrager:
</font>
<input type="text" name = "naam" size="30">
<font size="3">
Straat:
<b>
</b>
</font>
<input type="text" name = "straat" size="30">
<font size="3">
Nr.:
</font>
<input type="text" name = "nr" size="4">
<br>
<font size="3">
Postcode:
</font>
<input type="text" name = "postnr" size="5" maxlength="4">
<font size="3">
Gemeente :
</font>
<input type="text" name = "gemeente" size="22">
<font size="3">
Land:
<b>
<input type="text" name="T1" size="15">
</b>
</font>
<hr>
<font size="3">
U wil informatie
<b>
<select size="1" name="D1">
<option value="EHBO Sport (algemeen)">
EHBO Sport (algemeen)
</option>
<option value="Cursus">
Cursus
</option>
<option value="Diensten">
Diensten
</option>
<option value="Ziekenvervoer">
Ziekenvervoer
</option>
</select>
</b>
</font>
<p>
<font size="3">
U wil een dienst aanvragen voor:
<select size="1" name="D2">
<option value="Wiekerwedstrijd">
Wiekerwedstrijd
</option>
<option value="Autocross">
Autocross
</option>
<option value="Motorcross">
Motorcross
</option>
<option value="Paardensport">
Paardensport
</option>
<option value="Voetbalwedstrijd">
Voetbalwedstrijd
</option>
<option value="Watersport">
Watersport
</option>
<option value="Atletiekmeeting">
Atletiekmeeting
</option>
<option value="Vechtsport">
Vechtsport
</option>
<option value="Fuif">
Fuif
</option>
<option value="Buurtfeest">
Buurtfeest
</option>
<option value="Festival">
Festival
</option>
<option value="Andere">
Andere
</option>
</select>
</font>
</p>
<p>
<font size="3">
Soort
<select size="1" name="D3">
<option value="één Ambulce">
Eén Ambulce
</option>
<option value="één Ambulance + Vaste post">
Eén Ambulance + Vaste post
</option>
<option value="Twee Ambulances">
Twee Ambulances
</option>
<option value="Twee Ambulances + Vaste post">
Twee Ambulances + Vaste post
</option>
<option value="Twee Ambulances + Vaste post + Dokter">
Twee Ambulances + Vaste
post + Dokter
</option>
<option value="Drie Ambulances">
Drie Ambulances
</option>
<option value="Drie Ambulances">
Drie Ambulances + Vaste post
</option>
<option value="Drie Ambulances + Vaste post + Dokter">
Drie Ambulances + Vaste
post + Dokter
</option>
<option value="Andere">
Andere
</option>
</select>
</font>
</p>
<hr>
<p align="center">
<b>
<font size="3">
<u>
Informatie over evenement
</u>
</font>
</b>
<p align="left">
<font size="3">
Inrichtende club:
<input type="text" name="T2" size="20">
</font>
<font size="3">
<b>
Straat:
</b>
</font>
<input type="text" name = "straat1" size="30">
<font size="3">
Nr. :
</font>
<input type="text" name = "nr1" size="4">
<font size="3">
Straat:
</font>
<input type="text" name = "straat2" size="30">
<font size="3">
Gemeente:
</font>
<input type="text" name = "gemeente2" size="23">
<font size="3">
Uur start:
<input type="text" name="T4" size="20">
</font>
</p>
<p align="center">
<font size="3">
<b>
<u>
Hieronder kun je eventueel Uw bijkomende
vragen stellen
</u>
</b>
</font>
</p>
<p>
<textarea name="commentaar" cols="63" rows="3" wrap="virtual">
Jouw commentaar:
</textarea>
</p>
<p align="center">
<font size="3">
<b>
EHBO Sport dankt U
</b>
</font>
<br>
</p>
<hr>
<input type="submit" value="Formulier versturen">
<input type="reset" value="Formulier wissen">
<hr>
</form>
<!-- </form>
-->
<p align="center">
</p>
<!-- </form>
-->
<p align="center">
</p>
</td>
</tr>
<tr>
<td valign="top" class="base_txt" width="576">
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td height="51" valign="top" bgcolor="#D15956">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="178" class="All_right">
<b>
(C)2007 Build by
<a href="mailto:swat@du-feu.net">Swat</a>
</b>
</td>
<td>
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td background="../images/bot_menu_bg.gif" class="bgx">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="1">
<img src="../images/spacer.gif" width="15" height="29">
</td>
<td class="bottom_menu">
<p align="center">
<div align="center">
<center>
<table border="0">
<tr>
<td>
<script language="javascript">
<!--
document.write('<input onSelectstart="return false;" style="background-color: #000000; cursor: default; color: #00ff00; border: 3px ridge #CCFFCC; font-family: "times" system" value="Loading..." type="text" name="klokje" size="44" readonly>')
function geefdeklok()
// verander hierboven de kleuren van het klokje, alsmede de kleur van de omlijning, achtergrond
{
var klok = new Date()
var dagen = klok.getDate()
if(dagen<10)
dagen = "0" + dagen
var maanden = klok.getMonth() + 1
if(maanden<10)
maanden = "0" + maanden
var jaren = klok.getFullYear()
var uren = klok.getHours()
if(uren<10)
uren = "0" + uren
var minuten = klok.getMinutes()
if(minuten<10)
minuten = "0" + minuten
var seconden = klok.getSeconds()
if(seconden<10)
seconden = "0" + seconden
var detijd = dagen+"-"+maanden+"-"+jaren+" en de tijd is "+uren+":"+minuten+":"+seconden;
klokje.value = "Vandaag is het " + detijd;
}
setInterval("geefdeklok()", 1000)
// -->
</script>
</td>
</tr>
</table>
</center>
</div>
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<td>
<img src="../images/spacer.gif" width="6" height="1">
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