{"id":816,"date":"2024-11-18T18:46:00","date_gmt":"2024-11-18T18:46:00","guid":{"rendered":"https:\/\/www.wijkenergie2804.nl\/mammoet\/?page_id=816"},"modified":"2024-12-17T09:22:56","modified_gmt":"2024-12-17T09:22:56","slug":"aanmelden-wijkactie-gevels-impregneren","status":"publish","type":"page","link":"https:\/\/www.wijkenergie2804.nl\/mammoet\/home\/activiteiten\/collectieve-wijkacties\/aanmelden-wijkactie-gevels-impregneren\/","title":{"rendered":"Aanmelden wijkactie gevels impregneren"},"content":{"rendered":"<p>Voor meer informatie over deze actie, klik op onze <a href=\"https:\/\/www.wijkenergie2804.nl\/mammoet\/wp-content\/uploads\/sites\/3\/2024\/12\/Menukaart-Mammoet-Gevels-Impregneren-EXTERN.pdf\" target=\"_blank\" rel=\"noopener\">Menukaart Gevels Impregneren<\/a><\/p>\n<script>\nvar 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             <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_8'  action='\/mammoet\/wp-json\/wp\/v2\/pages\/816' data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_8_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/www.wijkenergie2804.nl\/mammoet\/wp-content\/uploads\/sites\/3\/2024\/11\/cropped-Logo-WijkEnergie2804-Mammoet-West-2.png.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.wijkenergie2804.nl\/mammoet\/wp-content\/uploads\/sites\/3\/2024\/11\/cropped-Logo-WijkEnergie2804-Mammoet-West-2.png.jpg\" alt=\"\" width=\"300\" height=\"225\" class=\"alignleft size-medium wp-image-1434\" \/><\/a><\/li><li id=\"field_8_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_6'>Graag uw achternaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_8_6' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >In welke buurt woont u?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_8_4'>\n\t\t\t<li class='gchoice gchoice_8_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='Bertelmanstraat'  id='choice_8_4_0'    \/>\n\t\t\t\t<label for='choice_8_4_0' id='label_8_4_0' class='gform-field-label gform-field-label--type-inline'>Bertelmanstraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_1'>\n\t\t\t\t<input name='input_4' type='radio' value='Calslaan'  id='choice_8_4_1'    \/>\n\t\t\t\t<label for='choice_8_4_1' id='label_8_4_1' class='gform-field-label gform-field-label--type-inline'>Calslaan<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_2'>\n\t\t\t\t<input name='input_4' type='radio' value='Kesperstraat'  id='choice_8_4_2'    \/>\n\t\t\t\t<label for='choice_8_4_2' id='label_8_4_2' class='gform-field-label gform-field-label--type-inline'>Kesperstraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_3'>\n\t\t\t\t<input name='input_4' type='radio' value='Kluitmanstraat'  id='choice_8_4_3'    \/>\n\t\t\t\t<label for='choice_8_4_3' id='label_8_4_3' class='gform-field-label gform-field-label--type-inline'>Kluitmanstraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_4'>\n\t\t\t\t<input name='input_4' type='radio' value='Kramersweg'  id='choice_8_4_4'    \/>\n\t\t\t\t<label for='choice_8_4_4' id='label_8_4_4' class='gform-field-label gform-field-label--type-inline'>Kramersweg<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_5'>\n\t\t\t\t<input name='input_4' type='radio' value='Raesbergenstraat'  id='choice_8_4_5'    \/>\n\t\t\t\t<label for='choice_8_4_5' id='label_8_4_5' class='gform-field-label gform-field-label--type-inline'>Raesbergenstraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_6'>\n\t\t\t\t<input name='input_4' type='radio' value='Terwenstraat'  id='choice_8_4_6'    \/>\n\t\t\t\t<label for='choice_8_4_6' id='label_8_4_6' class='gform-field-label gform-field-label--type-inline'>Terwenstraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_7'>\n\t\t\t\t<input name='input_4' type='radio' value='Van der Boschstraat'  id='choice_8_4_7'    \/>\n\t\t\t\t<label for='choice_8_4_7' id='label_8_4_7' class='gform-field-label gform-field-label--type-inline'>Van der Boschstraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_8'>\n\t\t\t\t<input name='input_4' type='radio' value='Van der Puttestraat'  id='choice_8_4_8'    \/>\n\t\t\t\t<label for='choice_8_4_8' id='label_8_4_8' class='gform-field-label gform-field-label--type-inline'>Van der Puttestraat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_4_9'>\n\t\t\t\t<input name='input_4' type='radio' value='Anna van Meertenstraat'  id='choice_8_4_9'    \/>\n\t\t\t\t<label for='choice_8_4_9' id='label_8_4_9' class='gform-field-label gform-field-label--type-inline'>Anna van Meertenstraat<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_8_37\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_11\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_11'>Graag uw e-mail adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_8_11' type='email' value='' class='small'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_8_22\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_12'>Uw telefoonnummer<\/label><div class='gfield_description' id='gfield_description_8_12'>Dit om de afspraken en werkzaamheden goed en tijdig te communiceren.<\/div><div class='ginput_container ginput_container_text'><input name='input_12' id='input_8_12' type='text' value='' class='small'  aria-describedby=\"gfield_description_8_12\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_35\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_29\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_29'>Hoe is de staat van uw gevels ?<\/label><div class='gfield_description' id='gfield_description_8_29'>Een korte omschrijving volstaat: goed, redelijk, gemiddeld, matig, slecht.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_8_29' class='textarea small'  aria-describedby=\"gfield_description_8_29\" maxlength='250'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_8_34\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Toestemming<\/label><div class='gfield_description' id='gfield_description_8_14'>Hierbij geef ik toestemming om mijn gegevens door te geven aan de verbonden wijkpartner (bedrijf, enz.) die de werkzaamheden gaat uitvoeren. Hij\/zij zal deze gegevens alleen gebruiken voor de uitvoering van de collectieve wijkactie.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_8_14'><li class='gchoice gchoice_8_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Toestemming'  id='choice_8_14_1'   aria-describedby=\"gfield_description_8_14\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_8_14_1' id='label_8_14_1' class='gform-field-label gform-field-label--type-inline'>Toestemming<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_8_33\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_5\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_5'>Heeft u nog vragen, suggesties of opmerkingen?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_8_5' class='textarea small'   maxlength='250'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_8_32\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br\/><\/li><li id=\"field_8_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Wilt u onze Energieco\u00f6peratie WijkEnergie2804 ondersteunen?<\/label><div class='gfield_description' id='gfield_description_8_31'>Voor onze dienstverlening vragen wij u om donateur\/ondersteuner te worden van energieco\u00f6peratie WijkEnergie 2804. U ondersteunt hiermee onze activiteiten voor de wijk en haar wijkbewoners. De kosten zijn \u20ac 6,00 per jaar en wordt jaarlijks automatisch verlengd. Dit geldt per huisadres. Uiteraard kunt u altijd uw bijdrage be\u00ebindigen. <\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_8_31'>\n\t\t\t<li class='gchoice gchoice_8_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='Ja, zeker'  id='choice_8_31_0'    \/>\n\t\t\t\t<label for='choice_8_31_0' id='label_8_31_0' class='gform-field-label gform-field-label--type-inline'>Ja, zeker<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='Nee, bedankt'  id='choice_8_31_1'    \/>\n\t\t\t\t<label for='choice_8_31_1' id='label_8_31_1' class='gform-field-label gform-field-label--type-inline'>Nee, bedankt<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='Ik ben al donateur'  id='choice_8_31_2'    \/>\n\t\t\t\t<label for='choice_8_31_2' id='label_8_31_2' class='gform-field-label gform-field-label--type-inline'>Ik ben al donateur<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_8_1\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_8_1 gfield_product_8_1 gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_8_1_1'>Aanmelding bijdrage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_1.1' value='Aanmelding bijdrage' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_8_1' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_1.2' id='ginput_base_price_8_1' value='\u20ac 6,00' aria-label='Aanmelding bijdrage Prijs'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_1.3' value='1' class='ginput_quantity_8_1 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_8_13\" class=\"gfield gfield--type-pronamic_pay_payment_method_selector gfield--input-type-select field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_13'>Kies een betaalmethode<\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_8_13' class='large gfield_select'     aria-invalid=\"false\" ><option value='ideal' selected='selected'>iDEAL<\/option><\/select><\/div><\/li><li id=\"field_8_38\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below 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