{"id":71033,"date":"2025-07-25T12:07:50","date_gmt":"2025-07-25T10:07:50","guid":{"rendered":"https:\/\/fhi.nl\/?page_id=71033"},"modified":"2026-07-02T10:22:37","modified_gmt":"2026-07-02T08:22:37","slug":"inschrijfformulier","status":"publish","type":"page","link":"https:\/\/fhi.nl\/en\/medischetechnologie\/voor-exposanten\/inschrijfformulier\/","title":{"rendered":"Medical Technology Registration Form"},"content":{"rendered":"\n<header id=\"header\" class=\"header header--low header--branch\">\n\n\t\n\t\t\t<div class=\"header__background header__background--graphic\"><\/div>\n\t\n\t<div class=\"container\">\n\t\t<div class=\"header__content\">\n\t\t\t<div class=\"header__first\">\n\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<h6 class=\"header__subtitle\">Deelnemen als exposant <\/h6>\n\t\t\t\t\n\t\t\t\t<h1 class=\"header__title\" >\n\t\t\t\t\tMedische Technologie event\t\t\t\t<\/h1>\n\n\t\t\t\t<div class=\"header__dots-line\">\n\t\t\t\t\t<svg width=\"431\" height=\"9\" viewBox=\"0 0 431 9\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M430.799 4.192a1.136 1.136 0 1 1-2.272-.001 1.136 1.136 0 0 1 2.272 0Zm-27.272 0a1.135 1.135 0 1 1-2.27 0 1.135 1.135 0 0 1 2.27 0Zm-27.27 0a1.136 1.136 0 1 1-2.272-.001 1.136 1.136 0 0 1 2.272 0Zm-27.272 0a1.39 1.39 0 1 1-2.78 0 1.39 1.39 0 0 1 2.78 0Zm-27.78 0a1.645 1.645 0 1 1-3.29 0 1.645 1.645 0 0 1 3.29 0Zm-28.29 0a1.9 1.9 0 1 1-3.799 0 1.9 1.9 0 0 1 3.799 0Zm-28.799 0a2.154 2.154 0 1 1-4.308 0 2.154 2.154 0 0 1 4.308 0Zm-29.308 0a2.41 2.41 0 1 1-4.819 0 2.41 2.41 0 0 1 4.819 0Zm-29.819 0a2.663 2.663 0 1 1-5.326.001 2.663 2.663 0 0 1 5.326-.001Zm-30.327 0a2.919 2.919 0 1 1-5.837 0 2.919 2.919 0 0 1 5.837 0Zm-30.837 0a3.173 3.173 0 1 1-6.345.001 3.173 3.173 0 0 1 6.345 0Zm-31.346 0a3.428 3.428 0 1 1-6.856 0 3.428 3.428 0 0 1 6.856 0Zm-31.856 0a3.683 3.683 0 1 1-7.365 0 3.683 3.683 0 0 1 7.365 0Zm-32.365 0a3.937 3.937 0 1 1-7.875 0 3.937 3.937 0 0 1 7.875 0Zm-32.874 0a4.192 4.192 0 1 1-8.384 0 4.192 4.192 0 0 1 8.384 0Z\" fill=\"#FFF960\"\/><\/svg>\t\t\t\t<\/div>\n\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"header__description\">\n\t\t\t\t\t\t\t<p>27 januari 2027, Vianen<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\n\t\t\t\t\t\t\t<div class=\"header__second\">\n\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"header__branch-logos\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/fhi.nl\/app\/uploads\/2024\/02\/Industriele-elektronica.svg\" class=\"header__branch-logo\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t<\/div>\n<\/header>\n\n\t<div class=\"header__meta \">\n\t<div class=\"container\">\n\t\t<div class=\"header__meta__category\">\n\n\t\t\t\t\t\t\t<div class=\"header__meta__detail\">\n\t\t\t\t\t<div>Branch<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/fhi.nl\/en\/kennishub\/?_branches_kennishub=industriele-elektronica\" class=\"header__meta__detail--branch\">\n\t\t\t\t\t\t\t\tIndustri\u00eble Elektronica\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n\n<div class=\"form bg--white\">\n\t<div class=\"container\">\n\t\t<div class=\"form__wrapper form__wrapper--fullwidth show-required-description--true\">\n\t\t\t\t\t\t<div class=\"form__column form__column--form\">\n\t\t\t\t\t\t\t\t\t<div class='heading-wrapper'><svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><circle cx=\"6.394\" cy=\"6.5\" r=\"6.394\" fill=\"#000\"\/><\/svg><h2 class='form__title'>Schrijf je nu in als exposant<\/h2><\/div>\t\t\t\t\t\t\t\t<link rel='preload' href='https:\/\/fhi.nl\/app\/themes\/fhi\/dist\/gforms.670b7e2f.css' as='style' ><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 deprecated in the form editor context and will be removed in Gravity Forms 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_111' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_111' id='gform_111'  action='\/en\/wp-json\/wp\/v2\/pages\/71033#gf_111' data-formid='111' novalidate>\n        <div id='gf_progressbar_wrapper_111' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_111_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_111' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_111_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_111_4'>Bedrijfsnaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_111_4' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_111_5\" 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_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Deelname aan het Medische Technologie event 2027<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_111_5'>\n\t\t\t<div class='gchoice gchoice_111_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='FHI-ledenprijs \u20ac2.375,- excl. BTW'  id='choice_111_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_111_5_0' id='label_111_5_0' class='gform-field-label gform-field-label--type-inline'>FHI-ledenprijs \u20ac2.375,- excl. BTW<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_111_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Niet-ledenprijs \u20ac3.300,- ex Btw'  id='choice_111_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_111_5_1' id='label_111_5_1' class='gform-field-label gform-field-label--type-inline'>Niet-ledenprijs \u20ac3.300,- ex Btw<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_111_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_111_2' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_111_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_111_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_111_1'>\n                            \n                            <span id='input_111_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_111_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_111_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_111_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_111_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_111_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_111_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_111_6'>E-mailadres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_111_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_111_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_111_9'>Telefoonnummer (mobiel\/ rechtstreekst)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_111_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_111_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_111_10'>E-mailadres facturatie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_111_10' type='text' value='' class='large'  aria-describedby=\"gfield_description_111_10\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_111_10'>Bij voorkeur het directe e-mailadres van de financi\u00eble afdeling\/ administratie <\/div><\/div><div id=\"field_111_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_111_14'>Ordernummer\/ PO nummer<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_111_14' type='text' value='' class='large'  aria-describedby=\"gfield_description_111_14\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_111_14'>Indien van toepassing <\/div><\/div><fieldset id=\"field_111_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Bijdrage programma<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_111_12'>\n\t\t\t<div class='gchoice gchoice_111_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Ja, wij verzorgen een bijdrage aan het programma'  id='choice_111_12_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_111_12\"   \/>\n\t\t\t\t\t<label for='choice_111_12_0' id='label_111_12_0' class='gform-field-label gform-field-label--type-inline'>Ja, wij verzorgen een bijdrage aan het programma<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_111_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Nee, verzorgen geen bijdrage aan het programma'  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Neem contact op met rik.meijerhof@fhi.nl om de mogelijkheden te bespreken.<\/div><\/fieldset><div id=\"field_111_13\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_111_13'>Beschrijving bijdrage: lezing\/praktijkcase\/workshop\/demo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_111_13' class='textarea large'  aria-describedby=\"gfield_description_111_13\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_111_13'>Beschrijf kort je voorstel voor een presentatie \/ workshop in het seminarprogramma. 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