<head>

		<!-- FAVICON -->
		<link rel="shortcut icon" href="favicon.png" type="image/x-icon">
		<link rel="icon" href="favicon.png" type="image/x-icon">
		
		<!-- TITLE -->
		<title>Registreren</title>
		
		<!-- DESCRIPTION -->
		<meta name="author" content=" " />
		<meta name="description" content="" />
		<meta name="keywords"  content="" />

		<!-- GOOGLE FONTS -->
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		<![endif]-->
	
	</head>

<?php

$captcha      = 'innovatie';
$price        = 5142.50;
$participants = 5;
$dates        = array(
  'cevitts_day1'        => 'CEVITTS 2012, Day 1 (March 27)',
  'cevitts_day2'  => 'CEVITTS 2012, Day 2 (March 28)' ,

);

// Form data
$formdata = array(
  "captcha"         => isset($_POST['captcha'])       ? strtolower(trim($_POST['captcha'])) : "",
  "promocode"       => isset($_POST['promocode'])       ? trim(strtolower($_POST['promocode']))   : "",
  "company"         => isset($_POST['company'])         ? trim($_POST['company'])                 : "",
  "country"         => isset($_POST['country'])         ? trim($_POST['country'])                 : "",
  "address"         => isset($_POST['address'])         ? trim($_POST['address'])                 : "",
  "city"            => isset($_POST['city'])            ? trim($_POST['city'])                    : "",
  "postalcode"      => isset($_POST['postalcode'])      ? trim(strtoupper($_POST['postalcode']))  : "",
  "phone"           => isset($_POST['phone'])           ? trim(strtolower($_POST['phone']))       : "",
  "mobile"          => isset($_POST['mobile'])          ? trim(strtolower($_POST['mobile']))      : "",
  "invoice"         => isset($_POST['invoice'])         ? trim($_POST['invoice'])                 : "",
  "payment"         => isset($_POST['payment'])         ? trim($_POST['payment'])                 : "online",
  "date"            => isset($_POST['date'])            ? trim($_POST['date'])                    : "",
  "participants"    => array(),
);
$errors = array();

if (isset($_POST['captcha']) && $captcha != $formdata['captcha']) { 
  $errors[] = 'VUL A.U.B. HET WOORD IN ZOALS AANGEGEVEN OM TE BEWIJZEN DAT U GEEN SPAMBOT BENT.'; 
}

// Participants
for ($i = 0; $i < $participants; $i++) {
  $participant = array(
    "firstname" => "",
    "lastname"  => "",
    "email"     => "",
    "jobrole"   => "",
	"twitter"   => "",
  );
  // Fields
  foreach ($participant as $field => &$value) {
    if (isset($_POST[$field][$i])) {
      $value = $_POST[$field][$i];
    }
  }
  $formdata['participants'][] = $participant;
}
  
// If the form was submitted
if (isset($_POST['action']) && empty($errors)) {
  // Example code: Adjust price if the first participant has filled in a first name
  if (!empty($formdata['participants'][0]['lastname'])) {
    $price += 0.00;
 
 }
  // The same for the second participant
  if (!empty($formdata['participants'][1]['lastname'])) {
    $price += 5057.50;
  }
    // The same for the third participant
  if (!empty($formdata['participants'][2]['lastname'])) {
    $price += 5057.50;
  }
    // The same for the fourth participant
  if (!empty($formdata['participants'][3]['lastname'])) {
    $price += 5057.50;
  }
      // The same for the fifth participant
  if (!empty($formdata['participants'][4]['lastname'])) {
    $price += 5057.50;
  }


  // Apply promotion codes
  if ($formdata['promocode'] == 'bitaaaa') {
    $price = $price * 0.50;
  }
  
  // Order data
$price = round($price, 2);
  $orderid = uniqid();
  $email = $formdata['participants'][0]['email'];
  
  // Write result to CSV
  $csvfile = '/home/bita/csv/registraties-bi.csv'; // Make sure this file can be written to
  if (!file_exists($csvfile) || filesize($csvfile) == 0) {
    // New file, create and add headers
    $csv = fopen($csvfile, 'a');
    $headers = array('Date', 'Order id', 'Price', 'Promotion code', 'Company', 'Address', 'City', 'Postal code', 'Phone number', 'Mobile number', 'Payment method', 'Invoice', );
	for ($i = 0; $i < $participants; $i++) {
      $headers[] = 'First name';
      $headers[] = 'Last name';
      $headers[] = 'Email';
      $headers[] = 'Role';
    }
    $headers[] = 'White Papers Computable';
    fputcsv($csv, $headers);
    fclose($csv);
  }
  $csv = fopen($csvfile, 'a');
  $fields = array();
  $fields[] = date('d-m-Y H:i:s');
  $fields[] = $orderid;
  $fields[] = $price;
  $fields[] = $formdata["promocode"];
  $fields[] = $formdata["company"];
  $fields[] = $formdata["address"];
  $fields[] = $formdata["city"];
  $fields[] = $formdata["postalcode"];
  $fields[] = $formdata["phone"];
  $fields[] = $formdata["mobile"];
  $fields[] = $formdata["payment"];
  $fields[] = $formdata["invoice"];
  foreach ($formdata['participants'] as $participant) {
    $fields[] = $participant["firstname"];
    $fields[] = $participant["lastname"];
    $fields[] = $participant["email"];
    $fields[] = $participant["jobrole"];
  }
    fputcsv($csv, $fields);
  fclose($csv);
  
  // Create email
  $subject = "Masterclass Business Innovation";

  $body  = "";
  $body .= "Order id:       ". $orderid ."\n";
  $body .= "Price:          ". $price   ."\n";
  $body .= "\n";
  $body .= "Promotion code: ". $formdata["promocode"]  ."\n";
  $body .= "Company:        ". $formdata["company"]    ."\n";
  $body .= "Country:        ". $formdata["country"]    ."\n";
  $body .= "Address:        ". $formdata["address"]    ."\n";
  $body .= "City:           ". $formdata["city"]    ."\n";
    $body .= "Country:           ". $formdata["country"]    ."\n";
  $body .= "Postal code:    ". $formdata["postalcode"] ."\n";
  $body .= "Phone number:   ". $formdata["phone"]      ."\n";
  $body .= "Mobile number:  ". $formdata["mobile"]     ."\n";
  $body .= "Payment method: ". $formdata["payment"]    ."\n";
  $body .= "Date:           ". $formdata["date"]       ."\n";
  $body .= "Invoice:\n";
  $body .= $formdata["invoice"] ."\n\n";
  
  $body .= "Participants:\n\n";
  
  foreach ($formdata['participants'] as $participant) {
    $body .= "  First name: ". $participant["firstname"] ."\n";
    $body .= "  Last name:  ". $participant["lastname"]  ."\n";
    $body .= "  Email:      ". $participant["email"]     ."\n";
    $body .= "  Job role:   ". $participant["jobrole"]   ."\n";
	$body .= "  Twitter:   ". $participant["twitter"]   ."\n";
    $body .= "\n";
	
	    $body .=  $participant["firstname"] ."\n";
    $body .= $participant["lastname"]  ."\n";
    $body .= $participant["email"]     ."\n";
    $body .= $participant["jobrole"]   ."\n";
	$body .= $participant["twitter"]   ."\n";
    $body .= "\n";
	
	$body .= $formdata["company"]    ."\n";
  $body .= $formdata["country"]    ."\n";
  $body .= $formdata["address"]    ."\n";
  $body .= $formdata["city"]    ."\n";
    $body .= $formdata["country"]    ."\n";
  $body .= $formdata["postalcode"] ."\n";
  $body .= $formdata["phone"]      ."\n";
  $body .= $formdata["mobile"]     ."\n";
  }

  $headers  = "Content-Type: text/plain\r\n";
  $headers .= "From: Masterclass Institute <info@masterclassinstitute.nl>\r\n";
			 		
  mail("jv@bita-center.com, hvb@bita-center.com, mh@bita-center.com", $subject, $body, $headers);
    mail($email, "Bevestiging registratie MasterClass serie Business Innovation", $body, $headers);
  
  // Display payment form
  if ($formdata['payment'] == 'online') {
?>
<div style="text-align: center">
  <p><strong>Online Payment Number <?php print $orderid; ?></strong></p>
  <p>Subscription fee: <?php print $price;?> &euro;</p>
  <form method="post" action="https://secure.ogone.com/ncol/prod/orderstandard.asp">
    <input type="hidden" name="PSPID" value="bolwerk">
    <input type="hidden" name="orderID" value="<?php print $orderid; ?>" />
    <input type="hidden" name="amount" value="<?php print $price * 100; ?>" />
    <input type="hidden" name="currency" value="EUR" />
    <input type="hidden" name="language" value="en_US" />
    <!-- lay out information -->
    <input type="hidden" name="TITLE" value="Masterclass Institute" />
    <input type="hidden" name="BGCOLOR" value="#FFFFFF" />
    <input type="hidden" name="TXTCOLOR" value="#000000" />
    <input type="hidden" name="TBLBGCOLOR" value="#FFFFFF" />
    <input type="hidden" name="TBLTXTCOLOR" value="#000000" />
    <input type="hidden" name="BUTTONBGCOLOR" value="#FFFFFF" />
    <input type="hidden" name="BUTTONTXTCOLOR" value="#000000" />
    <input type="hidden" name="LOGO" value="" />
    <input type="hidden" name="FONTTYPE" value="verdana" />
    <!-- miscellanous -->
    <!-- Post sale -->
    <input type="hidden" name="accepturl" value="http://www.masterclassinstitute.nl/validation1.html" />
    <input type="hidden" name="declineurl" value="http://www.masterclassinstitute.nl/validation2.html" />
    <input type="hidden" name="exceptionurl" value="http://www.masterclassinstitute.nl/validation2.html" />
    <input type="hidden" name="cancelurl" value="http://www.masterclassinstitute.nl/validation2.html" />
    <!-- -->
    <input type="hidden" name="COM" value="MasterClass Business Innovation" />
    <input type="hidden" name="CN" value="" />
    <input type="hidden" name="EMAIL" value="<?php echo htmlspecialchars($email); ?>" />
    <input type="hidden" name="PM" value="" />
    <input type="hidden" name="BRAND" value="<?php echo htmlspecialchars($formdata['company']); ?>" />
    <input type="hidden" name="ownerZIP" value="<?php echo htmlspecialchars($formdata['postalcode']); ?>" />
    <input type="hidden" name="owneraddress" value="<?php echo htmlspecialchars($formdata['address']); ?>" />
    <input type="submit" value="Proceed secure payment" />
  </form>
</div>
<?php
  }
  // Redirect
  else {
    header("Location: /validation1");
    exit();
  }
}
else {
?>

<form method="post" id="registratie">
  <h2>&nbsp;</h2>
  <p><input type="checkbox" checked="checked" />
  <h2>Ja, ik schrijf mij / wij schrijven ons in voor de MasterClass-serie 'Business Innovation'. Deelname kost €4250,- pp. excl. btw. </h2></p>
  <p>
    <?php
    if (count($errors)) {
      foreach ($errors as $error) {
        echo '<p>'. $error .'</p>';
      }
    }
  ?>
  </p>
<table class="table table-bordered table-striped" cellpadding="0" cellspacing="0" id="registratie">
    <tr>
      <th valign="top">Kortingscode:</th>
      <td valign="top"><input type="text" size="16" name="promocode" value="<?php print htmlspecialchars($formdata['promocode']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Bedrijf:</th>
      <td valign="top"><input type="text" size="75" name="company" value="<?php print htmlspecialchars($formdata['company']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Land:</th>
      <td valign="top"><p>
        <select name="country" value="<?php print htmlspecialchars($formdata['country']); ?>">
          <option value="">Country...</option>
          <option value="Afganistan">Afghanistan</option>
          <option value="Albania">Albania</option>
          <option value="Algeria">Algeria</option>
          <option value="American Samoa">American Samoa</option>
          <option value="Andorra">Andorra</option>
          <option value="Angola">Angola</option>
          <option value="Anguilla">Anguilla</option>
          <option value="Antigua &amp; Barbuda">Antigua &amp; Barbuda</option>
          <option value="Argentina">Argentina</option>
          <option value="Armenia">Armenia</option>
          <option value="Aruba">Aruba</option>
          <option value="Australia">Australia</option>
          <option value="Austria">Austria</option>
          <option value="Azerbaijan">Azerbaijan</option>
          <option value="Bahamas">Bahamas</option>
          <option value="Bahrain">Bahrain</option>
          <option value="Bangladesh">Bangladesh</option>
          <option value="Barbados">Barbados</option>
          <option value="Belarus">Belarus</option>
          <option value="Belgium">Belgium</option>
          <option value="Belize">Belize</option>
          <option value="Benin">Benin</option>
          <option value="Bermuda">Bermuda</option>
          <option value="Bhutan">Bhutan</option>
          <option value="Bolivia">Bolivia</option>
          <option value="Bonaire">Bonaire</option>
          <option value="Bosnia &amp; Herzegovina">Bosnia &amp; Herzegovina</option>
          <option value="Botswana">Botswana</option>
          <option value="Brazil">Brazil</option>
          <option value="British Indian Ocean Ter">British Indian Ocean Ter</option>
          <option value="Brunei">Brunei</option>
          <option value="Bulgaria">Bulgaria</option>
          <option value="Burkina Faso">Burkina Faso</option>
          <option value="Burundi">Burundi</option>
          <option value="Cambodia">Cambodia</option>
          <option value="Cameroon">Cameroon</option>
          <option value="Canada">Canada</option>
          <option value="Canary Islands">Canary Islands</option>
          <option value="Cape Verde">Cape Verde</option>
          <option value="Cayman Islands">Cayman Islands</option>
          <option value="Central African Republic">Central African Republic</option>
          <option value="Chad">Chad</option>
          <option value="Channel Islands">Channel Islands</option>
          <option value="Chile">Chile</option>
          <option value="China">China</option>
          <option value="Christmas Island">Christmas Island</option>
          <option value="Cocos Island">Cocos Island</option>
          <option value="Colombia">Colombia</option>
          <option value="Comoros">Comoros</option>
          <option value="Congo">Congo</option>
          <option value="Cook Islands">Cook Islands</option>
          <option value="Costa Rica">Costa Rica</option>
          <option value="Cote DIvoire">Cote D'Ivoire</option>
          <option value="Croatia">Croatia</option>
          <option value="Cuba">Cuba</option>
          <option value="Curaco">Curacao</option>
          <option value="Cyprus">Cyprus</option>
          <option value="Czech Republic">Czech Republic</option>
          <option value="Denmark">Denmark</option>
          <option value="Djibouti">Djibouti</option>
          <option value="Dominica">Dominica</option>
          <option value="Dominican Republic">Dominican Republic</option>
          <option value="East Timor">East Timor</option>
          <option value="Ecuador">Ecuador</option>
          <option value="Egypt">Egypt</option>
          <option value="El Salvador">El Salvador</option>
          <option value="Equatorial Guinea">Equatorial Guinea</option>
          <option value="Eritrea">Eritrea</option>
          <option value="Estonia">Estonia</option>
          <option value="Ethiopia">Ethiopia</option>
          <option value="Falkland Islands">Falkland Islands</option>
          <option value="Faroe Islands">Faroe Islands</option>
          <option value="Fiji">Fiji</option>
          <option value="Finland">Finland</option>
          <option value="France">France</option>
          <option value="French Guiana">French Guiana</option>
          <option value="French Polynesia">French Polynesia</option>
          <option value="French Southern Ter">French Southern Ter</option>
          <option value="Gabon">Gabon</option>
          <option value="Gambia">Gambia</option>
          <option value="Georgia">Georgia</option>
          <option value="Germany">Germany</option>
          <option value="Ghana">Ghana</option>
          <option value="Gibraltar">Gibraltar</option>
          <option value="Great Britain">Great Britain</option>
          <option value="Greece">Greece</option>
          <option value="Greenland">Greenland</option>
          <option value="Grenada">Grenada</option>
          <option value="Guadeloupe">Guadeloupe</option>
          <option value="Guam">Guam</option>
          <option value="Guatemala">Guatemala</option>
          <option value="Guinea">Guinea</option>
          <option value="Guyana">Guyana</option>
          <option value="Haiti">Haiti</option>
          <option value="Hawaii">Hawaii</option>
          <option value="Honduras">Honduras</option>
          <option value="Hong Kong">Hong Kong</option>
          <option value="Hungary">Hungary</option>
          <option value="Iceland">Iceland</option>
          <option value="India">India</option>
          <option value="Indonesia">Indonesia</option>
          <option value="Iran">Iran</option>
          <option value="Iraq">Iraq</option>
          <option value="Ireland">Ireland</option>
          <option value="Isle of Man">Isle of Man</option>
          <option value="Israel">Israel</option>
          <option value="Italy">Italy</option>
          <option value="Jamaica">Jamaica</option>
          <option value="Japan">Japan</option>
          <option value="Jordan">Jordan</option>
          <option value="Kazakhstan">Kazakhstan</option>
          <option value="Kenya">Kenya</option>
          <option value="Kiribati">Kiribati</option>
          <option value="Korea North">Korea North</option>
          <option value="Korea Sout">Korea South</option>
          <option value="Kuwait">Kuwait</option>
          <option value="Kyrgyzstan">Kyrgyzstan</option>
          <option value="Laos">Laos</option>
          <option value="Latvia">Latvia</option>
          <option value="Lebanon">Lebanon</option>
          <option value="Lesotho">Lesotho</option>
          <option value="Liberia">Liberia</option>
          <option value="Libya">Libya</option>
          <option value="Liechtenstein">Liechtenstein</option>
          <option value="Lithuania">Lithuania</option>
          <option value="Luxembourg">Luxembourg</option>
          <option value="Macau">Macau</option>
          <option value="Macedonia">Macedonia</option>
          <option value="Madagascar">Madagascar</option>
          <option value="Malaysia">Malaysia</option>
          <option value="Malawi">Malawi</option>
          <option value="Maldives">Maldives</option>
          <option value="Mali">Mali</option>
          <option value="Malta">Malta</option>
          <option value="Marshall Islands">Marshall Islands</option>
          <option value="Martinique">Martinique</option>
          <option value="Mauritania">Mauritania</option>
          <option value="Mauritius">Mauritius</option>
          <option value="Mayotte">Mayotte</option>
          <option value="Mexico">Mexico</option>
          <option value="Midway Islands">Midway Islands</option>
          <option value="Moldova">Moldova</option>
          <option value="Monaco">Monaco</option>
          <option value="Mongolia">Mongolia</option>
          <option value="Montserrat">Montserrat</option>
          <option value="Morocco">Morocco</option>
          <option value="Mozambique">Mozambique</option>
          <option value="Myanmar">Myanmar</option>
          <option value="Nambia">Nambia</option>
          <option value="Nauru">Nauru</option>
          <option value="Nepal">Nepal</option>
          <option value="Netherland Antilles">Netherland Antilles</option>
          <option value="Netherlands">Netherlands (Holland, Europe)</option>
          <option value="Nevis">Nevis</option>
          <option value="New Caledonia">New Caledonia</option>
          <option value="New Zealand">New Zealand</option>
          <option value="Nicaragua">Nicaragua</option>
          <option value="Niger">Niger</option>
          <option value="Nigeria">Nigeria</option>
          <option value="Niue">Niue</option>
          <option value="Norfolk Island">Norfolk Island</option>
          <option value="Norway">Norway</option>
          <option value="Oman">Oman</option>
          <option value="Pakistan">Pakistan</option>
          <option value="Palau Island">Palau Island</option>
          <option value="Palestine">Palestine</option>
          <option value="Panama">Panama</option>
          <option value="Papua New Guinea">Papua New Guinea</option>
          <option value="Paraguay">Paraguay</option>
          <option value="Peru">Peru</option>
          <option value="Phillipines">Philippines</option>
          <option value="Pitcairn Island">Pitcairn Island</option>
          <option value="Poland">Poland</option>
          <option value="Portugal">Portugal</option>
          <option value="Puerto Rico">Puerto Rico</option>
          <option value="Qatar">Qatar</option>
          <option value="Republic of Montenegro">Republic of Montenegro</option>
          <option value="Republic of Serbia">Republic of Serbia</option>
          <option value="Reunion">Reunion</option>
          <option value="Romania">Romania</option>
          <option value="Russia">Russia</option>
          <option value="Rwanda">Rwanda</option>
          <option value="St Barthelemy">St Barthelemy</option>
          <option value="St Eustatius">St Eustatius</option>
          <option value="St Helena">St Helena</option>
          <option value="St Kitts-Nevis">St Kitts-Nevis</option>
          <option value="St Lucia">St Lucia</option>
          <option value="St Maarten">St Maarten</option>
          <option value="St Pierre &amp; Miquelon">St Pierre &amp; Miquelon</option>
          <option value="St Vincent &amp; Grenadines">St Vincent &amp; Grenadines</option>
          <option value="Saipan">Saipan</option>
          <option value="Samoa">Samoa</option>
          <option value="Samoa American">Samoa American</option>
          <option value="San Marino">San Marino</option>
          <option value="Sao Tome & Principe">Sao Tome &amp; Principe</option>
          <option value="Saudi Arabia">Saudi Arabia</option>
          <option value="Senegal">Senegal</option>
          <option value="Seychelles">Seychelles</option>
          <option value="Sierra Leone">Sierra Leone</option>
          <option value="Singapore">Singapore</option>
          <option value="Slovakia">Slovakia</option>
          <option value="Slovenia">Slovenia</option>
          <option value="Solomon Islands">Solomon Islands</option>
          <option value="Somalia">Somalia</option>
          <option value="South Africa">South Africa</option>
          <option value="Spain">Spain</option>
          <option value="Sri Lanka">Sri Lanka</option>
          <option value="Sudan">Sudan</option>
          <option value="Suriname">Suriname</option>
          <option value="Swaziland">Swaziland</option>
          <option value="Sweden">Sweden</option>
          <option value="Switzerland">Switzerland</option>
          <option value="Syria">Syria</option>
          <option value="Tahiti">Tahiti</option>
          <option value="Taiwan">Taiwan</option>
          <option value="Tajikistan">Tajikistan</option>
          <option value="Tanzania">Tanzania</option>
          <option value="Thailand">Thailand</option>
          <option value="Togo">Togo</option>
          <option value="Tokelau">Tokelau</option>
          <option value="Tonga">Tonga</option>
          <option value="Trinidad &amp; Tobago">Trinidad &amp; Tobago</option>
          <option value="Tunisia">Tunisia</option>
          <option value="Turkey">Turkey</option>
          <option value="Turkmenistan">Turkmenistan</option>
          <option value="Turks &amp; Caicos Is">Turks &amp; Caicos Is</option>
          <option value="Tuvalu">Tuvalu</option>
          <option value="Uganda">Uganda</option>
          <option value="Ukraine">Ukraine</option>
          <option value="United Arab Erimates">United Arab Emirates</option>
          <option value="United Kingdom">United Kingdom</option>
          <option value="United States of America">United States of America</option>
          <option value="Uraguay">Uruguay</option>
          <option value="Uzbekistan">Uzbekistan</option>
          <option value="Vanuatu">Vanuatu</option>
          <option value="Vatican City State">Vatican City State</option>
          <option value="Venezuela">Venezuela</option>
          <option value="Vietnam">Vietnam</option>
          <option value="Virgin Islands (Brit)">Virgin Islands (Brit)</option>
          <option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
          <option value="Wake Island">Wake Island</option>
          <option value="Wallis &amp; Futana Is">Wallis &amp; Futana Is</option>
          <option value="Yemen">Yemen</option>
          <option value="Zaire">Zaire</option>
          <option value="Zambia">Zambia</option>
          <option value="Zimbabwe">Zimbabwe</option>
        </select>
      </p></td>
    </tr>
    <tr>
      <th valign="top">Adres:</th>
      <td valign="top"><input type="text" size="75" name="address" value="<?php print htmlspecialchars($formdata['address']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Stad:</th>
      <td valign="top"><input type="text" size="75" name="city" value="<?php print htmlspecialchars($formdata['city']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Poscode:</th>
      <td valign="top"><input type="text" size="75" name="postalcode" value="<?php print htmlspecialchars($formdata['postalcode']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Telefoonr:</th>
      <td valign="top"><input type="text" size="75" name="phone" value="<?php print htmlspecialchars($formdata['phone']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Mobiel:</th>
      <td valign="top"><input type="text" size="75" name="mobile" value="<?php print htmlspecialchars($formdata['mobile']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">CAPTCHA:</th>
      <td valign="top"><input type="text" size="40" name="captcha" value="" /><br/>
      <small>Vul hier boven het woord &quot;<b><?php print $captcha; ?></b>&quot; in om aan te tonen dat u geen spambot bent.</small></td>
    </tr>
  </table>
  
  <p>
    <?php
  foreach ($formdata['participants'] as $i => $participant) {
  ?>
  </p>
  <p>&nbsp; </p>
  <h3><strong>Deelnemer<?php print $i > 0 ? " ". ($i + 1) : ""; ?>:</strong></h3>
  <table class="table table-bordered table-striped" cellpadding="0" cellspacing="0" id="registratie">
    <tr>
      <th valign="top">Voornaam:*</th>
      <td valign="top"><input type="text" size="75" name="firstname[<?php print $i; ?>]" value="<?php print htmlspecialchars($participant['firstname']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Achternaam:*</th>
      <td valign="top"><input type="text" size="75" name="lastname[<?php print $i; ?>]" value="<?php print htmlspecialchars($participant['lastname']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Functie:*</th>
      <td valign="top"><input type="text" size="75" name="jobrole[<?php print $i; ?>]" value="<?php print htmlspecialchars($participant['jobrole']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Emailadres:*</th>
      <td valign="top"><input type="text" size="75" name="email[<?php print $i; ?>]" value="<?php print htmlspecialchars($participant['email']); ?>" /></td>
    </tr>
    <tr>
      <th valign="top">Twitter:</th>
      <td valign="top"><input type="text" size="75" name="twitter[<?php print $i; ?>]2" value="<?php print htmlspecialchars($participant['twitter']); ?>" /></td>
    </tr>
  </table>
  
  <?php
  }
  ?>
<br>
  <h3><strong><br>
  Factuur:</strong></h3>
<p>In het geval dat u een factuur wilt ontvangen en uw bedrijf heeft hier specifieke informatie voor nodig (ordernummer, kostenplaats, etc) vul die dan hierN onder in:</p>
<textarea name="invoice" rows="6" cols="75"><?php print htmlspecialchars($formdata['invoice']); ?></textarea>

<br>
  
  <h3><strong>Betaalmethode:</strong></h3>
  <input type="radio" name="payment" value="online" id="payment-online" <?php print $formdata['payment'] == 'online' ? 'checked="checked"' : ''; ?> /> <label for="payment-online"><strong>OPTIE 1: Online betaling (via een secure server)</strong></label>
  <p>Creditcards zullen via de Secure Server worden verwerkt. Na het verzenden van uw informatie zult u naar de Secure Server worden doorgeleid. (De prijs die u ziet is <strong>inclusief BTW</strong>).</p>
  <p>Wij accepteren:<br />
  <img alt="" src="img/payment.png" /><br>
  <br>
  
  <input type="radio" name="payment" value="bill" id="payment-bill" <?php print $formdata['payment'] == 'bill' ? 'checked="checked"' : ''; ?> /> <label for="payment-online"><strong>OPTIE 2: Stuur een rekening </strong></label> 
  (&euro; 20,- administratie kosten zullen in rekening worden gebracht)  <br>
  <br>
  <h3><strong>Algemene voorwaarden</strong></h3>
  <p>Tot 15 werkdagen voor de conferentie kunt u tegen de annuleringskosten van € 99,- annuleren. Als u na deze dag annuleert, dan bent u het volledige factuurbedrag verschuldigd. Annuleren kan alléén schriftelijk (per post of per fax). Vervanging door een collega is altijd toegestaan.<br>
  Door op de &quot;Registreer&quot; knop te drukken gaat u tevens akkoord met opname in ons mailbestand. Daarmee informeren we u in de toekomst over volgende edities van dit event en vergelijkbare activiteiten. Ten alle tijden kunt u zich bij een volgend emailbericht afmelden bij de lijst. </p>
  <input type="hidden" name="action" value="submit" />
  
  <div style="text-align: center">
    <input type="reset" value="Opnieuw" class="btn btn-large" />&nbsp;&nbsp;
    <input type="submit" value="Registreer" class="btn btn-success btn-large" />
    
    <p><br>
      <a href="contact">Neem contact op</a> voor meer informatie of vragen</p>
    <p>&nbsp;</p>
  </div>
  
  
</form>
<?php
}
?>