{"id":66,"date":"2024-09-11T12:16:23","date_gmt":"2024-09-11T12:16:23","guid":{"rendered":"https:\/\/care4medicals.be\/index.php\/registration\/"},"modified":"2025-09-09T15:05:04","modified_gmt":"2025-09-09T15:05:04","slug":"registration","status":"publish","type":"page","link":"https:\/\/care4medicals.be\/fr\/registration\/","title":{"rendered":"Inscription"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-f79af28e-5a91-4a98-8eae-1ccbe2eb98e1 wpforms-render-modern\" id=\"wpforms-68\"><form id=\"wpforms-form-68\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"68\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/66\" data-token=\"3bf9be88704e9e30af04c45919f49221\" data-token-time=\"1792760123\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-68-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Naam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-68-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-68-field_1-error\" required><label for=\"wpforms-68-field_1\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-68-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-68-field_1-last-error\" required><label for=\"wpforms-68-field_1-last\" class=\"wpforms-field-sublabel after\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-68-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-68-field_2\">Email  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-68-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-68-field_2-error\" required><\/div><div id=\"wpforms-68-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-68-field_18\">Telefoonnummer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-68-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-68-field_18-error\" required><\/div><div id=\"wpforms-68-field_19-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-68-field_19\">Event <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-68-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required=\"required\"><option value=\"Luik (FR) 24\/09\/2026\"  class=\"choice-3 depth-1\"  >Luik (FR) 24\/09\/2026<\/option><option value=\"Brussel (FR) 15\/10\/2026\"  class=\"choice-4 depth-1\"  >Brussel (FR) 15\/10\/2026<\/option><option value=\"Gent (NL) 19\/11\/2026\"  class=\"choice-5 depth-1\"  >Gent (NL) 19\/11\/2026<\/option><\/select><\/div><div id=\"wpforms-68-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-68-field_17\">RIZIV \/ INAMI <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-68-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-68-field_17-error\" aria-describedby=\"wpforms-68-field_17-description\" required><div id=\"wpforms-68-field_17-description\" class=\"wpforms-field-description\">Bent u student in de geneeskunde of tandheelkunde en nog niet in het bezit van een RIZIV-nummer? Gelieve ons in dat geval te contacteren via info@iomfcot.be<\/div><\/div><div id=\"wpforms-68-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-68-field_11\">Selecteer <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-68-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required=\"required\"><option value=\"Arts-specialist\"  class=\"choice-1 depth-1\"  >Arts-specialist<\/option><option value=\"Tandarts\"  class=\"choice-2 depth-1\"  >Tandarts<\/option><option value=\"Huisarts\"  class=\"choice-3 depth-1\"  >Huisarts<\/option><option value=\"Andere\"  selected='selected' class=\"choice-4 depth-1\"  >Andere<\/option><\/select><\/div>\t\t<div id=\"wpforms-68-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-68-field_3\" >opmerkingen?  RIZIV<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-68-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-68-field_12-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Selectievakken <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-68-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-68-field_12_1\" name=\"wpforms[fields][12][]\" value=\"Ik geef uitdrukkelijk toestemming aan IOMFCOT om de ingevulde persoonsgegevens te verwerken. Deze verwerking gebeurt enkel om uw aanvraag te beantwoorden en u daartoe te contacteren . U kan IOMFCOT steeds contacteren om uw gegevens in te zien, te wijzigen of te verwijderen. Meer info kan u lezen in de Privacyverklaring.\" aria-errormessage=\"wpforms-68-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-68-field_12_1\">Ik geef uitdrukkelijk toestemming aan IOMFCOT om de ingevulde persoonsgegevens te verwerken. Deze verwerking gebeurt enkel om uw aanvraag te beantwoorden en u daartoe te contacteren . U kan IOMFCOT steeds contacteren om uw gegevens in te zien, te wijzigen of te verwijderen. 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