<form class="md-form" style="color: #757575;" method="post" action="https://www.uisge-beatha.eu/"

  enctype="multipart/form-data">

  <div class="md-form"><input type="text" id="inputName" name="name" class="form-control" value="" required=""><label

      for="inputName">Uw naam</label></div>

  <div class="md-form"><input type="email" id="inputEmail" class="form-control" aria-describedby="inputEmail"

      placeholder="Voer geldig e-mail adres in" name="email" value="" required=""><label for="inputEmail"

      class="active">e-mail adres</label><small class="blue-text d-flex justify-content-start">Dit e-mail adres wordt

      nooit gedeeld.</small></div>

  <div class="col-12 col-md-6 form-check form-check-inline"><input type="radio" class="form-check-input"

      id="exampleRadios1" name="mailing" value="inschrijven" checked=""><label class="form-check-label"

      for="exampleRadios1">Inschrijven</label></div>

  <div class="col-12 col-md-6 form-check form-check-inline"><input type="radio" class="form-check-input"

      id="exampleRadios2" name="mailing" value="uitschrijven"><label class="form-check-label"

      for="exampleRadios2">Uitschrijven</label></div>

  <div class="g-recaptcha col-12 mt-4" data-sitekey="6LeEsKcUAAAAALptaHvvu84Y0KY8umo5YsiFd6iJ">

    <div style="width: 304px; height: 78px;">

      <div><iframe

          src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LeEsKcUAAAAALptaHvvu84Y0KY8umo5YsiFd6iJ&co=aHR0cHM6Ly93d3cudWlzZ2UtYmVhdGhhLmV1OjQ0Mw..&hl=pl&v=PRkVene3wKrZUWATSylf69ja&size=normal&cb=7fsnpgny87qf"

          width="304" height="78" role="presentation" name="a-dqk8b985a59q" frameborder="0" scrolling="no"

          sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>

      </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"

        style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>

    </div>

  </div>

  <div class="md-form d-flex flex-row mt-2"><button

      class="btn btn-sm blue-gradient btn-rounded waves-effect z-depth-0 white-text"

      type="submit">Verstuur</button><button

      class="btn btn-sm blue-gradient btn-rounded waves-effect z-depth-0 white-text" type="reset">Herstel</button></div>

  <input type="hidden" name="returnid" value="2"><input type="hidden" name="m3739bform" value="mailingForm"><input

    type="hidden" name="mact" value="CGBetterForms,m3739b,default,1"><input type="hidden" name="__guid"

    value="DD38B5ED-2946-4D21-B939-25178E379BE9"><input type="text" style="display: none;" name="__hpname" value="">

</form>