[paytium name="LOSSE COACHING SESSIE" description="LOSSE COACHING SESSIE"][paytium_field type="firstname" label="Voornaam" required="true" /][paytium_field type="lastname" label="Achternaam" required="true" /][paytium_field type="email" label="Email" required="true" newsletter="mailchimp" newsletter_label="Ik wil me gratis laten inspireren op het gebied van positief ouderschap & energiebalans voor moeders" /][paytium_field type="text" label="Straat" required="true" /][paytium_field type="text" label="Huisnummer" required="true" /][paytium_field type="text" label="Postcode" required="true" /][paytium_field type="text" label="Plaats" required="true" /][paytium_field type="text" label="Land" required="true" /][paytium_field type="text" label="Mobiele nummer" required="true" /][paytium_field type="label" label="LOSSE COACHING SESSIE voor €77" amount="0" /][paytium_button label="AANMELDEN VOOR LOSSE COACHING SESSIE" /][paytium_field type="label" label="Bedrag excl. BTW: € 60,83" amount="60,83" /][paytium_field type="label" label="+ BTW 21%: € 16,17" amount="16,17" /][paytium_total /][paytium_emails id="6902, 6649" /][/paytium]