[paytium name="TWEE IS NEE INSTAGRAM CURSUS" description="TWEE IS NEE INSTAGRAM CURSUS"][paytium_field type="name" label="Voornaam" required="true" /][paytium_field type="name" label="Achternaam" required="true" /][paytium_field type="email" label="Email" required="true" /][paytium_field type="text" label="Instagram account naam" required="true" /][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="label" label="TWEE IS NEE INSTAGRAM CURSUS voor €27" amount="27" /][paytium_total /][paytium_button label="Ja, ik wil 27 Euro investeren in de gezondheid van mijn kind" /][/paytium]