[contact-form to=’secretaris@wilskracht-amersfoort.nl’ subject=’Lidmaatschap opzegging via website’][contact-field label=’Opzegging per’ type=’text’ required=’1’/][contact-field label=’Naam’ type=’name’ required=’1’/][contact-field label=’Adres’ type=’text’ required=’1’/][contact-field label=’Postcode %26amp; Woonplaats’ type=’text’ required=’1’/][contact-field label=’Telefoonnummer’ type=’text’ required=’1’/][contact-field label=’Geboortedatum’ type=’text’ required=’1’/][contact-field label=’Instrument’ type=’radio’ required=’1′ options=’Eigen,Wilskracht,Muziekschool’/][contact-field label=’Instrument ingeleverd?’ type=’radio’ required=’1′ options=’Ja,Nee,NVT’/][contact-field label=’Uniform/Smoking ingeleverd?’ type=’radio’ required=’1′ options=’Ja,Nee,NVT’/][contact-field label=’Incasso stoppen?’ type=’radio’ required=’1′ options=’Ja,Nee,NVT’/][contact-field label=’Muziekschool stopzetten?’ type=’radio’ required=’1′ options=’Ja,Nee,NVT’/][contact-field label=’Reden van opzegging:’ type=’textarea’/][/contact-form]