<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->

    
<!-- Locale=en_US_ISO8859_1 -->

    
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


<!-- EOF: ./personal-templates/simple/generic/show -->

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


<!-- BOF: ./personal-templates/simple/personal/other/l37.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l37.settings.init -->


  <!-- BOF: ./personal-templates/simple/business/layout/l37.wait -->


<!-- EOF: ./personal-templates/simple/business/layout/l37.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="Rembrandt Dutch Club - come and enjoy our friendly atmosphere, dutch food and delicacies. Need a hobby or interest... we have a male choir, scrabble group, klaverjas tournaments and biljards.">
<META NAME="Keywords"    CONTENT="Dutch club, Rembrandt Dutch Club, Rembrandt Club, klaverjas,Dutch food, Holland Festival, Dutch Festival,">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://www.rembrandtdutchclub.com/form1.html">-->
<TITLE>Membership Application</TITLE></head>
<BODY  BGCOLOR="#E3E3EB"
 TEXT="#003d6d"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l37.layout -->

<TABLE HEIGHT="100%" WIDTH="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0>
    <TR>
       <TD VALIGN=TOP HEIGHT=59 WIDTH=238 ROWSPAN=2><img src="widgets/gen_0.1.gif" width=238 height=59></TD>
       <TD HEIGHT=35 ALIGN=CENTER VALIGN=BOTTOM BACKGROUND="widgets/gen_2.1.gif"><IMG src="widgets/gen_115.1.gif" WIDTH=304 HEIGHT=35></TD>
    </TR>
    <TR>
       <TD HEIGHT=24 BACKGROUND="widgets/gen_3.1.gif">&nbsp;</TD>
    </TR>
    <TR>
       <TD WIDTH=238 BACKGROUND="widgets/gen_4.1.gif" valign="top">
<table border="0" width="100%" cellspacing="0" cellpadding="0">
    <tr>
        <td width="100%"><IMG src="widgets/gen_1.1.gif" WIDTH=238 HEIGHT=96></td>
    </tr>
    <tr>
        <td width="100%">
    
                                                                        <a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_119.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_118.1.gif'"><img src="widgets/gen_118.1.gif" alt="Home" name="img6" border="0"></a><br>
                                                                        <a href="gpage4.html" onMouseOver="document.images['img19'].src='widgets/gen_19.1.gif'" onMouseOut="document.images['img19'].src='widgets/gen_18.1.gif'"><img src="widgets/gen_18.1.gif" alt="What's On" name="img19" border="0"></a><br>
                                                                        
                                                                        <a href="gpage2.html" onMouseOver="document.images['img361'].src='widgets/gen_201.1.gif'" onMouseOut="document.images['img361'].src='widgets/gen_200.1.gif'"><img src="widgets/gen_200.1.gif" alt="Volunteering" name="img361" border="0"></a><br>
                                                                        <a href="services.html" onMouseOver="document.images['img330'].src='widgets/gen_205.1.gif'" onMouseOut="document.images['img330'].src='widgets/gen_204.1.gif'"><img src="widgets/gen_204.1.gif" alt="Interest Groups" name="img330" border="0"></a><br>
                                                                        
                                                                        
                                                                        <a href="gpage12.html" onMouseOver="document.images['img197'].src='widgets/gen_131.1.gif'" onMouseOut="document.images['img197'].src='widgets/gen_130.1.gif'"><img src="widgets/gen_130.1.gif" alt="Noticeboard" name="img197" border="0"></a><br>
                                                                        <a href="gpage8.html" onMouseOver="document.images['img30'].src='widgets/gen_207.1.gif'" onMouseOut="document.images['img30'].src='widgets/gen_206.1.gif'"><img src="widgets/gen_206.1.gif" alt="Venue & Holiday Hire" name="img30" border="0"></a><br>
                                                                        <a href="gpage16.html" onMouseOver="document.images['img147'].src='widgets/gen_113.1.gif'" onMouseOut="document.images['img147'].src='widgets/gen_183.1.gif'"><img src="widgets/gen_183.1.gif" alt="Dutch Shop - EDAH" name="img147" border="0"></a><br>
                                                                        
                                                                        <a href="form1.html" onMouseOver="document.images['img62'].src='widgets/gen_69.1.gif'" onMouseOut="document.images['img62'].src='widgets/gen_68.1.gif'"><img src="widgets/gen_68.1.gif" alt="Membership Application" name="img62" border="0"></a><br>
                                                                        <a href="gpage10.html" onMouseOver="document.images['img187'].src='widgets/gen_107.1.gif'" onMouseOut="document.images['img187'].src='widgets/gen_106.1.gif'"><img src="widgets/gen_106.1.gif" alt="Sponsors" name="img187" border="0"></a><br>
                                                                        <a href="gpage5.html" onMouseOver="document.images['img24'].src='widgets/gen_21.1.gif'" onMouseOut="document.images['img24'].src='widgets/gen_181.1.gif'"><img src="widgets/gen_181.1.gif" alt="Contact Us" name="img24" border="0"></a><br>
                                                                        
                                                                        
                                                                        <a href="mailto:info@rembrandtdutchclub.com" onMouseOver="document.images['img_email'].src='widgets/gen_9.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_8.1.gif'"><img src="widgets/gen_8.1.gif" alt="e-mail me" name="img_email" border="0"></a><br></td>
</tr>
</table>
</TD>
<TD ALIGN=LEFT VALIGN=TOP>
                        <!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#003D6D'>

Membership Application

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
function validate(frm){
var i = 0;

if (frm.field_66.value=="") return error(frm.field_66);

if (frm.field_68.value=="") return error(frm.field_68);

if (frm.field_69.value=="") return error(frm.field_69);

if (frm.field_70.value=="") return error(frm.field_70);

if (frm.field_71.value=="") return error(frm.field_71);

if (frm.field_74.value=="") return error(frm.field_74);

if (frm.field_75.value=="") return error(frm.field_75);

for(i = 0; i < frm.field_76.length; i++)
if (frm.field_76[i].checked) break;
if (frm.field_76.length==i) return error(frm.field_76[0]);

for(i = 0; i < frm.field_77.length; i++)
if (frm.field_77[i].checked) break;
if (frm.field_77.length==i) return error(frm.field_77[0]);

for(i = 0; i < frm.field_78.length; i++)
if (frm.field_78[i].checked) break;
if (frm.field_78.length==i) return error(frm.field_78[0]);

if (frm.field_81.value=="") return error(frm.field_81);

for(i = 0; i < frm.field_168.length; i++)
if (frm.field_168[i].checked) break;
if (frm.field_168.length==i) return error(frm.field_168[0]);

return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://uranus.websiteactive.com/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Membership Application">
<input type="hidden" name="efrom" value="">
<input type="hidden" name="email" value="membership@rembrandtdutchclub.com">
<input type="hidden" name="esubj" value="Membership Application Form">
<input type="hidden" name="submit_url" value="onsubmit1.html">
<input type="hidden" name="error_url"  value="onerror1.html">
<input type="hidden" name="order" value="66 68 69 70 71 72 73 74 75 76 77 78 81 168 ">
<script>
var p = location.pathname;
if (p.charAt(p.length)!='/') {
    p = p.substring(0, p.lastIndexOf('/')+1);
}
document.forms[0].domain.value = location.protocol+'//'+location.host+p;
</script>
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_66" value="Title - Mr / Mrs / Ms">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Title - Mr / Mrs / Ms

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_66" style="width:100%">


</td></tr>

<input type="hidden" name="name_68" value="Surname">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Surname

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_68" style="width:100%">


</td></tr>

<input type="hidden" name="name_69" value="Given Names">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Given Names

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_69" style="width:100%">


</td></tr>

<input type="hidden" name="name_70" value="Address">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Address

</font>


 <font color="red" size="-1">*</font></td><td>


<textarea name="field_70" rows="4" cols="30"></textarea>

</td></tr>

<input type="hidden" name="name_71" value="Phone - Home">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Phone - Home

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_71" style="width:100%">


</td></tr>

<input type="hidden" name="name_72" value="Phone - Work">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Phone - Work

</font>


 </td><td>


<input type="text" name="field_72" style="width:100%">


</td></tr>

<input type="hidden" name="name_73" value="Mobile">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Mobile

</font>


 </td><td>


<input type="text" name="field_73" style="width:100%">


</td></tr>

<input type="hidden" name="name_74" value="Occupation">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Occupation

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_74" style="width:100%">


</td></tr>

<input type="hidden" name="name_75" value="Date of Birth">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Date of Birth

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_75" style="width:100%">


</td></tr>

<input type="hidden" name="name_76" value="Are you related to or of Dutch descent?">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Are you related to or of Dutch descent?

</font>


 <font color="red" size="-1">*</font></td><td>

<input type="radio" name="field_76" id="field_761" value="Yes"><label for="field_761">


<font face='Arial' size='2' color='#003d6d'>

Yes

</font>


</label> <input type="radio" name="field_76" id="field_762" value="No"><label for="field_762">


<font face='Arial' size='2' color='#003d6d'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_77" value="Is your spouse/partner becoming a member?">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Is your spouse/partner becoming a member?

</font>


 <font color="red" size="-1">*</font></td><td>

<input type="radio" name="field_77" id="field_771" value="Yes"><label for="field_771">


<font face='Arial' size='2' color='#003d6d'>

Yes

</font>


</label> <input type="radio" name="field_77" id="field_772" value="No"><label for="field_772">


<font face='Arial' size='2' color='#003d6d'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_78" value="Will you be collecting your monthly magazine from the Club? ">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Will you be collecting your monthly magazine from the Club? 

</font>


 <font color="red" size="-1">*</font></td><td>

<input type="radio" name="field_78" id="field_781" value="Yes"><label for="field_781">


<font face='Arial' size='2' color='#003d6d'>

Yes

</font>


</label> <input type="radio" name="field_78" id="field_782" value="No"><label for="field_782">


<font face='Arial' size='2' color='#003d6d'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_81" value="Membership Fees<br>Single $15........................Couple $25<br>Pensioner Single $10.........Couple $15   <i> Please indicate which applies</i> ">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

Membership Fees<br>Single $15........................Couple $25<br>Pensioner Single $10.........Couple $15   <i> Please indicate which applies</i> 

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_81" style="width:100%">


</td></tr>

<input type="hidden" name="name_168" value="<br>I understand, that by submitting this form and if admitted as a member, I will be bound by the Clubs Memorandum and Articles of Association of  the Rembrandt Dutch Club St Marys Ltd">
<tr><td>


<font face='Arial' size='2' color='#003d6d'>

<br>I understand, that by submitting this form and if admitted as a member, I will be bound by the Clubs Memorandum and Articles of Association of  the Rembrandt Dutch Club St Marys Ltd

</font>


 <font color="red" size="-1">*</font></td><td>
<input type="radio" name="field_168" id="field_1681" value="True"><label for="field_1681">


<font face='Arial' size='2' color='#003d6d'>

True

</font>


</label> <input type="radio" name="field_168" id="field_1682" value="False"><label for="field_1682">


<font face='Arial' size='2' color='#003d6d'>

False

</font>


</label>


</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
<br>
                        

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Home</A>|</nobr>

<nobr>|<a href="gpage4.html">What's On</A>|</nobr>

<nobr>|<a href="gpage2.html">Volunteering</A>|</nobr>

<nobr>|<a href="services.html">Interest Groups</A>|</nobr>

<nobr>|<a href="gpage12.html">Noticeboard</A>|</nobr>

<nobr>|<a href="gpage8.html">Venue & Holiday Hire</A>|</nobr>

<nobr>|<a href="gpage16.html">Dutch Shop - EDAH</A>|</nobr>

<nobr>|Membership Application|</nobr>

<nobr>|<a href="gpage10.html">Sponsors</A>|</nobr>

<nobr>|<a href="gpage5.html">Contact Us</A>|</nobr>
</center>
</font>

<br>
                        
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<a href="http://www.psoft.net" target="_blank"><img src="widgets/ss_button.gif" border="0"></a>

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</TD> 
  </TR>
</TABLE>
                
<!-- EOF: ./personal-templates/simple/business/layout/l37.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->