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E-mail adres: <input type='text' name='Mailadres'><br>
<input type='radio' name='actie' value='aanmelden' checked><FONT COLOR="#0000CC"> Aanmelden <input type='radio' name='actie' value='afmelden'><FONT COLOR="#0000CC"> Afmelden<br><br>
<input type='submit' value='Verstuur'>
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