<form id="signup-form" method="post" action="javascript:void(0)">
<fieldset>
<input type="hidden" name="land" title="land" class="signup-input" id="signup-input-country" value="nl" />
- <input type="text" name="name" id="signup-input-name" title="Vul uw naam in" value="Vul uw naam in"/>
- <input type="text" name="email" id="signup-input-email" title="Vul uw e-mailadres in" value="Vul uw e-mailadres in"/>
- <button type="submit" id="signup-submit" class="send">Nu aanmelden</button>
</fieldset>
</form>