Weer in verbinding met je authentieke zelf.

<div id="momence-plugin-lead-form"></div>
<script
    async
    type="module"
    id="momence-plugin-lead-form-src"
    host_id="40556"
    fields="firstName,lastName,email,phoneNumber,wellbeing_experience,wellness_motivation"
    token="oW7bJBp7bl"
    country_code="nl"
    source_id="31263"
    data-field-def='{"firstName":{"type":"text","label":"First name","required":true},"lastName":{"type":"text","label":"Last name","required":true},"email":{"type":"email","label":"Email","required":true,"hidden":false},"phoneNumber":{"type":"phone-number","label":"Phone number","required":false,"hidden":false},"wellbeing_experience":{"type":"multiselect","label":"What wellbeing experiences have you tried before?","required":false,"hidden":false,"selectOptions":["Breathwork","Sauna / Aufguss","Cold Water Immersion","None"]},"wellness_motivation":{"type":"dropdown","label":"What's your wellness motivation?","required":false,"hidden":false,"selectOptions":["I want to improve my athletic performance.","I want to relax.","I need active recovery activity on rest days.","I'm seeking transformation and personal growth.","Other reason"]}}'
    data-redirect-after-submit-to="https://432socialwellbeing.com/thanks"
    data-on-success-msg="Welcome to 432 Social Wellbeing."
    src="https://momence.com/plugin/lead-form/lead-form.js"
></script>

<style>
:root {
    --momenceColorBackground: #393632;
    --momenceColorPrimary: 217, 158, 65;
    --momenceColorBlack: 233, 232, 219;
}
</style>