member:_template
%%form_raw{memberimage}%%

Profession: %%form_data{profession}%%
Gender: %%form_data{gender}%%
Degree(s), Diploma(s) etc.: %%form_data{qualifications}%%
Graduate Education (Institute, Country): %%form_data{gradedu}%%
Post-graduate Education (Institute, country): %%form_data{postgrad}%%
Current Institution: %%form_data{institution}%%
iPath Member: %%form_data{iPathmember}%%
OERC Contributor: %%form_data{OERCcontributor}%%
Site Visit/Consultation: %%form_data{sitevisit}%%
Teaching Course/Workshop: %%form_data{teachingcourse}%%
INCTR Project: %%form_data{inctrproject}%%
email address: %%form_raw{email}%%
Address Line 1: %%form_data{address1}%%
Address Line 2: %%form_data{address2}%%
City: %%form_data{city}%%
Country: %%form_data{country}%%
Postal/Zip Code: %%form_data{postcode}%%
Comment/Special Interests: %%form_data{comment}%%

====

[[form]]
fields:
profession:
    label: Profession
    type: select
    values:
      0: General Physician
      1: General Surgeon
      2: Gynaecologist
      3: Gynaecological Oncologist
      4: Breast Cancer Surgeon
      5: Gastrointestinal Surgeon
      6: GI Surgical Oncologist
      7: Head and neck surgeon
      8: Surgical Oncologist
      9: Ophthalmologist
      10: Orthopedic Surgeon
      11: Medical Oncologist
      12: Radiation Oncologist
      13: Pediatric Oncologist
      14: Oncology Nurse
      15: Research Nurse
      16: Nurse Educator
      17: Pathologist
      18: Haematologist
      19: Epidemiologist
      20: Palliative Care Physician
      21: Palliative Care Nurse
      22: Psychosocial worker
      23: Other
      24: Choose
    default: 24
gender:
    label: Gender
    type: select
    values:
      0: "M"
      1: "F"
    default: 0
qualifications:
    label: Degree(s), Diploma(s) etc.
    type: text
gradedu:
    label: Graduate Education (Institute, Country)
    type: text
postgrad:
    label: Post-graduate Education (Institute, Country)
    type: text
institution:
    label: Institution
    type: text
iPathmember:
    label: iPath Member
    type: select
    values:
      0: "Yes"
      1: "No"
    default: 0
OERCcontributor:
    label: OERC Contributor
    type: select
    values:
      0: "Yes"
      1: "No"
    default: 0
sitevisit:
    label: Site Visit/Consultation
    type: select
    values:
      0: "Yes"
      1: "No"
    default: 0
teachingcourse:
    label: Teaching Course/Workshop
    type: select
    values:
      0: "Yes"
      1: "No"
    default: 0
inctrproject:
    label: INCTR Project
    type: select
    values:
      0: "Yes"
      1: "No"
    default: 0
email:
    label: email address
    match: /^[_a-zA-Z0-9\-\+]+(\.[_a-zA-Z0-9-]+)*@[a-zA-Z0-9-]+(\.[a-zA-Z0-9-]+)+$/
address1:
    label: Address Line 1
    type: text
    width: 50
address2:
    label: Address Line 2
    type: text
    width: 50
city:
  label: City
  type: text
  width: 50
country:
    label: Country
    type: text
    width: 50
postcode:
    label: Postal/Zip Code
    type: text
memberimage:
    label: Image
    type: file
comment:
    label: Comment/Special Interests
    type: text
    width: 50
    height: 3
[[/form]]

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License