[[form]]
fields:
profession:
label: Profession
type: select
values:
0: General Physician
1: General Surgeon
2: Surgical Oncologist
3: Medical Oncologist
4: Radiation Oncologist
5: Pediatric Oncologist
6: Oncology Nurse
7: Research Nurse
8: Pathologist
9: Haematologist
10: Epidemiologist
11: Other
12: Choose
default: 12
gender:
label: Gender
type: select
values:
0: "M"
1: "F"
default: 0
institution:
label: Institution
type: text
address:
label: Street
type: text
city:
label: City
type: text
country:
label: Country
type: text
i-Pathmember:
label: iPath Member
type: select
values:
0: "Yes"
1: "No"
default: 0
postcode:
label: Postal/Zip Code
type: text
email:
label: email address
match: /^[_a-zA-Z0-9\-\+]+(\.[_a-zA-Z0-9-]+)*@[a-zA-Z0-9-]+(\.[a-zA-Z0-9-]+)+$/
tel:
label: Telephone Number
type: text (include country and city codes)
DofA:
label: Date of Arrival
type: text (DD/MM/YYYY)
DofD:
label: Date of Departure
type: text (DD/MM/YYYY)
[[/form]]
INCTRBi:_template