INCTRBi:_template

[[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]]