pathwork:_template

[[form]]
fields:
meeting:
    label: Pathology Workshop 2014 (Arusha)
    type: select
    values:
      0: Yes
      1: No
    default: 0
profession:
    label: Profession
    type: select
    values:
      0: Pathologist
      1: Haematologist
      2: Surgical Oncologist
      3: Medical Oncologist
      4: Radiation Oncologist
      5: Pediatric Oncologist
      6: Oncology Nurse
      7: Research Nurse
      8: Other
      9: Choose
    default: 9
gender:
    label: Gender
    type: select
    values:
      0: "M"
      1: "F"
    default: 0
institution:
    label: Institution
    type: text
iPathmember:
    label: iPath Member
    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
regcat:
    label: Registration Category
    type: select
    values:
      0: African working in Africa ($150 prior to Dec 15)
      1: Working in any other country ($/euro 400 prior to Dec 15)
    default: 0
hotelroom:
    label: Room Type
    type: select
    values:
      0: Single
      1: Double
    default: 0
payment:
    label: Payment
    type: select
    values:
      0: Self-pay
      1: Own institution/organization
      2: Other support
      3: Seeking financial support
      4: INCTR has confirmed full/partial support
    default: 0
hotel:
    label: Hotel
    type: text
datearrival:
    label: Date Arrival
    type: text
datedepart:
    label: Date Departure
    type: text
[[/form]]

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