Transplant BU > Cloud Pages > API Internal Testing Forms > Central Pa Transplant Campaign Form - TEST FORM


      <h2>Central Pa Transplant Campaign Form - Test Form</h2>
      <form action="https://pages.upmc.com/central-pa-transplant-campaign-form-api-internal-testing-form" method="post">
         <label>Email</label>
         <input type="text" name="email_address"><br>
         <label>First Name</label>
         <input type="text" name="first_name"><br>
         <label>Last Name</label>
         <input type="text" name="last_name"><br>
         <label>Phone Number</label>
         <input type="text" name="phone_number"><br>

         <label>Are you interested in liver or kidney transplant?</label><br>
            <input type="radio" id="Liver Transplant" name="interest" value="Liver Transplant">
               <label for="Liver Transplant">Liver Transplant</label><br>
            <input type="radio" id="Kidney Transplant" name="interest" value="Kidney Transplant">
               <label for="Kidney Transplant">Kidney Transplant</label><br>

         <label>Category</label>
         <input type="text" name="category"><br>
         <label>Subcategory</label>
         <input type="text" name="subcategory"><br>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>