Cancer BU > CloudPages > API Internal Testing Forms > Hillman Cancer Center Wake Up to Wellness Series - TEST FORM


      <h2>Hillman Cancer Center Wake Up to Wellness Series - Test Form</h2>
      <form action="https://pages.upmc.com/hcc-wake-up-to-wellness-series-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><br>

         <label>I want to sign up for:</label><br>
            <select name="interest" id="interest" multiple>
               <option value="A Healthy Perspective on GI Cancers">A Healthy Perspective on GI Cancers</option>
               <option value="Hitting the Bullseye on Cancer">Hitting the Bullseye on Cancer</option>
               <option value="Ensuring Lung Longevity">Ensuring Lung Longevity</option>
               <option value="Immunotherapy: The Army Against Cancer within You">Immunotherapy: The Army Against Cancer within You</option>
               <option value="Cancer Surgeries 101">Cancer Surgeries 101</option>
            </select><br><br>

         <label>Region</label>
         <input type="text" name="region"><br><br>
         <label>Service Line</label>
         <input type="text" name="service_line"><br><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>