Cancer BU > Cloud Pages > API Internal Testing Forms > Hillman Fall Brand Campaign - TEST FORM


      <h2>Hillman Fall Brand Campaign - Test Form</h2>
      <form action="https://pages.upmc.com/hillman-fall-brand-campaign-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>Zip Code</label>
         <input type="text" name="zip_code"><br><br>
         
         <label>I would like to (check all that apply):</label><br>
            <select name="interest" id="interest" multiple>
                <option value="Sign up for the UPMC Hillman Cancer Center eNewsletter">Sign up for the UPMC Hillman Cancer Center eNewsletter</option>
                <option value="Submit an inquiry">Submit an inquiry</option>
            </select><br><br>

         <label>Sign up for the UPMC Hillman Cancer Center eNewsletter</label><br>
         <span>If you selected this value from the multiselect field above, enter "true". Otherwise, enter "false." This is for our internal testing purposes only.</span>
         <input type="text" name="interest_signup"><br><br>

         <label>Submit an inquiry</label><br>
         <span>If you selected this value from the multiselect field above, enter "true". Otherwise, enter "false". This is for our internal testing purposes only.</span>
         <input type="text" name="interest_inquiry"><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><br>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>