Sports Medicine BU > CloudPages > API Internal Testing Forms > Sports Medicine Newsletter - TEST FORM


      <h2>Sports Medicine Newsletter - Test Form</h2>
      <form action="https://pages.upmc.com/sports-medicine-newsletter-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>Age</label>
            <select name="age" id="age">
               <option value="" selected="selected">Select One</option>
               <option value="18 and under">18 and under</option>
               <option value="19 - 22">19 - 22</option>
               <option value="23 - 39">23 - 39</option>
               <option value="40 and over">40 and over</option>
            </select><br><br>

         <label>What best describes you?</label><br>
            <select name="title" id="title" multiple>
               <option value="Athlete">Athlete</option>
               <option value="Parent">Parent</option>
               <option value="Coach">Coach</option>
               <option value="Medical Professional">Medical Professional</option>
            </select><br><br>

         <label>I am interested in receiving future information on:</label><br>
            <select name="interest" id="interest" multiple>
               <option value="Sports Medicine services (includes nutrition, performance, physical therapy, and physician services)">Sports Medicine services (includes nutrition, performance, physical therapy, and physician services)</option>
               <option value="Concussion">Concussion</option>
            </select><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>