UPMC BU > CloudPages > API Internal Testing Forms > Why Magee Brand North Central Pa - TEST FORM


      <h2>Why Magee Brand North Central Pa - Test Form</h2>
      <form action="https://pages.upmc.com/why-magee-north-central-pa-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>

         <label>I would like to learn more about (check all that apply)</label><br>
            <select name="more_information" id="more_information" multiple>
                <option value="Women’s Health">Women’s Health</option>
                <option value="Pregnancy and Childbirth">Pregnancy and Childbirth</option>
            </select><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>