UPMC BU > Cloud Pages > API Internal Testing Forms > Womens Health Ladies Day Out - TEST FORM


      <h2>Womens Health Ladies Day Out - Test Form</h2>
      <form action="https://pages.upmc.com/womens-health-ladies-day-out-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>Will you be bringing a guest?</label><br>
         <select name="guest" id="guest" multiple>
         <option value="Yes">Yes</option>
         <option value="No">No</option>
         </select><br>
         <label>Guest First Name</label>
         <input type="text" name="guest_first_name"><br>
         <label>Guest Last Name</label>
         <input type="text" name="guest_last_name"><br>
         <label>Guest Email Address</label>
         <input type="text" name="guest_email_address"><br><br>

         <label>I agree to receive marketing emails from UPMC.<br> I understand that I may opt out of receiving such communications at any time.</label><br>
         <select name="marketing_opt_in" id="marketing_opt_in" multiple>
            <option value="true">true</option>
         </select><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>