app.e2ma.net Open in urlscan Pro
54.82.164.132  Public Scan

Form analysis
1 forms found in the DOM

Name: signup — POST

<form method="post" id="signup" name="signup">
  <input type="hidden" name="prev_member_email" id="id_prev_member_email">
  <input type="hidden" name="source" id="id_source">
  <input type="hidden" name="group_21881740" value="21881740" id="id_group_21881740">
  <input type="hidden" name="prev_member_email" value="">
  <div class="form-fields__fields-wrapper">
    <div class="field">
      <b class="emmaFormLabelBold">Preferred format</b>
      <span class="emmaFormLabelSmall">*</span>
      <div class="field-html ">
        <select name="plaintext_preferred" id="id_plaintext_preferred">
          <option value="False">HTML</option>
          <option value="True">Plaintext</option>
        </select>
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">First Name</b>
      <span class="emmaFormLabelSmall">*</span>
      <div class="field-html ">
        <input type="text" name="member_field_name_first" field_id="35724" required="" id="id_member_field_name_first">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Last Name</b>
      <span class="emmaFormLabelSmall">*</span>
      <div class="field-html ">
        <input type="text" name="member_field_name_last" field_id="36748" required="" id="id_member_field_name_last">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Email</b>
      <span class="emmaFormLabelSmall">*</span>
      <div class="field-html ">
        <input type="email" name="email" required="" id="id_email">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Phone</b>
      <span class="emmaFormLabelSmall">*</span>
      <div class="field-html ">
        <input type="text" name="member_field_phone" field_id="41868" required="" id="id_member_field_phone">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Company Name</b>
      <span class="emmaFormLabelSmall">*</span>
      <div class="field-html ">
        <input type="text" name="member_field_company_name" field_id="38796" required="" id="id_member_field_company_name">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Industry</b>
      <div class="field-html ">
        <input type="text" name="member_field_industry" field_id="292748" id="id_member_field_industry">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Title</b>
      <div class="field-html ">
        <input type="text" name="member_field_title" field_id="293772" id="id_member_field_title">
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Message</b>
      <div class="field-html ">
        <textarea name="member_field_message" cols="40" rows="10" field_id="5706636" id="id_member_field_message"></textarea>
      </div>
    </div>
    <div class="field">
      <b class="emmaFormLabelBold">Company e-mail</b>
      <div class="field-html ">
        <input type="text" name="member_field_e-mail" field_id="429964" id="id_member_field_e-mail">
      </div>
    </div>
  </div>
  <div class="form-required">
    <span class="emmaFormLabelSmall">*</span>
    <span class="emmaRequiredLabel"> = required field</span>
  </div>
  <div class="form-button">
    <input id="form-submit-input" type="submit" name="Submit" value="Submit">
  </div>
</form>

Text Content

Sign up today to receive our Free Consumer Trend eNewsletters... Health,
Wellness and Sustainability Consumer Insights
and Special Feature updates!
Preferred format *
HTML Plaintext
First Name *

Last Name *

Email *

Phone *

Company Name *

Industry

Title

Message

Company e-mail

* = required field