membership.ambulance.vic.gov.au Open in urlscan Pro
13.70.147.206  Public Scan

Form analysis
1 forms found in the DOM

Name: defaultFormctl00$PortalMainContent$C002 — POST /login/?ReturnUrl=https%3a%2f%2fmembership.ambulance.vic.gov.au%2fMemberPortal%2fmembership-renew&sf_cntrl_id=ctl00%24PortalMainContent%24C002

<form action="/login/?ReturnUrl=https%3a%2f%2fmembership.ambulance.vic.gov.au%2fMemberPortal%2fmembership-renew&amp;sf_cntrl_id=ctl00%24PortalMainContent%24C002" method="POST" name="defaultFormctl00$PortalMainContent$C002" role="form">
  <div class="validation-summary-valid" data-valmsg-summary="true">
    <ul>
      <li style="display:none"></li>
    </ul>
  </div>
  <div class="">
    <div class="">
      <h3>Log in</h3>
      <div class="form-group">
        <label for="UserName">Email / Username</label>
        <input aria-describedby="LoginUserName-1" aria-required="true" class="form-control" data-val="true" data-val-required="The Email / Username field is required." id="UserName" name="UserName" type="text" value="">
        <div id="LoginUserName-1" class="text-danger" role="alert" aria-live="assertive">
          <span class="form-text"><span class="field-validation-valid" data-valmsg-for="UserName" data-valmsg-replace="true"></span></span>
        </div>
      </div>
      <div class="form-group">
        <label for="Password">Password</label>
        <input aria-describedby="LoginPassword-1" aria-required="true" class="form-control" data-val="true" data-val-required="The Password field is required." id="Password" name="Password" type="password">
        <div id="LoginPassword-1" class="text-danger" role="alert" aria-live="assertive">
          <span class="form-text"><span class="field-validation-valid" data-valmsg-for="Password" data-valmsg-replace="true"></span></span>
        </div>
      </div>
      <div class="form-group row">
        <div class="checkbox col-lg-6 m-0">
          <label>
            <input checked="checked" data-val="true" data-val-required="The Remember me field is required." id="RememberMe" name="RememberMe" type="checkbox" value="true"><input name="RememberMe" type="hidden" value="false"> Remember me </label>
        </div>
      </div>
      <div class="form-group">
        <button type="submit" class="btn btn-primary">Log in</button>
      </div>
      <div class="sf-registration-link">
        <a href="/login/forgot-passwords">Reset or Create a new password</a>
      </div>
      <br>
      <div class="sf-registration-link">
        <a href="/sms-member-number">Receive your Membership Number Via SMS</a>
      </div>
      <br>
      <div class="sf-registration-link">
        <div>Not registered yet?</div>
        <a href="https://membership.ambulance.vic.gov.au/member-register">Join now</a>
      </div>
    </div>
  </div>
</form>

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Password

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Receive your Membership Number Via SMS

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