secureemail.nih.gov Open in urlscan Pro
156.40.55.32  Public Scan

Form analysis
1 forms found in the DOM

Name: userRegisterForm — POST /bds/UserRegisterAction.do

<form name="userRegisterForm" action="/bds/UserRegisterAction.do" method="post" class="nlv-form-small form-horizontal" autocomplete="off" onsubmit="return process(userRegisterForm);">
  <input type="hidden" name="method" value="registerUser">
  <input type="hidden" name="org.apache.struts.taglib.html.TOKEN" value="b88eae5eec3aa0a59a2d697f360c6c0161bc4b51ecd33407a7748439cebf8a7d">
  <input type="hidden" name="js" value="n">
  <input type="hidden" name="homephone" value="">
  <input type="hidden" name="workphone" value="">
  <input type="hidden" name="fax" value="">
  <input type="hidden" name="company" value="">
  <input type="hidden" name="jobtitle" value="">
  <input type="hidden" name="street" value="">
  <input type="hidden" name="city" value="">
  <input type="hidden" name="state" value="">
  <input type="hidden" name="zipcode" value="">
  <input type="hidden" name="country" value="">
  <input type="hidden" name="website" value="">
  <input type="hidden" name="id" value="A06911446328">
  <input type="hidden" name="w" value="">
  <!-- email -->
  <div class="form-group">
    <label for="inputEmail" class="col-sm-2 control-label"> Email address<span style="color:red">*</span>
    </label>
    <div id="inputEmail" class="col-sm-4">
      <input class="required form-control input-sm" type="text" name="email" id="emailAddr" maxlength="100" size="40" value="annalee.venneri@mt.gov" onchange="resetDisplayName()">
    </div>
  </div> <!-- end email -->
  <div class="vspacer5"></div>
  <!-- confirmemail -->
  <div class="form-group">
    <label for="confirmemail" class="col-sm-2 control-label"> Confirm email address<span style="color:red">*</span>
    </label>
    <div id="confirmemail" class="col-sm-4">
      <input class="required form-control input-sm" type="text" name="email2" maxlength="100" size="40" value="annalee.venneri@mt.gov">
    </div>
  </div> <!-- end confirmemail -->
  <div class="vspacer5"></div>
  <!-- name -->
  <div class="form-group">
    <label for="inputName" class="col-sm-2 control-label"> Name </label>
    <div id="inputName" class="row">
      <div class="col-sm-2">
        <input type="text" name="firstname" id="fName" maxlength="100" size="20" placeholder="First name" class="form-control input-sm" value="" onchange="resetDisplayName()">
      </div>
      <div class="col-sm-2">
        <input type="text" name="middlename" id="mName" maxlength="50" size="10" placeholder="Middle name" class="form-control input-sm" value="">
      </div>
      <div class="col-sm-2">
        <input type="text" name="lastname" id="lName" maxlength="100" size="20" placeholder="Last name" class="form-control input-sm" value="" onchange="resetDisplayName()">
      </div>
    </div>
  </div> <!-- end names -->
  <div class="vspacer5"></div>
  <!-- displayas -->
  <div class="form-group">
    <label for="displayas" class="col-sm-2 control-label"> Display as<span style="color:red">*</span>
    </label>
    <div id="displayas" class="col-sm-4">
      <input type="text" name="displayName" id="displayName" maxlength="100" size="20" class="required form-control input-sm" value="" onchange="recheckDisplayName()">
    </div>
  </div> <!-- end displayas -->
  <div class="vspacer10"></div>
  <!-- Dummy fields to prevent password auto population (Commented as this does not work for chrome.) -->
  <!--
    <input style="display:none;" type="text" name="somefakename" />
    <input style="display:none;" type="password" name="anotherfakename" />
    -->
  <!-- password -->
  <div class="form-group">
    <label for="password" class="col-sm-2 control-label"> Password<span style="color:red">*</span><br>
    </label>
    <div id="password">
      <div class="row">
        <div class="col-sm-4">
          <input class="required form-control input-sm" autocomplete="off" type="password" name="password1" maxlength="50" size="40" onkeyup="updateMeter(this.value, allowedList)">
        </div>
      </div>
    </div>
  </div> <!-- end password -->
  <!-- confirmpassword -->
  <div class="form-group">
    <label for="confirmpassword" class="col-sm-2 control-label"> Confirm password<span style="color:red">*</span>
    </label>
    <div id="confirmpassword">
      <div class="row">
        <div class="col-sm-4">
          <input class="required form-control input-sm" autocomplete="off" type="password" name="password2" maxlength="50" size="40" onkeyup="passwordsMatched(userRegisterForm.password1, userRegisterForm.password2)">
        </div>
      </div>
    </div>
  </div> <!-- end confirmpassword -->
  <!-- passwordreset -->
  <div class="form-group hide">
    <label for="passwordreset" class="col-sm-2 control-label"> Password reset question<span style="color:red">*</span>
    </label>
    <div id="passwordreset" class="row">
      <div class="col-sm-4">
        <select class="form-control input-sm select-sm" name="questionCodes" id="questionCodes">
          <option value="year">The year your mother was born (as 4 numeric digits)? </option>
          <option value="pin">A four digit PIN (personal identification number)? </option>
          <option value="mother">Your mother's first name? </option>
          <option value="color">What is your favorite color? </option>
          <option value="sport">What is your favorite sports team mascot? </option>
        </select>
        <input type="hidden" name="predefinedQ" value="true">
      </div>
    </div>
  </div>
  <div class="form-group hide">
    <label for="passwordresetans" class="col-sm-2 control-label">
    </label>
    <div id="passwordresetans" class="row">
      <div class="col-sm-4">
        <input type="text" name="answers" maxlength="50" size="30" placeholder="Answer" class="required form-control input-sm" value="" data-toggle="tooltip" title="Answer">
      </div>
      <div class="col-sm-2">
        <input type="text" name="hints" maxlength="100" size="20" placeholder="Hint" class="form-control input-sm" value="" data-toggle="tooltip" title="Hint">
      </div>
    </div>
  </div>
  <div class="vSpacer10"></div>
  <div class="vSpacer10"></div>
  <input type="hidden" name="tosAccepted" value="N">
  <div class="vSpacer10"></div>
  <div class="row">
    <div class="col-xs-offset-2 col-xs-8">
      <span style="color:red">* </span> Required fields
    </div>
  </div>
  <div class="vSpacer5"></div>
  <div class="row">
    <div class="col-xs-offset-2 col-xs-8">
      <input type="submit" name="register" class="btn btn-primary" value="Register" onclick="cookieStoreEmail();">
    </div>
  </div>
</form>

Text Content

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javascript in your browser.
 

User Registration
To view your workspace, you must be a registered user. Please enter your
information for registration, your email address will be your sign in username
Already registered? Visit the Account activation page or click here to have the
activation email resent to you.


For LDAP or Active Directory users, click here to sign in using your network
username and password.
Email address*


Confirm email address*


Name


Display as*


Password*


Confirm password*

Password reset question*
The year your mother was born (as 4 numeric digits)? A four digit PIN (personal
identification number)? Your mother's first name? What is your favorite color?
What is your favorite sports team mascot?




* Required fields


 * National Institutes of Health
   •
 * Department of Health and Human Services
   •
 * NIH Web Policies and Notices
   •
 * Freedom of Information Act
   •
 * HHS Vulnerability Disclosure


Caps Lock is On

YOUR PASSWORD MUST HAVE:

At least one uppercase letter
At least one lowercase letter
At least one number
At least one non-alphanumeric character
Between 7 and 50 characters long

PASSWORD STRENGTH: