public.govdelivery.com Open in urlscan Pro
2001:4838:101:2:66:117:61:24  Public Scan

Form analysis
1 forms found in the DOM

POST /accounts/USVHA/subscriber/qualify

<form action="/accounts/USVHA/subscriber/qualify" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token"
    value="T4ducl1P64Tsvp6IlHlOrN5Pbk1QSZDxYdXHCuIKik+pTiKLK18TFpNhtd+zGaFgHsbFav/rvILmhzaLPPH7Zg==">
  <fieldset id="quick_subscribe_new">
    <legend>
      <h1> Email Updates </h1>
    </legend>
    <div id="quick_subscribe_new_instructions"> To sign up for updates or to access your subscriber preferences, please enter your contact information below. </div>
    <ol class="form">
      <li>
        <label for="subscription_type">Subscription Type</label>
        <div class="input_group">
          <select name="subscription_type" id="subscription_type">
            <option value="email">Email</option>
            <option value="phone">SMS/Text Message</option>
          </select>
        </div>
      </li>
      <li class="wireless_fields" style="display: none">
        <label for="phone"><img class="required" alt="" aria-hidden="true" src="https://content.govdelivery.com/images/required.gif">Wireless Number</label>
        <div class="input_group">
          <select name="country_code_display" id="country_code_display" disabled="disabled" aria-label="Country code">
            <option value="1 (US)">1 (US)</option>
            <option value="1">1</option>
          </select>
          <input type="hidden" name="country_code" id="country_code" value="1" title="Country code">
          <input type="tel" name="phone" id="phone" value="" class="medium wireless_text_field" title="Provide your full phone number without country code or characters such as a dash or space. e.g 5555550123"
            oninvalid="setCustomValidity('Provide your full phone number without country code or characters such as a dash or space. e.g 5555550123')" pattern="[0-9]{10}"
            oninput="if (validity.patternMismatch) { setCustomValidity('Provide your full phone number without country code or characters such as a dash or space. e.g 5555550123'); } else { setCustomValidity(''); }">
        </div>
      </li>
      <li class="email_fields" style="display: block">
        <label for="email"><img class="required" alt="" aria-hidden="true" src="https://content.govdelivery.com/images/required.gif">Email Address</label>
        <input type="email" name="email" id="email" value="" class="long email_text_field" required="required">
      </li>
    </ol>
    <span aria-hidden="aria-hidden" style="display: none">
      <label for="name"><img class="required" alt="" aria-hidden="true" src="https://content.govdelivery.com/images/required.gif">Name</label>
      <input type="text" name="name" id="name" value="" aria-disabled="true" autocomplete="off">
    </span>
    <div class="button_panel">
      <input type="submit" name="commit" value="Submit" data-disable-with="Submit"><input type="button" value="Cancel" class="cancel_button">
    </div>
  </fieldset>
</form>

Text Content

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EMAIL UPDATES

To sign up for updates or to access your subscriber preferences, please enter
your contact information below.
 1. Subscription Type
    Email SMS/Text Message
 2. Wireless Number
    1 (US) 1
 3. Email Address

Name

Your contact information is used to deliver requested updates or to access your
subscriber preferences.

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