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151.101.1.195  Public Scan

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Submitted URL: https://www.osr.braingymacademy.in/
Effective URL: https://neartail.com/public/102474479021708892554/all/form/1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg
Submission: On April 27 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://docs.google.com/forms/u/1/d/e/1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg/formResponse

<form dir="ltr" id="Publish1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg" class="ff-form ff-layout-default ff-public-mode ff-text-left" method="POST"
  action="https://docs.google.com/forms/u/1/d/e/1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg/formResponse">
  <input type="hidden" name="id" value="1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg">
  <input type="hidden" name="pageHistory" value="">
  <input type="hidden" id="Payment1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg" name="paymentId" value="">
  <input type="hidden" id="PaymentData1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg" name="paymentData" value="">
  <input type="hidden" id="Accepted1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg" name="accepted" value="">
  <input type="hidden" id="AcceptedAt1FAIpQLSf3_BsjKiOtVLYtrH8E3lqCRPNwkCZmxdPYpOx5lazNSecydg" name="acceptedAt" value="">
  <div class="ff-section" id="ff-sec-root" style="display:block;">
    <img src="https://lh4.googleusercontent.com/tmKmmIO2HBSHasR2N4A_RCgfp4--u1jf5axjIyzYlDlRzr7JZmBzapeK7LCFNLcDafus2Tz6Qo5GLA9t7IKCh67-pjhyyK2C2uRRtMWRsmhKle_ZHOUDeiXYERiOGdncww=w1561" class="ff-banner-image ff-image">
    <h3 class="ff-title" id="ff-title-root"> INDIA CUBERS LEAGUE 4.0 </h3>
    <div class="ff-description mdViewer">
      <p> On Spot Registration </p>
    </div>
    <div class="ff-secfields">
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-1491914238">
        <label class="ff-item-qs " for="Widget1491914238"> Name of the participant. (As required on the certificate) <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1491914238" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="text" class="ff-widget-control rest-form-control" id="Widget1491914238" name="entry.743525074" value="" placeholder="" required="">
        <div id="Error1491914238" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-733582643">
        <label class="ff-item-qs " for="Widget733582643"> Date of Birth (please mention in DD/MM/YYYY Format) <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static733582643" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="text" class="ff-widget-control rest-form-control" id="Widget733582643" name="entry.2057268816" value="" placeholder="" required="">
        <div id="Error733582643" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-701641834">
        <label class="ff-item-qs " for="Widget701641834"> Contact number. (Whatsapp number only) <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static701641834" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="text" class="ff-widget-control rest-form-control" id="Widget701641834" name="entry.935597200" autocomplete="tel" autocorrect="off" spellcheck="false" value="" placeholder="" required="">
        <div id="Error701641834" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-991455922">
        <label class="ff-item-qs " for="Widget991455922"> Email Id <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static991455922" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="email" pattern="[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,63}$" class="ff-widget-control rest-form-control ff-email-widget" id="Widget991455922" name="entry.1873071144" autocomplete="email" autocorrect="off" spellcheck="false"
          value="" placeholder="" required="">
        <div id="Error991455922" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-339595293">
        <label class="ff-item-qs " for="Widget339595293"> City <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static339595293" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="text" class="ff-widget-control rest-form-control" id="Widget339595293" name="entry.1772419776" value="" placeholder="" required="">
        <div id="Error339595293" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-1521866701">
        <label class="ff-item-qs " for="Widget1521866701"> How did you hear about us? <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1521866701" class="ff-help form-text mdViewer">If referred by mentor, please mention the name<br></small>
        <input type="text" class="ff-widget-control rest-form-control" id="Widget1521866701" name="entry.1299026920" value="" placeholder="">
        <div id="Error1521866701" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-multiple_choice ff-full-width  ff-item-noprd" id="ff-id-2012798665">
        <label class="ff-item-qs " for="Widget2012798665"> Registration Fee <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static2012798665" class="ff-help form-text mdViewer"> If referred by mentor, please mention the name<br>
        </small>
        <div class="ff-widget-control ff-check-table ">
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="radio" name="entry.928075216" id="entry.928075216.Registration Fee ₹500"
              onclick="entr=928075216; if(formFacade.draft.entry[entr]==this.value){ delete formFacade.draft.entry[entr]; this.checked=false; formFacade.saveDraft(); }" value="Registration Fee ₹500" required="">
            <label class="ff-form-check-label" for="entry.928075216.Registration Fee ₹500"> Registration Fee ₹500 </label>
          </div>
        </div>
        <div id="Error2012798665" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-checkbox ff-full-width  ff-item-noprd" id="ff-id-1511011974">
        <label class="ff-item-qs " for="Widget1511011974"> Events to participate <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1511011974" class="ff-help form-text mdViewer"> If referred by mentor, please mention the name<br>
        </small>
        <div class="ff-widget-control ff-check-table ">
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.2x2x2 - ₹350" value="2x2x2 - ₹350">
            <label class="ff-form-check-label" for="entry.519693357.2x2x2 - ₹350"> 2x2x2 - ₹350 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.3x3x3 - ₹350" value="3x3x3 - ₹350">
            <label class="ff-form-check-label" for="entry.519693357.3x3x3 - ₹350"> 3x3x3 - ₹350 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.4x4x4 - ₹350" value="4x4x4 - ₹350">
            <label class="ff-form-check-label" for="entry.519693357.4x4x4 - ₹350"> 4x4x4 - ₹350 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.5x5x5 - ₹350" value="5x5x5 - ₹350">
            <label class="ff-form-check-label" for="entry.519693357.5x5x5 - ₹350"> 5x5x5 - ₹350 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.Pyraminx -₹350" value="Pyraminx -₹350">
            <label class="ff-form-check-label" for="entry.519693357.Pyraminx -₹350"> Pyraminx -₹350 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.Skewb - ₹350" value="Skewb - ₹350">
            <label class="ff-form-check-label" for="entry.519693357.Skewb - ₹350"> Skewb - ₹350 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.519693357" id="entry.519693357.Mirror - ₹350" value="Mirror - ₹350">
            <label class="ff-form-check-label" for="entry.519693357.Mirror - ₹350"> Mirror - ₹350 </label>
          </div>
        </div>
        <input type="hidden" name="entry.519693357_sentinel" title="Events to participate" class="ff-check-required">
        <div id="Error1511011974" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-checkbox ff-full-width  ff-item-noprd" id="ff-id-1977615602">
        <label class="ff-item-qs " for="Widget1977615602"> Special events <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1977615602" class="ff-help-empty ff-help form-text mdViewer"></small>
        <div class="ff-widget-control ff-check-table ">
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.135459512" id="entry.135459512.3 Cube Relay (2x2x2,3x3x3 and Pyraminx) - ₹500" value="3 Cube Relay (2x2x2,3x3x3 and Pyraminx) - ₹500">
            <label class="ff-form-check-label" for="entry.135459512.3 Cube Relay (2x2x2,3x3x3 and Pyraminx) - ₹500"> 3 Cube Relay (2x2x2,3x3x3 and Pyraminx) - ₹500 </label>
          </div>
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="checkbox" name="entry.135459512" id="entry.135459512.Expert Relay - (3x3x3,4x4x4 and 5x5x5)  ₹500" value="Expert Relay - (3x3x3,4x4x4 and 5x5x5)  ₹500">
            <label class="ff-form-check-label" for="entry.135459512.Expert Relay - (3x3x3,4x4x4 and 5x5x5)  ₹500"> Expert Relay - (3x3x3,4x4x4 and 5x5x5) ₹500 </label>
          </div>
        </div>
        <input type="hidden" name="entry.135459512_sentinel" title="Special events" class="">
        <div id="Error1977615602" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-1166935420">
        <label class="ff-item-qs " for="Widget1166935420"> Total amount to be paid <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1166935420" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="text" class="ff-widget-control ff-readonly rest-form-control" id="Display1166935420" value="" readonly="" required="">
        <input type="hidden" id="Widget1166935420" name="entry.112917752" value="0">
        <div id="Error1166935420" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-multiple_choice ff-full-width  ff-item-noprd" id="ff-id-1172965011">
        <label class="ff-item-qs " for="Widget1172965011"> Mode of Payment <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1172965011" class="ff-help-empty ff-help form-text mdViewer"></small>
        <div class="ff-widget-control ff-check-table ">
          <div class="ff-form-check">
            <input class="ff-form-check-input" type="radio" name="entry.1556340701" id="entry.1556340701.Upi 9004896292"
              onclick="entr=1556340701; if(formFacade.draft.entry[entr]==this.value){ delete formFacade.draft.entry[entr]; this.checked=false; formFacade.saveDraft(); }" value="Upi 9004896292" required="">
            <label class="ff-form-check-label" for="entry.1556340701.Upi 9004896292"> Upi 9004896292 </label>
          </div>
        </div>
        <div id="Error1172965011" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-file ff-full-width  ff-item-noprd" id="ff-id-1313072452">
        <label class="ff-item-qs " for="Widget1313072452"> Add screenshot of payment <span class="ff-required">*</span>
          <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static1313072452" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="hidden" id="Widget1313072452" name="entry.743445450" value="">
        <div id="Display1313072452" class="ff-widget-control ff-file-upload" data-files="" data-entry="743445450" data-id="1313072452" data-uppied="true"><a class="addfile" href="javascript:void(0)">Add file</a></div>
        <div id="Error1313072452" class="ff-widget-error"></div>
      </div>
      <div class="rest-form-group ff-item   ff-text ff-part-width  ff-item-noprd" id="ff-id-434402734">
        <label class="ff-item-qs " for="Widget434402734"> Comment, if any <i class="ff-editwidget material-icons">
                    settings
                  </i>
        </label>
        <small id="Static434402734" class="ff-help-empty ff-help form-text mdViewer"></small>
        <input type="text" class="ff-widget-control rest-form-control" id="Widget434402734" name="entry.784150758" value="" placeholder="">
        <div id="Error434402734" class="ff-widget-error"></div>
      </div>
    </div>
    <div class="ff-button-bar">
      <button type="button" class="rest-btn rest-btn-lg rest-btn-primary ff-submit" id="ff-submit-root" onclick="formFacade.submit(this.form, 'root')">
        <img style="" src="https://formfacade.com/img/send.svg" class="ff-submit-icon">
        <span> Submit </span>
      </button>
    </div>
  </div>
  <div class="ff-section" id="ff-sec-ending" style="display:none">
    <div class="ff-secfields">
      <h3 class="ff-title">INDIA CUBERS LEAGUE 4.0</h3>
      <p style="padding-bottom:80px;">Click Submit to finish.</p>
    </div>
    <div class="ff-button-bar">
      <button type="button" class="rest-btn rest-btn-lg rest-btn-secondary ff-back" onclick="formFacade.gotoSection(this.form, 'root', 'back')">
        <!-- arrow back SVG -->
        <span class="material-icons">arrow_back</span>
        <span>Back</span>
      </button>
      <button type="button" class="rest-btn rest-btn-lg rest-btn-primary ff-submit" onclick="formFacade.submit(this.form, '-3')">
        <!-- send SVG -->
        <svg xmlns="http://www.w3.org/2000/svg" height="19" viewBox="0 -960 960 960" width="19" role="img" aria-label="Submit">
          <path d="M120-160v-640l760 320-760 320Zm80-120 474-200-474-200v140l240 60-240 60v140Zm0 0v-400 400Z"></path>
        </svg>
        <span>Submit</span>
      </button>
    </div>
  </div>
</form>

Text Content

India Cubers League 4.0
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INDIA CUBERS LEAGUE 4.0

Start


INDIA CUBERS LEAGUE 4.0

On Spot Registration

Name of the participant. (As required on the certificate) * settings

Date of Birth (please mention in DD/MM/YYYY Format) * settings

Contact number. (Whatsapp number only) * settings

Email Id * settings

City * settings

How did you hear about us? settings If referred by mentor, please mention the
name


Registration Fee * settings If referred by mentor, please mention the name

Registration Fee ₹500

Events to participate * settings If referred by mentor, please mention the name

2x2x2 - ₹350
3x3x3 - ₹350
4x4x4 - ₹350
5x5x5 - ₹350
Pyraminx -₹350
Skewb - ₹350
Mirror - ₹350

Special events settings
3 Cube Relay (2x2x2,3x3x3 and Pyraminx) - ₹500
Expert Relay - (3x3x3,4x4x4 and 5x5x5) ₹500

Total amount to be paid * settings

Mode of Payment * settings
Upi 9004896292

Add screenshot of payment * settings
Add file

Comment, if any settings

Submit


INDIA CUBERS LEAGUE 4.0

Click Submit to finish.

arrow_back Back Submit



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