cam.ecri.org Open in urlscan Pro
8.14.164.88  Public Scan

Form analysis
2 forms found in the DOM

POST /ECRIMembership/RegisterUser

<form id="frmUserRegistration" method="post" action="/ECRIMembership/RegisterUser">
  <input id="Invitationtype" name="Invitationtype" type="hidden" value="SeatUser">
  <input id="hdnUserType" name="ActivatingUserType" type="hidden" value="NewUser">
  <div class="reg-form-sec">
    <div class="reg-form-sec-title">
      <span>PROFILE INFORMATION</span>
    </div><br>
    <table class="cam-reg-form-table">
      <tbody>
        <tr>
          <td class="cam-reg-label-col">
            <label>Email ID</label>
          </td>
          <td class="cam-reg-data-col" style="padding-left:40px;"> samantha.cox@bd.com <input id="hdnEmailID" name="UserProfile.Email" type="hidden" value="samantha.cox@bd.com">
          </td>
        </tr>
        <tr>
          <td class=" cam-reg-label-col">
            <label>First Name</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col" style="padding-left:42px;"><input id="txtFirstName" maxlength="50" name="UserProfile.FirstName" style="width:150px;" type="text" value=""><span id="valFirstName" class="cam-validation-message"></span></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Middle Name</label>
          </td>
          <td class="cam-reg-data-col" style="padding-left:42px;"><input id="txtMiddleName" maxlength="50" name="UserProfile.MiddleName" style="width:150px;" type="text" value=""></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Last Name</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col" style="padding-left:42px;"><input id="txtLastName" maxlength="50" name="UserProfile.LastName" style="width:150px;" type="text" value=""><span id="valLastName" class="cam-validation-message"></span></td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="reg-form-sec">
    <div class="reg-form-sec-title">
      <span>INSTITUTION </span>
    </div><br>
    <table class="cam-reg-form-table">
      <tbody>
        <tr>
          <td class="cam-reg-label-col">
            <label>Institution Name</label>
          </td>
          <td class="cam-reg-data-col" style="padding-left:22px;"> BD Medical Inc <input id="UserProfile_ParentCustomerName" name="UserProfile.ParentCustomerName" type="hidden" value="BD Medical Inc">
            <input id="UserProfile_ParentCustomerGuid" name="UserProfile.ParentCustomerGuid" type="hidden" value="3d4de4fa-9e29-dc11-be33-000f20dad965">
            <input id="Invitationtype" name="Invitationtype" type="hidden" value="SeatUser">
            <input id="ActivatingUserType" name="ActivatingUserType" type="hidden" value="NewUser">
          </td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Department</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col" style="padding-left:22px;">
            <input id="txtDepartment" maxlength="150" name="UserProfile.Department" style="width:250px;" type="text" value="">
            <span id="valDepartment" class="cam-validation-message"></span>
          </td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Title</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col" style="padding-left:22px;">
            <input id="txtTitle" maxlength="150" name="UserProfile.Title" style="width:250px;" type="text" value="">
            <span id="valTitle" class="cam-validation-message"></span>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="reg-form-sec">
    <div class="reg-form-sec-title">
      <span>ADDRESS</span>
    </div><br>
    <table class="cam-reg-form-table">
      <tbody>
        <tr>
          <td class="cam-reg-label-col">
            <label>Line 1</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col"><input id="txtAddrLine1" maxlength="250" name="UserProfile.Address.Line1" style="width:250px;" type="text" value="1 Becton Dr"><span id="valAddrLine1" class="cam-validation-message"></span></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Line 2</label>
          </td>
          <td class="cam-reg-data-col"><input id="UserProfile_Address_Line2" maxlength="250" name="UserProfile.Address.Line2" style="width:250px;" type="text" value=""></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Line 3</label>
          </td>
          <td class="cam-reg-data-col"><input id="UserProfile_Address_Line3" maxlength="250" name="UserProfile.Address.Line3" style="width:250px;" type="text" value=""></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>City</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col"><input id="txtCity" maxlength="150" name="UserProfile.Address.City" style="width:150px;" type="text" value="Franklin Lakes"><span id="valCity" class="cam-validation-message"></span></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Postal Code</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col"><input id="txtPC" maxlength="20" name="UserProfile.Address.PostalCode" style="width:100px;" type="text" value="07417-1880"><span id="valPC" class="cam-validation-message"></span></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Country</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col">
            <span>
              <script type="text/javascript">
                JQ(document).ready(function() {
                  UserCountry_ShowSelected();
                });
              </script>
              <select class="select" id="ddCountries" onchange="UserCountry_GetSelected()" size="1" style="height:23px;width:150px;">
                <option id="0" value="Select">- Select a Country -</option>
                <option id="0" value="USA">USA</option>
                <option id="0" value="AFGHANISTAN">Afghanistan</option>
                <option id="0" value="ALBANIA">Albania</option>
                <option id="0" value="ALGERIA">Algeria</option>
                <option id="0" value="ANDORRA">Andorra</option>
                <option id="0" value="ANGOLA">Angola</option>
                <option id="0" value="ANGUILLA">Anguilla</option>
                <option id="0" value="ANTIGUA AND BARBUDA">Antigua And Barbuda</option>
                <option id="0" value="ARGENTINA">Argentina</option>
                <option id="0" value="ARMENIA">Armenia</option>
                <option id="0" value="ARUBA">Aruba</option>
                <option id="0" value="AUSTRALIA">Australia</option>
                <option id="0" value="AUSTRIA">Austria</option>
                <option id="0" value="AZERBAIJAN">Azerbaijan</option>
                <option id="0" value="BAHAMAS">Bahamas</option>
                <option id="0" value="BAHRAIN">Bahrain</option>
                <option id="0" value="BANGLADESH">Bangladesh</option>
                <option id="0" value="BARBADOS">Barbados</option>
                <option id="0" value="BELARUS">Belarus</option>
                <option id="0" value="BELGIUM">Belgium</option>
                <option id="0" value="BELIZE">Belize</option>
                <option id="0" value="BENIN">Benin</option>
                <option id="0" value="BERMUDA">Bermuda</option>
                <option id="0" value="BHUTAN">Bhutan</option>
                <option id="0" value="BOLIVIA">Bolivia</option>
                <option id="0" value="BOSNIA">Bosnia</option>
                <option id="0" value="BOTSWANA">Botswana</option>
                <option id="0" value="BRAZIL">Brazil</option>
                <option id="0" value="BRUNEI">Brunei</option>
                <option id="0" value="BULGARIA">Bulgaria</option>
                <option id="0" value="BURKINA FASO">Burkina Faso</option>
                <option id="0" value="BURUNDI">Burundi</option>
                <option id="0" value="CAMBODIA">Cambodia</option>
                <option id="0" value="CAMEROON">Cameroon</option>
                <option id="0" value="CANADA">Canada</option>
                <option id="0" value="CAPE VERDE ISLAND">Cape Verde Island</option>
                <option id="0" value="CAYMAN ISLANDS">Cayman Islands</option>
                <option id="0" value="CENTRAL AFRICAN REPUBLIC">Central African Republic</option>
                <option id="0" value="CHAD">Chad</option>
                <option id="0" value="CHILE">Chile</option>
                <option id="0" value="CHINA">China</option>
                <option id="0" value="COLOMBIA">Colombia</option>
                <option id="0" value="COMOROS">Comoros</option>
                <option id="0" value="CONGO">Congo</option>
                <option id="0" value="COSTA RICA">Costa Rica</option>
                <option id="0" value="CROATIA">Croatia</option>
                <option id="0" value="CUBA">Cuba</option>
                <option id="0" value="CYPRUS">Cyprus</option>
                <option id="0" value="CZECH REPUBLIC">Czech Republic</option>
                <option id="0" value="DENMARK">Denmark</option>
                <option id="0" value="DJIBOUTI">Djibouti</option>
                <option id="0" value="DOMINICA">Dominica</option>
                <option id="0" value="DOMINICAN REP.">Dominican Rep.</option>
                <option id="0" value="ECUADOR">Ecuador</option>
                <option id="0" value="EGYPT">Egypt</option>
                <option id="0" value="EL SALVADOR">El Salvador</option>
                <option id="0" value="EQUATORIAL GUINEA">Equatorial Guinea</option>
                <option id="0" value="ERITREA">Eritrea</option>
                <option id="0" value="ESTONIA">Estonia</option>
                <option id="0" value="ETHIOPIA">Ethiopia</option>
                <option id="0" value="FALKLAND ISLANDS">Falkland Islands</option>
                <option id="0" value="FIJI">Fiji</option>
                <option id="0" value="FINLAND">Finland</option>
                <option id="0" value="FRANCE">France</option>
                <option id="0" value="FRENCH POLYNESIA">French Polynesia</option>
                <option id="0" value="GABON">Gabon</option>
                <option id="0" value="GAMBIA">Gambia</option>
                <option id="0" value="GEORGIA">Georgia</option>
                <option id="0" value="GERMANY">Germany</option>
                <option id="0" value="GHANA">Ghana</option>
                <option id="0" value="GIBRALTAR">Gibraltar</option>
                <option id="0" value="GREECE">Greece</option>
                <option id="0" value="GRENADA">Grenada</option>
                <option id="0" value="GUATEMALA">Guatemala</option>
                <option id="0" value="GUINEA">Guinea</option>
                <option id="0" value="GUINEA-BISSAU">Guinea-Bissau</option>
                <option id="0" value="GUYANA">Guyana</option>
                <option id="0" value="HAITI">Haiti</option>
                <option id="0" value="HONDURAS">Honduras</option>
                <option id="0" value="HONG KONG">Hong Kong</option>
                <option id="0" value="HUNGARY">Hungary</option>
                <option id="0" value="ICELAND">Iceland</option>
                <option id="0" value="INDIA">India</option>
                <option id="0" value="INDONESIA">Indonesia</option>
                <option id="0" value="IRAN">Iran</option>
                <option id="0" value="IRAQ">Iraq</option>
                <option id="0" value="IRELAND">Ireland</option>
                <option id="0" value="ISRAEL">Israel</option>
                <option id="0" value="ITALY">Italy</option>
                <option id="0" value="JAMAICA">Jamaica</option>
                <option id="0" value="JAPAN">Japan</option>
                <option id="0" value="JORDAN">Jordan</option>
                <option id="0" value="KAZAKHSTAN">Kazakhstan</option>
                <option id="0" value="KENYA">Kenya</option>
                <option id="0" value="KUWAIT">Kuwait</option>
                <option id="0" value="KYRGYZSTAN">Kyrgyzstan</option>
                <option id="0" value="LAOS">Laos</option>
                <option id="0" value="LATVIA">Latvia</option>
                <option id="0" value="LEBANON">Lebanon</option>
                <option id="0" value="LESOTHO">Lesotho</option>
                <option id="0" value="LIBERIA">Liberia</option>
                <option id="0" value="LIBYA">Libya</option>
                <option id="0" value="LITHUANIA">Lithuania</option>
                <option id="0" value="LUXEMBOURG">Luxembourg</option>
                <option id="0" value="MACAU">Macau</option>
                <option id="0" value="MACEDONIA (FORMER YUG. REP.)">Macedonia (Former Yug. Rep.)</option>
                <option id="0" value="MADAGASCAR">Madagascar</option>
                <option id="0" value="MALAWI">Malawi</option>
                <option id="0" value="MALAYSIA">Malaysia</option>
                <option id="0" value="MALDIVES">Maldives</option>
                <option id="0" value="MALI">Mali</option>
                <option id="0" value="MALTA">Malta</option>
                <option id="0" value="MAURITANIA">Mauritania</option>
                <option id="0" value="MAURITIUS">Mauritius</option>
                <option id="0" value="MEXICO">Mexico</option>
                <option id="0" value="MOLDOVA">Moldova</option>
                <option id="0" value="MONGOLIA">Mongolia</option>
                <option id="0" value="MONTSERRAT">Montserrat</option>
                <option id="0" value="MOROCCO">Morocco</option>
                <option id="0" value="MOZAMBIQUE">Mozambique</option>
                <option id="0" value="MYANMAR">Myanmar</option>
                <option id="0" value="NAMIBIA">Namibia</option>
                <option id="0" value="NEPAL">Nepal</option>
                <option id="0" value="NETHERLANDS">Netherlands</option>
                <option id="0" value="NETHERLANDS ANTILLES">Netherlands Antilles</option>
                <option id="0" value="NEW CALEDONIA">New Caledonia</option>
                <option id="0" value="NEW ZEALAND">New Zealand</option>
                <option id="0" value="NICARAGUA">Nicaragua</option>
                <option id="0" value="NIGER">Niger</option>
                <option id="0" value="NIGERIA">Nigeria</option>
                <option id="0" value="NORTH KOREA">North Korea</option>
                <option id="0" value="NORWAY">Norway</option>
                <option id="0" value="OMAN">Oman</option>
                <option id="0" value="PAKISTAN">Pakistan</option>
                <option id="0" value="PANAMA">Panama</option>
                <option id="0" value="PAPUA NEW GUINEA">Papua New Guinea</option>
                <option id="0" value="PARAGUAY">Paraguay</option>
                <option id="0" value="PERU">Peru</option>
                <option id="0" value="PHILIPPINES">Philippines</option>
                <option id="0" value="POLAND">Poland</option>
                <option id="0" value="PORTUGAL">Portugal</option>
                <option id="0" value="QATAR">Qatar</option>
                <option id="0" value="ROMANIA">Romania</option>
                <option id="0" value="RUSSIA">Russia</option>
                <option id="0" value="RWANDA">Rwanda</option>
                <option id="0" value="S. GEORGIA &amp; S. SANDWICH ISLS.">S. Georgia &amp; S. Sandwich Isls.</option>
                <option id="0" value="SAMOA (WESTERN)">Samoa (Western)</option>
                <option id="0" value="SAO TOME &amp; PRINCIPE">Sao Tome &amp; Principe</option>
                <option id="0" value="SAUDI ARABIA">Saudi Arabia</option>
                <option id="0" value="SENEGAL">Senegal</option>
                <option id="0" value="SEYCHELLES">Seychelles</option>
                <option id="0" value="SIERRA LEONE">Sierra Leone</option>
                <option id="0" value="SINGAPORE">Singapore</option>
                <option id="0" value="SLOVAKIA">Slovakia</option>
                <option id="0" value="SLOVENIA">Slovenia</option>
                <option id="0" value="SOLOMON ISLAND">Solomon Island</option>
                <option id="0" value="SOMALIA">Somalia</option>
                <option id="0" value="SOUTH AFRICA">South Africa</option>
                <option id="0" value="SOUTH KOREA">South Korea</option>
                <option id="0" value="SPAIN">Spain</option>
                <option id="0" value="SRI LANKA">Sri Lanka</option>
                <option id="0" value="ST. HELENA">St. Helena</option>
                <option id="0" value="ST. KITTS AND NEVIS">St. Kitts And Nevis</option>
                <option id="0" value="ST. LUCIA">St. Lucia</option>
                <option id="0" value="ST. VINCENT AND THE GRENADINES">St. Vincent And The Grenadines</option>
                <option id="0" value="SUDAN">Sudan</option>
                <option id="0" value="SURINAME">Suriname</option>
                <option id="0" value="SWAZILAND">Swaziland</option>
                <option id="0" value="SWEDEN">Sweden</option>
                <option id="0" value="SWITZERLAND">Switzerland</option>
                <option id="0" value="SYRIA">Syria</option>
                <option id="0" value="TADJIKISTAN">Tadjikistan</option>
                <option id="0" value="TAIWAN">Taiwan</option>
                <option id="0" value="TANZANIA">Tanzania</option>
                <option id="0" value="THAILAND">Thailand</option>
                <option id="0" value="TOGO">Togo</option>
                <option id="0" value="TONGA">Tonga</option>
                <option id="0" value="TRINIDAD AND TOBAGO">Trinidad And Tobago</option>
                <option id="0" value="TUNISIA">Tunisia</option>
                <option id="0" value="TURKEY">Turkey</option>
                <option id="0" value="TURKMENISTAN">Turkmenistan</option>
                <option id="0" value="UGANDA">Uganda</option>
                <option id="0" value="UKRAINE">Ukraine</option>
                <option id="0" value="UNITED ARAB EMIRATES">United Arab Emirates</option>
                <option id="0" value="UNITED KINGDOM">United Kingdom</option>
                <option id="0" value="URUGUAY">Uruguay</option>
                <option id="0" value="UZBEKISTAN">Uzbekistan</option>
                <option id="0" value="VANUATU">Vanuatu</option>
                <option id="0" value="VENEZUELA">Venezuela</option>
                <option id="0" value="VIET NAM">Viet Nam</option>
                <option id="0" value="WALLIS AND FUTUNA ISLANDS">Wallis And Futuna Islands</option>
                <option id="0" value="WESTERN SAMOA">Western Samoa</option>
                <option id="0" value="YEMEN">Yemen</option>
                <option id="0" value="YUGOSLAVIA">Yugoslavia</option>
                <option id="0" value="ZAIRE">Zaire</option>
                <option id="0" value="ZAMBIA">Zambia</option>
                <option id="0" value="ZIMBABWE">Zimbabwe</option>
                <option id="0" value="UNKNOWN">Unknown</option>
              </select>
            </span>
            <input id="txtCountry" maxlength="50" name="UserProfile.Address.Country" style="width:150px;display:none" type="text" value="USA">
            <span id="valCountry" class="cam-validation-message"></span>
          </td>
        </tr>
        <tr style="max-height:30px;">
          <td class="cam-reg-label-col" style="height:30px;">
            <label>State Or Province</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col" style="height:30px;">
            <span id="spanDropDownUserState">
              <script type="text/javascript">
                JQ(document).ready(function() {
                  UserState_ShowSelected();
                });
              </script>
              <select id="ddStates" onchange="UserState_GetSelected()" size="1" style="height:23px;width:150px;">
                <option id="Select">- Select a State -</option>
                <option id="AL" value="AL">Alabama</option>
                <option id="AK" value="AK">Alaska</option>
                <option id="AZ" value="AZ">Arizona</option>
                <option id="AR" value="AR">Arkansas</option>
                <option id="CA" value="CA">California</option>
                <option id="CO" value="CO">Colorado</option>
                <option id="CT" value="CT">Connecticut</option>
                <option id="DE" value="DE">Delaware</option>
                <option id="DC" value="DC">District of Columbia</option>
                <option id="FL" value="FL">Florida</option>
                <option id="GA" value="GA">Georgia</option>
                <option id="HI" value="HI">Hawaii</option>
                <option id="ID" value="ID">Idaho</option>
                <option id="IL" value="IL">Illinois</option>
                <option id="IN" value="IN">Indiana</option>
                <option id="IA" value="IA">Iowa</option>
                <option id="KS" value="KS">Kansas</option>
                <option id="KY" value="KY">Kentucky</option>
                <option id="LA" value="LA">Louisiana</option>
                <option id="ME" value="ME">Maine</option>
                <option id="MD" value="MD">Maryland</option>
                <option id="MA" value="MA">Massachusetts</option>
                <option id="MI" value="MI">Michigan</option>
                <option id="MN" value="MN">Minnesota</option>
                <option id="MS" value="MS">Mississippi</option>
                <option id="MO" value="MO">Missouri</option>
                <option id="MT" value="MT">Montana</option>
                <option id="NE" value="NE">Nebraska</option>
                <option id="NV" value="NV">Nevada</option>
                <option id="NH" value="NH">New Hampshire</option>
                <option id="NJ" value="NJ">New Jersey</option>
                <option id="NM" value="NM">New Mexico</option>
                <option id="NY" value="NY">New York</option>
                <option id="NC" value="NC">North Carolina</option>
                <option id="ND" value="ND">North Dakota</option>
                <option id="OH" value="OH">Ohio</option>
                <option id="OK" value="OK">Oklahoma</option>
                <option id="OR" value="OR">Oregon</option>
                <option id="PA" value="PA">Pennsylvania</option>
                <option id="RI" value="RI">Rhode Island</option>
                <option id="SC" value="SC">South Carolina</option>
                <option id="SD" value="SD">South Dakota</option>
                <option id="TN" value="TN">Tennessee</option>
                <option id="TX" value="TX">Texas</option>
                <option id="UT" value="UT">Utah</option>
                <option id="VT" value="VT">Vermont</option>
                <option id="VA" value="VA">Virginia</option>
                <option id="WA" value="WA">Washington</option>
                <option id="WV" value="WV">West Virginia</option>
                <option id="WI" value="WI">Wisconsin</option>
                <option id="WY" value="WY">Wyoming</option>
                <option id="AS" value="AS">American Samoa</option>
                <option id="DC" value="DC">District of Columbia</option>
                <option id="FM" value="FM">Federated States of Micronesia</option>
                <option id="GU" value="GU">Guam</option>
                <option id="MH" value="MH">Marshall Islands</option>
                <option id="MP" value="MP">Northern Mariana Islands</option>
                <option id="PW" value="PW">Palau</option>
                <option id="PR" value="PR">Puerto Rico</option>
                <option id="VI" value="VI">Virgin Islands</option>
                <option id="AE" value="AE">Armed Forces Africa</option>
                <option id="AA" value="AA">Armed Forces Americas</option>
                <option id="AE" value="AE">Armed Forces Canada</option>
                <option id="AE" value="AE">Armed Forces Europe</option>
                <option id="AE" value="AE">Armed Forces Middle East</option>
                <option id="AP" value="AP">Armed Forces Pacific</option>
              </select>
            </span>
            <span id="spantxtState" style="display:none;"><input id="txtState" maxlength="50" name="UserProfile.Address.StateOrProvince" style="width:150px;" type="text" value="NJ"></span>
            <span id="valState" class="cam-validation-message">
            </span>
          </td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Phone Number</label><span class="cam-required-field"></span>
          </td>
          <td class="cam-reg-data-col"><input id="txtPhone" maxlength="50" name="UserProfile.Phone" style="width:150px;" type="text" value=""><span id="valPhone" class="cam-validation-message"></span></td>
        </tr>
        <tr>
          <td class="cam-reg-label-col">
            <label>Fax Number</label>
          </td>
          <td class="cam-reg-data-col"><input id="UserProfile_Fax" maxlength="50" name="UserProfile.Fax" style="width:150px;" type="text" value=""></td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="reg-form-sec">
    <div class="reg-form-sec-title">
      <span>NOTIFICATION CONFIRMATION </span>
    </div><br>
    <div>
      <p>Would you like to receive special interest e-mail(s) from ECRI? </p>
    </div><br>
    <table class="cam-reg-form-table">
      <tbody>
        <tr>
          <td style="padding-bottom:5px;"><input class="checkbox" id="UserProfile_ReceiveMembership" name="UserProfile.ReceiveMembership" type="checkbox" value="true"><input name="UserProfile.ReceiveMembership" type="hidden" value="false"></td>
          <td style="text-align: left;"> &nbsp; <strong>Membership News</strong>
          </td>
        </tr>
        <tr>
          <td style="padding-bottom:5px;"><input class="checkbox" id="UserProfile_ReceiveNewProducts" name="UserProfile.ReceiveNewProducts" type="checkbox" value="true"><input name="UserProfile.ReceiveNewProducts" type="hidden" value="false"></td>
          <td style="text-align: left;"> &nbsp; <strong>New Product and Service Announcements</strong>
          </td>
        </tr>
        <tr>
          <td style="padding-bottom:5px;"><input class="checkbox" id="UserProfile_ReceiveEducation" name="UserProfile.ReceiveEducation" type="checkbox" value="true"><input name="UserProfile.ReceiveEducation" type="hidden" value="false"></td>
          <td style="text-align: left;"> &nbsp; <strong>Educational Events</strong>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="reg-form-sec">
    <div class="reg-form-sec-title">
      <span>PASSWORD CONFIRMATION</span>
    </div>
    <div><br><span> Password must be at least 8 characters long and contain at least 2 of the following: Uppercase letter, Number, or Special Character (such as !, $, #, %)</span></div><br>
    <table class="cam-reg-form-table">
      <tbody>
        <tr>
          <td class="cam-reg-label-col"><label>New Password</label><span class="cam-required-field"></span></td>
          <td class="cam-reg-data-col">
            <input id="txtPassword" maxlength="32" name="NewPassword" style="width:150px;" type="password">
          </td>
          <td>
            <div id="valPassword" class="cam-validation-message"></div>
          </td>
        </tr>
        <tr>
          <td class="cam-reg-label-col"><label>Confirm Password</label><span class="cam-required-field"></span></td>
          <td class="cam-reg-data-col"><input id="txtConfirmPassword" maxlength="32" name="ConfirmPassword" style="width:150px;" type="password"></td>
          <td>
            <div id="valConfirmPassword" class="cam-validation-message"></div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div style="min-height:50px;">
    <table style="width:100%;height:50px;">
      <tbody>
        <tr style="width:100%;height:50px;">
          <td style="width:50%;padding-bottom:15px;"><span class="pull-left cam-required-field"><strong>Required</strong></span></td>
          <td style="width:50%;">
            <div class=" pull-right blue-button-wrapper">
              <span>
                <button type="button" value="Submit" name="SubmitButton" class="blue-button" onclick="RegistrationForm_Submit()">Submit</button>&nbsp;&nbsp; <button type="button" value="Cancel" name="SubmitButton" class="blue-button"
                  onclick="RegistrationForm_Cancel()">Cancel</button>
              </span>
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
</form>

POST /ECRIMembership/Decline

<form action="/ECRIMembership/Decline" method="post">
  <input type="hidden" name="UserEmail" value="samantha.cox@bd.com">
  <input type="hidden" name="AccessType" value="SeatUser">
  <div class="cam-reg-form-border" style="text-align:left;width:100%; height:100%;">
    <p>Are you sure you want to decline the invitation to the following ECRI membership(s).</p><br>
    <ul style="padding-left:50px;max-height:50px;height:50px;overflow-y:auto;">
      <li><strong>Capital Market Intelligence</strong></li>
      <li><strong>Supply Market Intelligence</strong></li>
    </ul>
    <p>If you declining the invitation, the seat reserved for you will be released and given to another person.<br> Do you want to continue?</p>
    <div class="blue-button-wrapper pull-right">
      <span>
        <input type="submit" name="SubmitButton" value="Yes" class="blue-button">&nbsp;&nbsp; <button type="button" name="SubmitButton" value="No" class="blue-button" onclick="CancelDecline()">No</button>
      </span>
    </div>
  </div>
</form>

Text Content

My ECRI








ECRI MEMBERSHIP ACTIVATION


Your membership administrator has granted you access to the following membership
program(s):

 * Capital Market Intelligence
 * Supply Market Intelligence


In order to access the membership program(s), you must first accept this
invitation. Please click the Accept button below and you will be guided through
the process to complete your profile.

If you do not wish to accept the invitation, click Decline and your seat will be
released so that it can be assigned to another user.

To learn more about our programs offered by ECRI, please visit our products and
services page.

--------------------------------------------------------------------------------

ECRI is an independent nonprofit that researches the best approaches to
improving patient care. Designated as an Evidence-based Practice Center by the
U.S. Agency for Healthcare Research and Quality. ECRI and the Institute for Safe
Medication Practices PSO is designated as a federally certified Patient Safety
Organization. ECRI helps you assess and address your patient safety, quality,
and risk management challenges; select the safest, most effective medical
devices, procedures, and drugs; procure healthcare technology in the most
cost-effective manner; develop evidence-based health coverage policies; and
align hospital and health facility capital investments with your strategic
technology needs.



I Accept   I Decline

Please complete the below registration form and click Submit to activate your
membership or click Cancel to activate it later.

PROFILE INFORMATION


Email ID samantha.cox@bd.com First Name Middle Name Last Name

INSTITUTION


Institution Name BD Medical Inc Department Title

ADDRESS


Line 1 Line 2 Line 3 City Postal Code Country - Select a Country - USA
Afghanistan Albania Algeria Andorra Angola Anguilla Antigua And Barbuda
Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh
Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana
Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde
Island Cayman Islands Central African Republic Chad Chile China Colombia Comoros
Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica
Dominican Rep. Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia
Ethiopia Falkland Islands Fiji Finland France French Polynesia Gabon Gambia
Georgia Germany Ghana Gibraltar Greece Grenada Guatemala Guinea Guinea-Bissau
Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq
Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan
Laos Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Macau Macedonia
(Former Yug. Rep.) Madagascar Malawi Malaysia Maldives Mali Malta Mauritania
Mauritius Mexico Moldova Mongolia Montserrat Morocco Mozambique Myanmar Namibia
Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger
Nigeria North Korea Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru
Philippines Poland Portugal Qatar Romania Russia Rwanda S. Georgia & S. Sandwich
Isls. Samoa (Western) Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra
Leone Singapore Slovakia Slovenia Solomon Island Somalia South Africa South
Korea Spain Sri Lanka St. Helena St. Kitts And Nevis St. Lucia St. Vincent And
The Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Tadjikistan
Taiwan Tanzania Thailand Togo Tonga Trinidad And Tobago Tunisia Turkey
Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom Uruguay
Uzbekistan Vanuatu Venezuela Viet Nam Wallis And Futuna Islands Western Samoa
Yemen Yugoslavia Zaire Zambia Zimbabwe Unknown State Or Province - Select a
State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware
District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming American Samoa District of Columbia Federated States
of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico
Virgin Islands Armed Forces Africa Armed Forces Americas Armed Forces Canada
Armed Forces Europe Armed Forces Middle East Armed Forces Pacific Phone Number
Fax Number

NOTIFICATION CONFIRMATION


Would you like to receive special interest e-mail(s) from ECRI?


  Membership News   New Product and Service Announcements   Educational Events

PASSWORD CONFIRMATION

Password must be at least 8 characters long and contain at least 2 of the
following: Uppercase letter, Number, or Special Character (such as !, $, #, %)


New Password

Confirm Password


Required
Submit   Cancel

Are you sure you want to decline the invitation to the following ECRI
membership(s).


 * Capital Market Intelligence
 * Supply Market Intelligence

If you declining the invitation, the seat reserved for you will be released and
given to another person.
Do you want to continue?

   No
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