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gravity-defyer-medical-technology-corp.myklpages.com Open in urlscan Pro
2606:4700::6812:159b  Public Scan

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Submitted URL: https://trk.klclick1.com/ls/click?upn=HrLkfkZpw3hKyz8w4O3GEGRf-2FCq-2FJ2Xlq69dPVUMAfbgLfygJEPDmwOEZQoNFPGQw2hk-2BryC2yxVU...
Effective URL: https://gravity-defyer-medical-technology-corp.myklpages.com/p/preference_page?a=XMQhgx&c=01HJ8T230393SCFP321ZMCB7T8&k=18add8dbe2c52967663396e29cbf939a&g=TZ9...
Submission: On December 27 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST 

<form action="" id="preferences_form" method="POST" role="form" class="form-horizontal" novalidate="novalidate">
  <input type="hidden" name="$fields" value="EmailInterests,EmailFrequency,Birthday">
  <input type="hidden" name="$list_fields" value="EmailInterests">
  <!-- <input type="hidden" name="$unsubscribed_url" value="/p/preferences_updated" /> -->
  <!-- <input type="hidden" name="$updated_profile_url" value="/p/preferences_updated" /> -->
  <!--<p class="required-fields">
           <span>*</span> Required Information
           </p>-->
  <div class="form-group">
    <div class="col-sm-12">
      <input type="text" class="form-control" id="first_name" name="$first_name" value="" placeholder="Name*">
    </div>
  </div>
  <div class="email_group form-group">
    <div class="col-sm-12">
      <input type="email" class="form-control" id="email" name="$email" value="" placeholder="Email*">
    </div>
  </div>
  <div class="birthday_heading">
    <p>Enter your birthday date to receive a gift on your birthday:</p>
  </div>
  <div class="form-group birthday_group">
    <!--            <label for="klaviyo_birthday_controls" class="col-sm-3">Birthday:</label>-->
    <div class="col-sm-12 birthday_widget_container">
      <div class="klaviyo_field_group select-date-widget">
        <div class="klaviyo_birthday_controls">
          <select id="Birthday_month_select" name="Birthday_month">
            <option value="">Month</option>
            <option value="1">January</option>
            <option value="2">February</option>
            <option value="3">March</option>
            <option value="4">April</option>
            <option value="5">May</option>
            <option value="6">June</option>
            <option value="7">July</option>
            <option value="8">August</option>
            <option value="9">September</option>
            <option value="10">October</option>
            <option value="11">November</option>
            <option value="12">December</option>
          </select>
          <select id="Birthday_day_select" name="Birthday_day">
            <option value="">Day</option>
            <option value="1">1</option>
            <option value="2">2</option>
            <option value="3">3</option>
            <option value="4">4</option>
            <option value="5">5</option>
            <option value="6">6</option>
            <option value="7">7</option>
            <option value="8">8</option>
            <option value="9">9</option>
            <option value="10">10</option>
            <option value="11">11</option>
            <option value="12">12</option>
            <option value="13">13</option>
            <option value="14">14</option>
            <option value="15">15</option>
            <option value="16">16</option>
            <option value="17">17</option>
            <option value="18">18</option>
            <option value="19">19</option>
            <option value="20">20</option>
            <option value="21">21</option>
            <option value="22">22</option>
            <option value="23">23</option>
            <option value="24">24</option>
            <option value="25">25</option>
            <option value="26">26</option>
            <option value="27">27</option>
            <option value="28">28</option>
            <option value="29">29</option>
            <option value="30">30</option>
          </select>
          <select id="Birthday_year_select" name="Birthday_year">
            <option value="">Year</option>
            <option value="2023">2023</option>
            <option value="2022">2022</option>
            <option value="2021">2021</option>
            <option value="2020">2020</option>
            <option value="2019">2019</option>
            <option value="2018">2018</option>
            <option value="2017">2017</option>
            <option value="2016">2016</option>
            <option value="2015">2015</option>
            <option value="2014">2014</option>
            <option value="2013">2013</option>
            <option value="2012">2012</option>
            <option value="2011">2011</option>
            <option value="2010">2010</option>
            <option value="2009">2009</option>
            <option value="2008">2008</option>
            <option value="2007">2007</option>
            <option value="2006">2006</option>
            <option value="2005">2005</option>
            <option value="2004">2004</option>
            <option value="2003">2003</option>
            <option value="2002">2002</option>
            <option value="2001">2001</option>
            <option value="2000">2000</option>
            <option value="1999">1999</option>
            <option value="1998">1998</option>
            <option value="1997">1997</option>
            <option value="1996">1996</option>
            <option value="1995">1995</option>
            <option value="1994">1994</option>
            <option value="1993">1993</option>
            <option value="1992">1992</option>
            <option value="1991">1991</option>
            <option value="1990">1990</option>
            <option value="1989">1989</option>
            <option value="1988">1988</option>
            <option value="1987">1987</option>
            <option value="1986">1986</option>
            <option value="1985">1985</option>
            <option value="1984">1984</option>
            <option value="1983">1983</option>
            <option value="1982">1982</option>
            <option value="1981">1981</option>
            <option value="1980">1980</option>
            <option value="1979">1979</option>
            <option value="1978">1978</option>
            <option value="1977">1977</option>
            <option value="1976">1976</option>
            <option value="1975">1975</option>
            <option value="1974">1974</option>
            <option value="1973">1973</option>
            <option value="1972">1972</option>
            <option value="1971">1971</option>
            <option value="1970">1970</option>
            <option value="1969">1969</option>
            <option value="1968">1968</option>
            <option value="1967">1967</option>
            <option value="1966">1966</option>
            <option value="1965">1965</option>
            <option value="1964">1964</option>
            <option value="1963">1963</option>
            <option value="1962">1962</option>
            <option value="1961">1961</option>
            <option value="1960">1960</option>
            <option value="1959">1959</option>
            <option value="1958">1958</option>
            <option value="1957">1957</option>
            <option value="1956">1956</option>
            <option value="1955">1955</option>
            <option value="1954">1954</option>
            <option value="1953">1953</option>
            <option value="1952">1952</option>
            <option value="1951">1951</option>
            <option value="1950">1950</option>
            <option value="1949">1949</option>
            <option value="1948">1948</option>
            <option value="1947">1947</option>
            <option value="1946">1946</option>
            <option value="1945">1945</option>
            <option value="1944">1944</option>
            <option value="1943">1943</option>
            <option value="1942">1942</option>
            <option value="1941">1941</option>
            <option value="1940">1940</option>
            <option value="1939">1939</option>
            <option value="1938">1938</option>
            <option value="1937">1937</option>
            <option value="1936">1936</option>
            <option value="1935">1935</option>
            <option value="1934">1934</option>
            <option value="1933">1933</option>
            <option value="1932">1932</option>
            <option value="1931">1931</option>
            <option value="1930">1930</option>
            <option value="1929">1929</option>
            <option value="1928">1928</option>
            <option value="1927">1927</option>
            <option value="1926">1926</option>
            <option value="1925">1925</option>
            <option value="1924">1924</option>
          </select>
          <input id="Birthday" type="hidden" name="Birthday" value="">
        </div>
      </div>
    </div>
  </div>
  <div class="form-group col-md-12">
    <label for="interests" class="control-label interests_and_email_frequency_headings">How often would you like to hear from us?</label>
    <div class="interests_and_email_frequency_choices_container">
      <div class="radio_input_container">
        <input class="radio-custom" type="radio" name="EmailFrequency" id="email_frequency_0" value="All Emails" checked="checked">
        <label for="email_frequency_0" class="radio-custom-label">All Emails </label>
      </div>
      <div class="radio_input_container">
        <input class="radio-custom" type="radio" name="EmailFrequency" id="email_frequency_1" value="Weekly">
        <label for="email_frequency_1" class="radio-custom-label">Once per Week</label>
      </div>
      <div class="radio_input_container">
        <input class="radio-custom" type="radio" name="EmailFrequency" id="email_frequency_2" value="Monthly">
        <label for="email_frequency_2" class="radio-custom-label">Once per Month</label>
      </div>
      <div class="radio_input_container">
        <input class="radio-custom" type="radio" name="EmailFrequency" id="email_frequency_3" value="Snooze">
        <label for="email_frequency_3" class="radio-custom-label">Snooze all emails for 30 days</label>
      </div>
    </div>
  </div>
  <div class="form-group col-md-12">
    <label for="interests" class="control-label control-label-2 interests_and_email_frequency_headings">Interests <span>(select as many as you like)</span></label>
    <div class="interests_and_email_frequency_choices_container checkbox_choices_container">
      <div class="checkbox_half_width">
        <div class="checkbox">
          <label class="checkbox_container">
            <input type="checkbox" name="EmailInterests" value="All Emails, Promotions &amp; Sales, New Product Releases, Events" checked="checked">
            <span class="checkmark">All Emails</span>
          </label>
        </div>
        <div class="checkbox">
          <label class="checkbox_container">
            <input type="checkbox" name="EmailInterests" value="Promotions &amp; Sales">
            <span class="checkmark">Promotions &amp; Sales</span>
          </label>
        </div>
      </div>
      <div class="checkbox_half_width">
        <div class="checkbox">
          <label class="checkbox_container">
            <input type="checkbox" name="EmailInterests" value="New Product Releases">
            <span class="checkmark">New Product Releases</span>
          </label>
        </div>
        <div class="checkbox">
          <label class="checkbox_container">
            <input type="checkbox" name="EmailInterests" value="Events">
            <span class="checkmark">Events</span>
          </label>
        </div>
      </div>
    </div>
  </div>
  <div class="unsubscribe_checkbox_container">
    <div class="checkbox unsubscribe_checkbox_div">
      <label class="unsub_checkbox_container">
        <input type="checkbox" id="unsub" name="$unsubscribe" value="true">
        <span class="checkmark unsubscribe_checkmark"></span> Unsubscribe from all emails </label>
    </div>
  </div>
  <div class="clearfix form-actions button_container">
    <!-- <button type="submit" class="btn update_button">Update Preferences</button> -->
    <button type="submit" class="btn update_button">save my preferences</button>
  </div>
</form>

Text Content

EMAIL PREFERENCES

We never want to bombard you with useless, annoying emails -- we hate those.
Give us a little more information below and we’ll tailor our emails to fit your
needs and interests (while blasting those useless messages into outer space --
not your inbox). And if you’d like to hear from us less -- period -- that’s
fine, too! We’re not too sensitive.

Enter your birthday date to receive a gift on your birthday:

Month January February March April May June July August September October
November December Day123456789101112131415161718192021222324252627282930 Year
2023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924
How often would you like to hear from us?
All Emails
Once per Week
Once per Month
Snooze all emails for 30 days
Interests (select as many as you like)
All Emails
Promotions & Sales
New Product Releases
Events
Unsubscribe from all emails
save my preferences

© 2008-2023 Gravity Defyer Corp.