tannaevents2.unugwa.co.tz Open in urlscan Pro
164.68.113.219 Public Scan

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URL:
https://tannaevents2.unugwa.co.tz/
Submission: On December 09 via api (December 9th 2024, 7:33:23 pm UTC) from US — Scanned from DE

Form analysis
3 forms found in the DOM

Name: contactForm — POST

<form method="POST" id="contactForm" name="contactForm" class="contactForm">
  <div class="row">
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="name">Full Name</label>
        <input type="text" class="form-control" name="name" id="name" placeholder="Name">
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="email">Email Address</label>
        <input type="email" class="form-control" name="email" id="email" placeholder="Email">
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="name">Contact No</label>
        <input type="text" class="form-control" name="contact" id="contact" placeholder="contact">
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="email">Professional Rank</label>
        <select type="text" class="form-control" name="pro" required="true">
          <option value="">Select Professional</option>
          <option value="nurse">NURSE</option>
          <option value="ano">ANO</option>
          <option value="no">NO</option>
          <option value="nurse specialist">NURSE SPECIALIST</option>
          <option value="student">STUDENT</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="name">Citizenship</label>
        <select type="text" class="form-control" name="nation" required="true">
          <option value="">Select Country</option>
          <option value="tan">Tanzania</option>
          <option value="ken">Kenya</option>
          <option value="ugan">Uganda</option>
          <option value="rwan">Rwanda</option>
          <option value="bur">Burundi</option>
          <option value="con">Congo DR</option>
          <option value="zam">Zambia</option>
          <option value="sout">South Africa</option>
          <option value="madag">Madagascar</option>
          <option value="leso">Lesotho</option>
          <option value="eswat">Eswatini</option>
          <option value="others">Others</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <!-- Update the JavaScript function to toggle abstract upload field -->
      <script>
        function toggleAbstractUpload() {
          var abstractSubmission = document.getElementById("abstractSubmission");
          var abstractUploadField = document.getElementById("abstractUploadField");
          if (abstractSubmission.value === "Yes") {
            abstractUploadField.style.display = "block";
          } else {
            abstractUploadField.style.display = "none";
          }
        }
      </script>
      <!-- Update the form to include abstract submission and upload fields -->
      <div class="col-md-6">
        <div class="form-group">
          <label class="label" for="email">Abstract Submission</label>
          <select type="text" class="form-control" name="abstract" id="abstractSubmission" required="true" onchange="toggleAbstractUpload()">
            <option value="">Select</option>
            <option value="Yes">Yes</option>
            <option value="No">No</option>
          </select>
        </div>
      </div>
      <script>
        function toggleAbstractUpload() {
          var abstractSubmission = document.getElementById("abstractSubmission");
          var abstractUploadField = document.getElementById("abstractUploadField");
          if (abstractSubmission.value === "Yes") {
            abstractUploadField.style.display = "block";
          } else {
            abstractUploadField.style.display = "none";
          }
        }
      </script>
      <div id="abstractUploadField" class="col-md-6" style="display: none;">
        <div class="form-group">
          <label class="label" for="#">Abstract Upload</label>
          <input type="file" class="form-control" name="abstractFile" id="abstractUploadField" placeholder="Upload Abstract">
        </div>
      </div>
    </div>
    <div id="abstractUploadField" class="col-md-6" style="display: none;">
      <div class="form-group">
        <label class="label" for="#">Abstract Upload</label>
        <input type="file" class="form-control" name="abstractFile" id="abstractUploadField" placeholder="Upload Abstract">
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="#">Venue</label>
        <input type="text" class="form-control" name="venue" id="venue" placeholder="Venue">
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="#">Participant Category</label>
        <select type="text" class="form-control" name="edate" id="edate" required="true" onchange="updateAmount()">
          <option value="">Select Category</option>
          <option value="members">MEMBERS</option>
          <option value="nonmembers">NON MEMBERS</option>
          <option value="noncitizen">NON CITIZEN</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="subject">Type of Event:</label>
        <select type="text" class="form-control" name="eventtype" required="true">
          <option value="">Choose Event Type</option>
          <option value="AGM &amp; NND">AGM &amp; NND</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="info">Amount</label>
        <select type="text" class="form-control" name="info" id="info" required="true">
          <option value="">Select</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="email">Payment Mode</label>
        <select type="text" class="form-control" name="mode" required="true">
          <option value="">Select Mode of Payment</option>
          <option value="cash">CASH</option>
          <option value="bank">BANK</option>
          <option value="mobile">MOBILE NETWORK MONEY </option>
          <option value="transfer">ELECTRONIC TRANSFER</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="#">Branch </label>
        <select type="text" class="form-control" name="est" required="true">
          <option value="">Select Branch</option>
          <option value="NON-MEMBER">NON-MEMBER</option>
          <option value="KILIMANJARO REGIONAL BRANCH">KILIMANJARO REGIONAL BRANCH</option>
          <option value="TANNA HQ">TANNA HQ</option>
          <option value="ARUSHA REGIONAL BRANCH">ARUSHA REGIONAL BRANCH</option>
          <option value="MUHIMBILI NH BRANCH">MUHIMBILI NH BRANCH</option>
          <option value="MOI BRANCH">MOI BRANCH</option>
          <option value="MLOGANZILA MNH BRANCH">MLOGANZILA MNH BRANCH</option>
          <option value="OCEAN ROAD CANCER INSTITUTE BRANCH">OCEAN ROAD CANCER INSTITUTE BRANCH</option>
          <option value="BENJAMIN MKAPA HOSPITAL BRANCH">BENJAMIN MKAPA HOSPITAL BRANCH</option>
          <option value="DODOMA REGIONAL BRANCH">DODOMA REGIONAL BRANCH</option>
          <option value="KIGAMBONI MC BRANCH">KIGAMBONI MC BRANCH</option>
          <option value="KINONDONI MC BRANCH">KINONDONI MC BRANCH</option>
          <option value="ILALA MC BRANCH">ILALA MC BRANCH</option>
          <option value="TEMEKE MC BRANCH">TEMEKE MC BRANCH</option>
          <option value="UBUNGO MC BRANCH">UBUNGO MC BRANCH</option>
          <option value="BUGANDO MEDICAL CENTRE BRANCH">BUGANDO MEDICAL CENTRE BRANCH</option>
          <option value="KCMC MEDICAL CENTRE BRANCH">KCMC MEDICAL CENTRE BRANCH</option>
          <option value="IRINGA REGIONAL BRANCH">IRINGA REGIONAL BRANCH</option>
          <option value="LINDI REGIONAL BRANCH">LINDI REGIONAL BRANCH</option>
          <option value="KATAVI REGIONAL BRANCH">KATAVI REGIONAL BRANCH</option>
          <option value="MTWARA REGIONAL BRANCH">MTWARA REGIONAL BRANCH</option>
          <option value="PWANI REGIONAL BRANCH">PWANI REGIONAL BRANCH</option>
          <option value="MOROGORO REGIONAL BRANCH">MOROGORO REGIONAL BRANCH</option>
          <option value="TANGA REGIONAL BRANCH">TANGA REGIONAL BRANCH</option>
          <option value="MBEYA REGIONAL BRANCH">MBEYA REGIONAL BRANCH</option>
          <option value="MWANZA REGIONAL BRANCH">MWANZA REGIONAL BRANCH</option>
          <option value="MARA REGIONAL BRANCH">MARA REGIONAL BRANCH</option>
          <option value="KAGERA REGIONAL BRANCH">KAGERA REGIONAL BRANCH</option>
          <option value="GEITA REGIONAL BRANCH">GEITA REGIONAL BRANCH</option>
          <option value="SIMIYU REGIONAL BRANCH">SIMIYU REGIONAL BRANCH</option>
          <option value="SHINYANGA REGIONAL BRANCH">SHINYANGA REGIONAL BRANCH</option>
          <option value="KIGOMA REGIONAL BRANCH">KIGOMA REGIONAL BRANCH</option>
          <option value="TABORA REGIONAL BRANCH">TABORA REGIONAL BRANCH</option>
          <option value="RUKWA REGIONAL BRANCH">RUKWA REGIONAL BRANCH</option>
          <option value="SONGWE REGIONAL BRANCH">SONGWE REGIONAL BRANCH</option>
          <option value="RUVUMA REGIONAL BRANCH">RUVUMA REGIONAL BRANCH</option>
          <option value="NJOMBE REGIONAL BRANCH">NJOMBE REGIONAL BRANCH</option>
          <option value="SINGIDA REGIONAL BRANCH">SINGIDA REGIONAL BRANCH</option>
          <option value="MT. MERU HOSPITAL BRANCH">MT. MERU HOSPITAL BRANCH</option>
          <option value="MANYARA REGIONAL BRANCH">MANYARA REGIONAL BRANCH</option>
          <option value="ARUSHA LUTHERAN MEDICAL CENTRE BRANCH">ARUSHA LUTHERAN MEDICAL CENTRE BRANCH</option>
          <option value="JAKAYA KIKWETE CARDIAC INSTITUTE BRANCH">JAKAYA KIKWETE CARDIAC INSTITUTE BRANCH</option>
          <option value="KAIRUKI MEMORIAL HOSPITAL BRANCH">KAIRUKI MEMORIAL HOSPITAL BRANCH</option>
          <option value="MIREMBE HOSPITAL BRANCH">MIREMBE HOSPITAL BRANCH</option>
          <option value="MBEYA ZONAL REFERRAL BRANCH">MBEYA ZONAL REFERRAL BRANCH</option>
          <option value="MWANANYAMALA HOSPITAL BRANCH">MWANANYAMALA HOSPITAL BRANCH</option>
          <option value="RABININSIA MEMORIAL HOSPITAL BRANCH">RABININSIA MEMORIAL HOSPITAL BRANCH</option>
          <option value="SEKOU TOURE HOSPITAL BRANCH">SEKOU TOURE HOSPITAL BRANCH</option>
          <option value="ST. GASPAR ITIGI HOSPITAL BRANCH">ST. GASPAR ITIGI HOSPITAL BRANCH</option>
          <option value="TPDF BRANCH">TPDF BRANCH</option>
          <option value="TUMBI REFERRAL HOSPITAL BRANCH">TUMBI REFERRAL HOSPITAL BRANCH</option>
          <option value="MAWENZI REGIONAL REFERRAL HOSPITAL BRANCH">MAWENZI REGIONAL REFERRAL HOSPITAL BRANCH</option>
          <option value="DODOMA REGIONAL REFERRAL HOSPITAL BRANCH">DODOMA REGIONAL REFERRAL HOSPITAL BRANCH</option>
          <option value="GEITA REGIONAL REFERRAL HOSPITAL BRANCH">GEITA REGIONAL REFERRAL HOSPITAL BRANCH</option>
          <option value="BUKOBA REGIONAL REFERRAL HOSPITAL BRANCH">BUKOBA REGIONAL REFERRAL HOSPITAL BRANCH</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label class="label" for="#">Other Address (Non-Members)</label>
        <input type="text" class="form-control" name="address" id="address" placeholder="Address">
      </div>
    </div>
    <div class="col-md-12">
      <div class="form-group">
        <input type="submit" value=" SUBMIT REGISTRATION" name="submit" class="btn btn-sm btn-info">
        <div class="submitting"></div>
      </div>
    </div>
  </div>
</form>

POST

<form class="forms-sample" method="post">
  <div class="form-group">
    <label for="exampleInputName1">Remarks :</label>
    <textarea name="remark" placeholder="Remark" rows="12" cols="14" class="form-control wd-450" required="true"></textarea>
  </div>
  <div class="form-group">
    <label for="exampleTextarea1">Status :</label>
    <select name="status" class="form-control wd-450" required="true">
      <option value="">Select status</option>
      <option value="Paid" selected="true">Paid</option>
      <option value="Cancelled">Cancelled</option>
    </select>
  </div>
  <div class="modal-footer">
    <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
    <button type="submit" name="submit2" class="btn btn-primary">Update</button>
  </div>
</form>

POST

<form role="form" id="" method="post" enctype="multipart/form-data" class="">
  <div class="form-group first">
    <input type="text" class="form-control form-control-lg" name="username" id="exampleInputEmail1" placeholder="Username" required="">
  </div>
  <div class="form-group last">
    <input type="password" name="password" class="form-control form-control-lg" id="exampleInputPassword1" placeholder="Password" required="">
  </div>
  <div class="mt-3">
    <button name="login" class="btn btn-block btn-info btn-lg font-weight-medium auth-form-btn">SIGN IN</button>
  </div>
  <div class="text-center mt-4 font-weight-light">
    <a href="forgot_password.php" class="text-secondary">
                                        Forgot Password
                                    </a>
  </div>
</form>

Text Content

"Welcome to register for the coming event of AGM & NND 8 - 12 May in Tanga at
REGAL NAIVETRA COMPLEX"
Click Here for REGISTRATION
Mark Attendance

Full Name
Email Address
Contact No
Professional Rank Select Professional NURSE ANO NO NURSE SPECIALIST STUDENT
Citizenship Select Country Tanzania Kenya Uganda Rwanda Burundi Congo DR Zambia
South Africa Madagascar Lesotho Eswatini Others
Abstract Submission Select Yes No
Abstract Upload
Abstract Upload
Venue
Participant Category Select Category MEMBERS NON MEMBERS NON CITIZEN
Type of Event: Choose Event Type AGM & NND
Amount Select
Payment Mode Select Mode of Payment CASH BANK MOBILE NETWORK MONEY ELECTRONIC
TRANSFER
Branch Select Branch NON-MEMBER KILIMANJARO REGIONAL BRANCH TANNA HQ ARUSHA
REGIONAL BRANCH MUHIMBILI NH BRANCH MOI BRANCH MLOGANZILA MNH BRANCH OCEAN ROAD
CANCER INSTITUTE BRANCH BENJAMIN MKAPA HOSPITAL BRANCH DODOMA REGIONAL BRANCH
KIGAMBONI MC BRANCH KINONDONI MC BRANCH ILALA MC BRANCH TEMEKE MC BRANCH UBUNGO
MC BRANCH BUGANDO MEDICAL CENTRE BRANCH KCMC MEDICAL CENTRE BRANCH IRINGA
REGIONAL BRANCH LINDI REGIONAL BRANCH KATAVI REGIONAL BRANCH MTWARA REGIONAL
BRANCH PWANI REGIONAL BRANCH MOROGORO REGIONAL BRANCH TANGA REGIONAL BRANCH
MBEYA REGIONAL BRANCH MWANZA REGIONAL BRANCH MARA REGIONAL BRANCH KAGERA
REGIONAL BRANCH GEITA REGIONAL BRANCH SIMIYU REGIONAL BRANCH SHINYANGA REGIONAL
BRANCH KIGOMA REGIONAL BRANCH TABORA REGIONAL BRANCH RUKWA REGIONAL BRANCH
SONGWE REGIONAL BRANCH RUVUMA REGIONAL BRANCH NJOMBE REGIONAL BRANCH SINGIDA
REGIONAL BRANCH MT. MERU HOSPITAL BRANCH MANYARA REGIONAL BRANCH ARUSHA LUTHERAN
MEDICAL CENTRE BRANCH JAKAYA KIKWETE CARDIAC INSTITUTE BRANCH KAIRUKI MEMORIAL
HOSPITAL BRANCH MIREMBE HOSPITAL BRANCH MBEYA ZONAL REFERRAL BRANCH MWANANYAMALA
HOSPITAL BRANCH RABININSIA MEMORIAL HOSPITAL BRANCH SEKOU TOURE HOSPITAL BRANCH
ST. GASPAR ITIGI HOSPITAL BRANCH TPDF BRANCH TUMBI REFERRAL HOSPITAL BRANCH
MAWENZI REGIONAL REFERRAL HOSPITAL BRANCH DODOMA REGIONAL REFERRAL HOSPITAL
BRANCH GEITA REGIONAL REFERRAL HOSPITAL BRANCH BUKOBA REGIONAL REFERRAL HOSPITAL
BRANCH
Other Address (Non-Members)

×


TAKE ACTION

×
Remarks :
Status : Select status Paid Cancelled
Close Update




PROVIDE CREDENTIALS !

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tannaevents2.unugwa.co.tz Open in urlscan Pro 164.68.113.219 Public Scan

Form analysis 3 forms found in the DOM

Name: contactForm — POST

POST

POST

Text Content

tannaevents2.unugwa.co.tz Open in urlscan Pro
164.68.113.219 Public Scan

Form analysis
3 forms found in the DOM