www.impact22ndjanuary-wiewlite.com Open in urlscan Pro
51.79.178.75  Public Scan

Form analysis
2 forms found in the DOM

POST javascript:void(0);

<form method="post" id="submit_user_login_form" action="javascript:void(0);" autocomplete="on">
  <input type="hidden" name="submit_user_login_form" value="true">
  <div class="form-row">
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="login_email" class="sr-only">Email Address*</label>
      <input type="email" name="f2" class="form-control" id="login_email" placeholder="Email Address*" required="">
    </div>
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-3 col-xl-3">
      <button type="submit" name="submit_btn_add" id="submit_btn" class="btn btn-block login-btn">Sign in</button>
    </div>
  </div>
</form>

POST javascript:void(0);

<form method="post" action="javascript:void(0);" id="submit_user_form" autocomplete="on">
  <input type="hidden" name="submit_user_form" value="true">
  <div class="form-row">
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="f1" class="sr-only">Full Name*</label>
      <input name="f1" id="f1" placeholder="Full Name*" type="text" class="form-control text-capitalize" required="">
    </div>
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="f3" class="sr-only">City*</label>
      <input name="f3" id="f3" placeholder="City*" type="text" class="form-control text-capitalize" required="">
    </div>
  </div>
  <div class="form-row">
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="f4" class="sr-only">Degree*</label>
      <input name="f4" id="f4" placeholder="Degree*" type="text" class="form-control text-capitalize" required="">
    </div>
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="f5" class="sr-only">Mci Registration No.*</label>
      <input name="f5" id="f5" placeholder="Mci Registration No.*" type="text" class="form-control text-capitalize" required="">
    </div>
  </div>
  <div class="form-row">
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="f6" class="sr-only">Mobile*</label>
      <input name="f6" maxlength="10" id="f6" placeholder="Mobile*" type="text" class="form-control" required="">
    </div>
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6">
      <label for="f7" class="sr-only">Speciality &amp; Affiliated Institution*</label>
      <input name="f7" id="f7" placeholder="Speciality &amp; Affiliated Institution*" type="text" class="form-control text-capitalize" required="">
    </div>
  </div>
  <div class="form-row">
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-5 col-xl-5">
      <label for="f2" class="sr-only">Email Address*</label>
      <input name="f2" id="f2" placeholder="Email Address*" type="email" class="form-control" required="">
    </div>
    <div class="form-group col-12 col-sm-12 col-md-12 col-lg-7 col-xl-7">
      <div class="form-row">
        <div class="col-12 col-sm-12 col-md-4 col-lg-4 col-xl-4 mb-3">
          <button type="submit" name="submit_btn_add" id="submit_btn" class="btn btn-block login-btn">Sign up</button>
        </div>
        <div class="col-12 col-sm-12 col-md-8 col-lg-8 col-xl-8 mb-3">
          <!--https://calendar.google.com/calendar/u/0/r/eventedit?text=Indian+Medical+Association+%7C+IMPACT+&dates=20211120T030000/20211120T040000&uid=61922053ea9eed633646c717&details=INDIAN%C2%A0MEDICAL+ASSOCIATION+INITIATIVE+TO%0AIMPROVISE+PHYSICIANS%E2%80%99+ACCESS+TO+CONTINOUS+MEDICAL%0AEDUCATION+AT+PRIMARY+HEALTHCARE+LEVEL%0A%0ALink:+https://www.impact20thnovember-wiewlite.com/&ctz=Asia/Kolkata-->
          <a class="btn btn-block login-btn ace_btn" href="javascript:void(0)">ADD TO CALENDAR</a>
        </div>
      </div>
    </div>
  </div>
</form>

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Full Name*
City*
Degree*
Mci Registration No.*
Mobile*
Speciality & Affiliated Institution*
Email Address*
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