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e-dermopharmasummit2024.com Open in urlscan Pro
15.236.177.131  Public Scan

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Submitted URL: https://www.e-dermopharmasummit2024.com/
Effective URL: https://e-dermopharmasummit2024.com/summit-2024/register
Submission: On September 09 via api from US — Scanned from FR

Form analysis 1 forms found in the DOM

Name: register_form — POST 

<form name="register_form" method="post" autocomplete="off">
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_19ef61c8-de2b-4ca7-8596-a41f3e4c8ca3">
    <div class="container">
      <div class="form-row">
        <div class="register-form-field register-form-field-attendee_name col-md-6  form-group" id="register-form-field_19ef61c8-de2b-4ca7-8596-a41f3e4c8ca3"><label for="register_form_19ef61c8-de2b-4ca7-8596-a41f3e4c8ca3"
            class="required">Nombre</label><input type="text" id="register_form_19ef61c8-de2b-4ca7-8596-a41f3e4c8ca3" name="register_form[19ef61c8-de2b-4ca7-8596-a41f3e4c8ca3]" required="required" class="field-required form-control"></div>
        <div class="register-form-field register-form-field-attendee_surname col-md-6  form-group" id="register-form-field_1ecae82a-943c-4454-8278-124a91a8bc60"><label for="register_form_1ecae82a-943c-4454-8278-124a91a8bc60"
            class="required">Apellidos</label><input type="text" id="register_form_1ecae82a-943c-4454-8278-124a91a8bc60" name="register_form[1ecae82a-943c-4454-8278-124a91a8bc60]" required="required" class="field-required form-control"></div>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_11cf8420-bdef-48cb-ab89-aa8a08e36518">
    <div class="container">
      <div class="form-row">
        <div class="register-form-field register-form-field-attendee_email col-md-6  form-group" id="register-form-field_11cf8420-bdef-48cb-ab89-aa8a08e36518"><label for="register_form_11cf8420-bdef-48cb-ab89-aa8a08e36518"
            class="required">Email</label><input type="email" id="register_form_11cf8420-bdef-48cb-ab89-aa8a08e36518" name="register_form[11cf8420-bdef-48cb-ab89-aa8a08e36518]" required="required" class="field-required form-control"></div>
        <div class="register-form-field register-form-field-attendee_phone_number col-md-6  form-group" id="register-form-field_da71324d-f886-4f5a-8410-d3ee9b216a7d"><label for="register_form_da71324d-f886-4f5a-8410-d3ee9b216a7d"
            class="required">Teléfono móvil</label><input type="tel" id="register_form_da71324d-f886-4f5a-8410-d3ee9b216a7d" name="register_form[da71324d-f886-4f5a-8410-d3ee9b216a7d]" required="required" class="field-required form-control"></div>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_826d6709-05b8-46e7-a2c6-5d10718c5cb6">
    <div class="container">
      <div class="form-row">
        <div class="register-form-field register-form-field-attendee_company col-md-6  form-group" id="register-form-field_826d6709-05b8-46e7-a2c6-5d10718c5cb6"><label for="register_form_826d6709-05b8-46e7-a2c6-5d10718c5cb6" class="required">Cliente
            / Farmacia</label><input type="text" id="register_form_826d6709-05b8-46e7-a2c6-5d10718c5cb6" name="register_form[826d6709-05b8-46e7-a2c6-5d10718c5cb6]" required="required" class="field-required form-control"></div>
        <div class="register-form-field register-form-field-text col-md-6  form-group" id="register-form-field_15ed3dc1-0b1a-4b31-8c38-8288e078c44e"><label for="register_form_15ed3dc1-0b1a-4b31-8c38-8288e078c44e" class="required">DNI</label><input
            type="text" id="register_form_15ed3dc1-0b1a-4b31-8c38-8288e078c44e" name="register_form[15ed3dc1-0b1a-4b31-8c38-8288e078c44e]" required="required" class="field-required form-control"></div>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_45de76b0-b566-49af-adac-4a2b9e790a31">
    <div class="container">
      <div class="form-row">
        <fieldset class="register-form-field register-form-field-choice_list col-md-6  form-group" id="register-form-field_45de76b0-b566-49af-adac-4a2b9e790a31">
          <legend class="col-form-label required">¿Necesitas traslado desde tu ciudad origen para viajar a Madrid?</legend>
          <div id="register_form_45de76b0-b566-49af-adac-4a2b9e790a31" class="field-required form-check-inline">
            <div class="form-check">
              <input type="radio" id="register_form_45de76b0-b566-49af-adac-4a2b9e790a31_0" name="register_form[45de76b0-b566-49af-adac-4a2b9e790a31]" required="required" class="form-check-input" value="Si_traslado">
              <label class="form-check-label required" for="register_form_45de76b0-b566-49af-adac-4a2b9e790a31_0">Sí</label>
            </div>
            <div class="form-check">
              <input type="radio" id="register_form_45de76b0-b566-49af-adac-4a2b9e790a31_1" name="register_form[45de76b0-b566-49af-adac-4a2b9e790a31]" required="required" class="form-check-input" value="No_traslado">
              <label class="form-check-label required" for="register_form_45de76b0-b566-49af-adac-4a2b9e790a31_1">No</label>
            </div>
          </div>
        </fieldset>
        <div class="register-form-field register-form-field-text col-md-6  form-group" id="register-form-field_cfa13cd3-659f-482e-b21e-a3ac1cb0d0e5" style="display: none;"><label for="register_form_cfa13cd3-659f-482e-b21e-a3ac1cb0d0e5"
            class="required">Indica desde que ciudad:</label><input type="text" id="register_form_cfa13cd3-659f-482e-b21e-a3ac1cb0d0e5" name="register_form[cfa13cd3-659f-482e-b21e-a3ac1cb0d0e5]" required="required"
            class="field-required form-control field-dependent" disabled=""></div>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_8df60f60-1f07-4fb0-8251-2e5681d6c991">
    <div class="container">
      <div class="form-row">
        <fieldset class="register-form-field register-form-field-choice_list col-md-6  form-group" id="register-form-field_8df60f60-1f07-4fb0-8251-2e5681d6c991">
          <legend class="col-form-label required">¿Necesitas alojamiento?</legend>
          <div id="register_form_8df60f60-1f07-4fb0-8251-2e5681d6c991" class="field-required form-check-inline">
            <div class="form-check">
              <input type="radio" id="register_form_8df60f60-1f07-4fb0-8251-2e5681d6c991_0" name="register_form[8df60f60-1f07-4fb0-8251-2e5681d6c991]" required="required" class="form-check-input" value="Si_alojamiento">
              <label class="form-check-label required" for="register_form_8df60f60-1f07-4fb0-8251-2e5681d6c991_0">Sí</label>
            </div>
            <div class="form-check">
              <input type="radio" id="register_form_8df60f60-1f07-4fb0-8251-2e5681d6c991_1" name="register_form[8df60f60-1f07-4fb0-8251-2e5681d6c991]" required="required" class="form-check-input" value="No_alojamiento">
              <label class="form-check-label required" for="register_form_8df60f60-1f07-4fb0-8251-2e5681d6c991_1">No</label>
            </div>
          </div>
        </fieldset>
        <fieldset class="register-form-field register-form-field-choice_list col-md-6  form-group" id="register-form-field_499a4eb4-877f-4b22-b8cd-beea384c0d85" style="display: none;">
          <legend class="col-form-label required">¿Compartes habitación con tu acompañante?</legend>
          <div id="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85" class="field-required form-check-inline field-dependent" aria-describedby="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_help" style="display: none;">
            <div class="form-check">
              <input type="radio" id="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_0" name="register_form[499a4eb4-877f-4b22-b8cd-beea384c0d85]" required="required" class="form-check-input" value="Si_comparte" disabled="">
              <label class="form-check-label required" for="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_0">Sí</label>
            </div>
            <div class="form-check">
              <input type="radio" id="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_1" name="register_form[499a4eb4-877f-4b22-b8cd-beea384c0d85]" required="required" class="form-check-input" value="No_comparte" disabled="">
              <label class="form-check-label required" for="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_1">No</label>
            </div>
            <div class="form-check">
              <input type="radio" id="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_2" name="register_form[499a4eb4-877f-4b22-b8cd-beea384c0d85]" required="required" class="form-check-input" value="No_acompañante" disabled="">
              <label class="form-check-label required" for="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_2">No llevo acompañante</label>
            </div>
          </div><small id="register_form_499a4eb4-877f-4b22-b8cd-beea384c0d85_help" class="form-text text-muted">Máximo 2 asistentes por cliente.</small>
        </fieldset>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_6edc0cc5-79ff-471f-862e-f22e213652f6">
    <div class="container">
      <div class="form-row">
        <div class="register-form-field register-form-field-separator invisible col-md-6 " id="field_6edc0cc5-79ff-471f-862e-f22e213652f6">
          <hr style="color:transparent;">
        </div>
        <style>
          @media (max-width:768px) {
            #field_6edc0cc5-79ff-471f-862e-f22e213652f6 {
              display: none;
            }
          }
        </style>
        <div class="register-form-field register-form-field-text col-md-6  form-group" id="register-form-field_d99a0ca1-485e-4036-936a-205ee44ac264" style="display: none;"><label for="register_form_d99a0ca1-485e-4036-936a-205ee44ac264"
            class="required">Indica el nombre y apellidos de tu acompañante</label><input type="text" id="register_form_d99a0ca1-485e-4036-936a-205ee44ac264" name="register_form[d99a0ca1-485e-4036-936a-205ee44ac264]" required="required"
            class="field-required form-control field-dependent" disabled=""></div>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_50a634f5-294e-41b5-8d6e-491bb32a4c33">
    <div class="container">
      <div class="form-row">
        <fieldset class="register-form-field register-form-field-choice_list col-md-6  form-group" id="register-form-field_50a634f5-294e-41b5-8d6e-491bb32a4c33">
          <legend class="col-form-label required">¿Asistirás a la cena del día 13 de noviembre?</legend>
          <div id="register_form_50a634f5-294e-41b5-8d6e-491bb32a4c33" class="field-required form-check-inline">
            <div class="form-check">
              <input type="radio" id="register_form_50a634f5-294e-41b5-8d6e-491bb32a4c33_0" name="register_form[50a634f5-294e-41b5-8d6e-491bb32a4c33]" required="required" class="form-check-input" value="Si_cena">
              <label class="form-check-label required" for="register_form_50a634f5-294e-41b5-8d6e-491bb32a4c33_0">Sí</label>
            </div>
            <div class="form-check">
              <input type="radio" id="register_form_50a634f5-294e-41b5-8d6e-491bb32a4c33_1" name="register_form[50a634f5-294e-41b5-8d6e-491bb32a4c33]" required="required" class="form-check-input" value="No_cena">
              <label class="form-check-label required" for="register_form_50a634f5-294e-41b5-8d6e-491bb32a4c33_1">No</label>
            </div>
          </div>
        </fieldset>
        <div class="register-form-field register-form-field-separator invisible col-md-6 " id="field_46f02e8c-2ab2-4beb-bcd7-6b0e47162faa">
          <hr style="color:transparent;">
        </div>
        <style>
          @media (max-width:768px) {
            #field_46f02e8c-2ab2-4beb-bcd7-6b0e47162faa {
              display: none;
            }
          }
        </style>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_820ac38f-00f0-4b82-a2bb-de10ea24b53b">
    <div class="container">
      <div class="form-row">
        <fieldset class="register-form-field register-form-field-choice_list col-md-6  form-group" id="register-form-field_820ac38f-00f0-4b82-a2bb-de10ea24b53b">
          <legend class="col-form-label required">¿Alguna alergia o intolerancia?</legend>
          <div id="register_form_820ac38f-00f0-4b82-a2bb-de10ea24b53b" class="field-required form-check-inline">
            <div class="form-check">
              <input type="radio" id="register_form_820ac38f-00f0-4b82-a2bb-de10ea24b53b_0" name="register_form[820ac38f-00f0-4b82-a2bb-de10ea24b53b]" required="required" class="form-check-input" value="Si_alergia">
              <label class="form-check-label required" for="register_form_820ac38f-00f0-4b82-a2bb-de10ea24b53b_0">Sí</label>
            </div>
            <div class="form-check">
              <input type="radio" id="register_form_820ac38f-00f0-4b82-a2bb-de10ea24b53b_1" name="register_form[820ac38f-00f0-4b82-a2bb-de10ea24b53b]" required="required" class="form-check-input" value="No_alergia">
              <label class="form-check-label required" for="register_form_820ac38f-00f0-4b82-a2bb-de10ea24b53b_1">No</label>
            </div>
          </div>
        </fieldset>
        <div class="register-form-field register-form-field-text col-md-6  form-group" id="register-form-field_435f772b-bb02-48c3-82e6-6ad7f34bbe4b" style="display: none;"><label for="register_form_435f772b-bb02-48c3-82e6-6ad7f34bbe4b"
            class="required">Indica cuáles:</label><input type="text" id="register_form_435f772b-bb02-48c3-82e6-6ad7f34bbe4b" name="register_form[435f772b-bb02-48c3-82e6-6ad7f34bbe4b]" required="required"
            class="field-required form-control field-dependent" disabled=""></div>
      </div>
    </div>
  </div>
  <div class="register-form-field-container-wrapper" id="register-form-field-wrapper_73b23bde-7f2b-4767-9996-9927f6303b1a">
    <div class="container">
      <div class="form-row">
        <div class="register-form-field register-form-field-separator visible col-md-12 " id="field_73b23bde-7f2b-4767-9996-9927f6303b1a">
          <hr>
        </div>
      </div>
    </div>
  </div>
  <div class="register-form-submit-wrapper text-center">
    <div class="container container-submit pt-2">
      <button type="submit" class="btn btn-submit col-sm-12 col-md-3">
        <span class="oi oi-pencil" aria-hidden="true"></span>
        <span class="btn-label"> Enviar </span>
      </button>
    </div>
  </div>
  <input type="hidden" id="register_form__token" name="register_form[_token]" value="42b73f0fa5c8248fa931.c3MpWGJxTxRaUxl1k3Q72ACDCQgtpJGR_WwwaL4D4DY.HBxDBwoLLEU4GSxCpTlXv1HMcTxi3db7kl1BJ9x0lgE6KV4gIEAnZA0dUA">
</form>

Text Content

Esta página necesita JavaScript para funcionar correctamente

Tiene desactivado JavaScript en su navegador, es necesario activarlo para poder
completar el registro


L' ORÉAL E-DERMOPHARMA SUMMIT 2024

Nombre
Apellidos
Email
Teléfono móvil
Cliente / Farmacia
DNI
¿Necesitas traslado desde tu ciudad origen para viajar a Madrid?
Sí
No
Indica desde que ciudad:
¿Necesitas alojamiento?
Sí
No
¿Compartes habitación con tu acompañante?
Sí
No
No llevo acompañante
Máximo 2 asistentes por cliente.

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

Indica el nombre y apellidos de tu acompañante
¿Asistirás a la cena del día 13 de noviembre?
Sí
No

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

¿Alguna alergia o intolerancia?
Sí
No
Indica cuáles:

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

Enviar