Difference between revisions of "Workshop2010:registrationform"

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{{#form: action=<nowiki>http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.cgi</nowiki> | method=post}}
 
{{#form: action=<nowiki>http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.cgi</nowiki> | method=post}}
  
Title: {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}
+
'''Contact details'''
 +
 
 +
Title (Mr/Mrs/Dr/Prof): {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}
  
 
Name: {{#input:type=textarea|name=name|cols=30|style=width:auto|rows=1}}
 
Name: {{#input:type=textarea|name=name|cols=30|style=width:auto|rows=1}}
  
Affiliation: {{#input:type=textarea|name=affiliation|cols=30|style=width:auto|rows=1}}
+
Affiliation: {{#input:type=textarea|name=affiliation|cols=50|style=width:auto|rows=1}}
 +
 
 +
Work address: {{#input:type=textarea|rows=3|cols=30|style=width:auto}}
  
Address: {{#input:type=textarea|rows=3|cols=30|style=width:auto}}
+
{{#input:type=hidden|name=wabik}}
  
{{#input:type=hidden|name=dupa}}
+
Telephone (with international dial code): {{#input:type=textarea|name=tel|rows=1|cols=20|style=width:auto}}
  
{{#input:type=select|name=contribution|
+
Email: {{#input:type=textarea|name=email|rows=1|cols=20|style=width:auto}}
 +
----
 +
{|
 +
|-
 +
| '''Your contribution to the Workshop:'''
 +
| {{#input:type=select|name=contribution|
 
*none
 
*none
 
*talk
 
*talk
*poster
+
*poster}}
}}
+
|-
 +
| Title:
 +
| {{#input:type=textarea|name=title|rows=1|cols=50|style=width:auto}}
 +
|-
 +
| Brief abstract:
 +
| {{#input:type=textarea|name=abstract|rows=4|cols=50|style=width:auto}}
 +
|}
 +
 
 +
----
 +
'''Accommodation'''
 +
 
 +
{|
 +
|-
 +
| Requested from date:
 +
| {{#input:type=textarea|name=accom_from|rows=1|cols=10|style=width:auto}}
 +
| Check-out date:
 +
| {{#input:type=textarea|name=accom_checkout|rows=1|cols=10|style=width:auto}}
 +
|}
 +
 
 +
----
 +
'''Financial support'''
 +
 
 +
''We are able to provide limited support for travel and accommodation, mainly for students.''
 +
 
 +
{|
 +
|-
 +
| I would like to apply for the support:
 +
| {{#input:type=select|name=support|
 +
*yes
 +
*no|value=no}}
 +
|-
 +
| Justification:
 +
| {{#input:type=textarea|name=support_justification|rows=3|cols=50|style=width:auto}}
 +
|}
  
 +
----
 
{{#input:type=submit|value=Send}}
 
{{#input:type=submit|value=Send}}
  
 
{{#formend:}}
 
{{#formend:}}

Revision as of 18:37, 28 February 2010

Please do not fill the form yet as it is not working yet!


{{#form: action=http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.cgi | method=post}}

Contact details

Title (Mr/Mrs/Dr/Prof): {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}

Name: {{#input:type=textarea|name=name|cols=30|style=width:auto|rows=1}}

Affiliation: {{#input:type=textarea|name=affiliation|cols=50|style=width:auto|rows=1}}

Work address: {{#input:type=textarea|rows=3|cols=30|style=width:auto}}

{{#input:type=hidden|name=wabik}}

Telephone (with international dial code): {{#input:type=textarea|name=tel|rows=1|cols=20|style=width:auto}}

Email: {{#input:type=textarea|name=email|rows=1|cols=20|style=width:auto}}


Your contribution to the Workshop: name=contribution|
  • none
  • talk
  • poster}}
Title: name=title|rows=1|cols=50|style=width:auto}}
Brief abstract: name=abstract|rows=4|cols=50|style=width:auto}}

Accommodation

Requested from date: name=accom_from|rows=1|cols=10|style=width:auto}} Check-out date: name=accom_checkout|rows=1|cols=10|style=width:auto}}

Financial support

We are able to provide limited support for travel and accommodation, mainly for students.

I would like to apply for the support: name=support|
  • yes
  • no|value=no}}
Justification: name=support_justification|rows=3|cols=50|style=width:auto}}

{{#input:type=submit|value=Send}}

{{#formend:}}