Differences

This shows you the differences between two versions of the page.

--- software:surgplan [2020/05/12 16:02]
ahuaulme created
+++ software:surgplan [2020/05/13 16:54] (current)
ahuaulme
@@ Line 1: / Line 1: @@
-====== SurgPlan access form ======
+====== SurgePlan access form ======
 <html>
-<form role="form" action="" method="post">
+<form role="form" action="https://docs.google.com/forms/u/0/d/e/1FAIpQLSc5-88iY1qbpheC8bjswfNHO3B7IdH2ETU0df7G8wVrYlMGoQ/formResponse" target="_self" method="post">
                     <div class="form-group">
                         <label for="fname">First Name: <span class="text-danger">* </span></label>
-                        <input type="text" class="form-control" name="" placeholder="Enter your first name here.">
+                        <input type="text" class="form-control" name="entry.1621723030" placeholder="Enter your first name here." required>
                     </div>
+                    <br></br>
                     <div class="form-group">
                         <label for="lname">Last Name: <span class="text-danger">* </span></label>
-                        <input type="text" class="form-control" name=""placeholder="Enter your last name here.">
+                        <input type="text" class="form-control" name="entry.569451349" placeholder="Enter your last name here." required>
                     </div>
+                    <br></br>
                     <div class="form-group">
                         <label for="email">Email address: <span class="text-danger">* </span></label>
-                        <input type="email" class="form-control" name="" placeholder="Enter your email address.">
+                        <input type="email" class="form-control" name="entry.343075552" placeholder="Enter your email address." required>
                     </div>
+                    <br></br>
                     <div class="form-group">
                         <label for="institute">Institute/Organization: <span class="text-danger">* </span></label>
-                        <input type="text" class="form-control" name="" placeholder="Institute / Organization name.">
+                        <input type="text" class="form-control" name="entry.81017266" placeholder="Institute / Organization name." required>
                     </div>
-                    <div class="row">
+                    <br></br>
-                        <div class="col-xs-12"><span class="text-danger"></span></div>
+                    </div class="form-group">
-                    <button class="btn btn-default btn-primary">Submit</button>
+<p xmlns:dct="http://purl.org/dc/terms/" xmlns:cc="http://creativecommons.org/ns#" class="license-text"><a rel="cc:attributionURL" href="http://medicis.univ-rennes1.fr"><span rel="dct:title">SurgePlan</span></a> by <a rel="cc:attributionURL" href="http://medicis.univ-rennes1.fr/pierre.jannin"><span rel="cc:attributionName">Pierre Jannin</span></a> is under licence CC BY-NC-ND 4.0<a href="https://creativecommons.org/licenses/by-nc-nd/4.0"><img style="height:22px!important;margin-left: 3px;vertical-align:text-bottom;" src="https://creativecommons.org/images/deed/cc_blue_x2.png" /><img  style="height:22px!important;margin-left: 3px;vertical-align:text-bottom;" src="https://creativecommons.org/images/deed/attribution_icon_blue_x2.png" /><img  style="height:22px!important;margin-left: 3px;vertical-align:text-bottom;" src="https://creativecommons.org/images/deed/nc_blue_x2.png" /><img  style="height:22px!important;margin-left: 3px;vertical-align:text-bottom;" src="https://creativecommons.org/images/deed/nd_blue_x2.png" /></a></p>
+                        <br></br>
+                        <input type="checkbox" id="checkBox" name="entry.700164823" required>
+                        <label for="checkBox">I understand the rights and duties of the license CC BY-NC-ND 4.0.  </label>
+                    </div>
+                    <center>
+                    <input  type="submit" value="Submit">
+                    </center>
                 </form>
 </html>