{"id":866,"date":"2023-10-31T05:37:41","date_gmt":"2023-10-31T05:37:41","guid":{"rendered":"https:\/\/sarbinfotech.com\/RCCMembers\/registration\/"},"modified":"2023-11-05T18:58:58","modified_gmt":"2023-11-05T18:58:58","slug":"register","status":"publish","type":"page","link":"https:\/\/rasayucancerclinic.com\/associate-member\/register\/","title":{"rendered":"Associate Membership Registration"},"content":{"rendered":"\t<div class='user-registration ur-frontend-form  ur-frontend-form--bordered ' id='user-registration-form-868'>\n\t\t\t\t\t\t\t\t<form method='post' class='register' data-form-id=\"868\"\n\t\t\t\tdata-enable-strength-password=\"1\" data-minimum-password-strength=\"3\"\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t data-captcha-enabled=\"1\">\n\n\t\t\t\t<div class=\"ur-form-row\" data-row-id=\"0\">\t\t\t\t\t\t\t<div class=\"ur-form-grid ur-grid-1\"\n\t\t\t\t\t\t\t\tstyle=\"width:99%\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"first_name\" class=\"ur-field-item field-first_name \" data-ref-id=\"first_name\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"first_name_field\" data-priority=\"\" ><label for=\"first_name\" class=\"ur-label\">Your Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"first_name\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"first_name\" id=\"first_name\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Your Name\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"number_box_1699019382\" class=\"ur-field-item field-number \" data-ref-id=\"number_box_1699019382\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"number_box_1699019382_field\" data-priority=\"\" ><label for=\"number_box_1699019382\" class=\"ur-label\">Phone Number <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"number_box_1699019382\" type=\"number\" class=\"input-text   input-number ur-frontend-field  \" name=\"number_box_1699019382\" id=\"number_box_1699019382\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Phone Number\" step=\"1\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"user_email\" class=\"ur-field-item field-user_email \" data-ref-id=\"user_email\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"user_email_field\" data-priority=\"\" ><label for=\"user_email\" class=\"ur-label\">Email ID <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"user_email\" type=\"email\" class=\"input-text   input-email ur-frontend-field  \" name=\"user_email\" id=\"user_email\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Email ID\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"textarea_1698731457\" class=\"ur-field-item field-textarea \" data-ref-id=\"textarea_1698731457\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"textarea_1698731457_field\" data-priority=\"\" ><label for=\"textarea_1698731457\" class=\"ur-label\">Address <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><textarea style=\"margin-bottom:0px;\" data-rules=\"\" data-id=\"textarea_1698731457\" name=\"textarea_1698731457\" class=\"input-text ur-frontend-field  \" id=\"textarea_1698731457\" placeholder=\"\"  rows=\"2\" cols=\"5\"required=\"required\" data-label=\"Address\"><\/textarea><div style=\"text-align: right; font-size:14px; color:#737373; margin-top:0px;\"> <div class=\"ur-input-count\" data-count-type=\"characters\" style=\"display: inline-block; margin-right: 1px;\">0<\/div>&nbsp;<div style=\"display: inline-block;\"> characters<\/div><\/div><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"input_box_1698731193\" class=\"ur-field-item field-text \" data-ref-id=\"input_box_1698731193\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"input_box_1698731193_field\" data-priority=\"\" ><label for=\"input_box_1698731193\" class=\"ur-label\">Hospital Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"input_box_1698731193\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"input_box_1698731193\" id=\"input_box_1698731193\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Hospital Name\" maxlength=\"50\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"textarea_1698731237\" class=\"ur-field-item field-textarea \" data-ref-id=\"textarea_1698731237\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required\" id=\"textarea_1698731237_field\" data-priority=\"\" ><label for=\"textarea_1698731237\" class=\"ur-label\">Hospital Address <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><textarea style=\"margin-bottom:0px;\" data-rules=\"\" data-id=\"textarea_1698731237\" name=\"textarea_1698731237\" class=\"input-text ur-frontend-field  \" id=\"textarea_1698731237\" placeholder=\"\"  rows=\"2\" cols=\"5\"required=\"required\" data-label=\"Hospital Address\"><\/textarea><div style=\"text-align: right; font-size:14px; color:#737373; margin-top:0px;\"> <div class=\"ur-input-count\" data-count-type=\"characters\" style=\"display: inline-block; margin-right: 1px;\">0<\/div>&nbsp;<div style=\"display: inline-block;\"> characters<\/div><\/div><\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"input_box_1698731302\" class=\"ur-field-item field-text \" data-ref-id=\"input_box_1698731302\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"input_box_1698731302_field\" data-priority=\"\" ><label for=\"input_box_1698731302\" class=\"ur-label\">Hospital Contact No.<\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"input_box_1698731302\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"input_box_1698731302\" id=\"input_box_1698731302\" placeholder=\"\"  value=\"\" data-label=\"Hospital Contact No.\" maxlength=\"50\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"email_1698731368\" class=\"ur-field-item field-email \" data-ref-id=\"email_1698731368\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"email_1698731368_field\" data-priority=\"\" ><label for=\"email_1698731368\" class=\"ur-label\">Hospital Mail id<\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"email_1698731368\" type=\"email\" class=\"input-text   input-email ur-frontend-field  \" name=\"email_1698731368\" id=\"email_1698731368\" placeholder=\"\"  value=\"\" data-label=\"Hospital Mail id\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"input_box_1698731397\" class=\"ur-field-item field-text \" data-ref-id=\"input_box_1698731397\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"input_box_1698731397_field\" data-priority=\"\" ><label for=\"input_box_1698731397\" class=\"ur-label\">Hospital URL<\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"input_box_1698731397\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"input_box_1698731397\" id=\"input_box_1698731397\" placeholder=\"\"  value=\"\" data-label=\"Hospital URL\" maxlength=\"50\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"input_box_1698731418\" class=\"ur-field-item field-text \" data-ref-id=\"input_box_1698731418\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row \" id=\"input_box_1698731418_field\" data-priority=\"\" ><label for=\"input_box_1698731418\" class=\"ur-label\">Council Registration Number<\/label> <span class=\"input-wrapper\"> <input  data-rules=\"\" data-id=\"input_box_1698731418\" type=\"text\" class=\"input-text   input-text ur-frontend-field  \" name=\"input_box_1698731418\" id=\"input_box_1698731418\" placeholder=\"\"  value=\"\" data-label=\"Council Registration Number\" maxlength=\"50\" \/> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div  data-field-id=\"user_pass\" class=\"ur-field-item field-user_pass \" data-ref-id=\"user_pass\" data-field-pattern-enabled=\"0\" data-field-pattern-value=\" \" data-field-pattern-message=\" \">\n\t\t\t\t\t\t\t\t\t\t<div class=\"form-row validate-required hide_show_password\" id=\"user_pass_field\" data-priority=\"\"><label for=\"user_pass\" class=\"ur-label\">Password <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <span class=\"input-wrapper\"> <span class=\"password-input-group input-form-field-icons\"><input data-rules=\"\" data-id=\"user_pass\" type=\"password\" class=\"input-text  input-password ur-frontend-field  \" name=\"user_pass\" id=\"user_pass\" placeholder=\"\"  value=\"\" required=\"required\" data-label=\"Password\" \/><a href=\"javaScript:void(0)\" class=\"password_preview dashicons dashicons-hidden\" title=\" Show password \"><\/a><\/span> <\/span> <\/div>\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"ur-recaptcha-node\"> <div id=\"node_recaptcha_register\" class=\"g-recaptcha\"><\/div><\/div>\t\t\t\t\t\t<div class=\"ur-button-container \" >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<button type=\"submit\" class=\"btn button ur-submit-button \"  conditional_rules=\"&quot;&quot;\">\n\t\t\t\t\t\t\t\t<span><\/span>\n\t\t\t\t\t\t\t\tSubmit\t\t\t\t\t\t\t<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t<div style=\"clear:both\"><\/div>\n\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"ur-registration-language\" value=\"en-US\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"ur-user-form-id\" value=\"868\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"ur-redirect-url\" value=\"https:\/\/rasayucancerclinic.com\/associate-memeber\/thank-you\/\"\/>\n\t\t\t\t<input type=\"hidden\" id=\"ur_frontend_form_nonce\" name=\"ur_frontend_form_nonce\" value=\"8c7f68233b\" \/>\n\t\t\t\t\n\t\t\t<\/form>\n\t\t\t\n\t\t<div style=\"clear:both\"><\/div>\n\t<\/div>\n\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/narrow-width.php","meta":{"pmpro_default_level":"","footnotes":""},"class_list":["post-866","page","type-page","status-publish","hentry","pmpro-has-access"],"_links":{"self":[{"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/pages\/866","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/comments?post=866"}],"version-history":[{"count":0,"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/pages\/866\/revisions"}],"wp:attachment":[{"href":"https:\/\/rasayucancerclinic.com\/associate-member\/wp-json\/wp\/v2\/media?parent=866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}