Template:Join

<_form action="email" id="joinform" messageonsuccess="Thank you for your message." recaptcha-v3-action="joinform"> <_email template="MediaWiki:FlexForm_join_template"></_email> <_label for="name">Full Name</_label> <_input type="text" id="name" name="name" required="required" placeholder="Your full name.."/> <_label for="email">Email</_label> <_input type="text" id="email" name="email" required="required" placeholder="Your email.."/> <_label for="email">Registration Number</_label> <_input type="text" id="registration" name="registration" required="required" placeholder="Your registration number.."/> <_label class="left" for="specialty">What is your specialty?</_label> <_select name="specialty" class="dropdown" id="specialty" > <_input type="option" value="Please select">Please select</_input> <_input type="option" value="Musculoskeletal Medicine Specialist" selected="_selected">Musculoskeletal Medicine Specialist</_input> <_input type="option" value="Musculoskeletal Medicine Registrar">Musculoskeletal Medicine Registrar</_input> <_input type="option" value="General Practitioner">General Practitioner</_input> <_input type="option" value="Other Doctor">Other Doctor</_input> </_select>

Are you an NZCMM member?

 <_input type="radio" id="no" name="nzcmm" value="no" />
 <_label for="huey">No</_label>

 <_input type="radio" id="yes" name="nzcmm" value="yes"/>
 <_label for="dewey">Yes</_label>

<_label for="message">Message</_label> <_input type="textarea" rows="10" id="message" name="message" required="required" placeholder="Your message.."/> <_input type="submit" value="Submit"/> </_form>