Form:Module questionnaire

Model Questionnaire

STILL WORKING ON THIS (ALBERT) Please take some time to complete the form below. Make sure that after you complete the questionnaire you submit the form by pressing the submission button at the bottom of this page. Thank you for your time in advance!

{{#form:method=POST| }}

{{#input:type=hidden|name=formmailer}}	{{#input:type=hidden|name=title|value=:Organization}}
First Name:	{{#input:type=text|name=First name }}
Last Name:	{{#input:type=text|name=Last name}}
{{#input: type = hidden | name = content | value = {{#dpl:category={{test1 | test2}}}} }} {{#input:type = select | name = cat | *Select category {{#dpl: namespace = Category | mode = userformat | listseparators = ,\n }} }} }}
Institute / Organization:	{{#input:type=text|name=Institute}}
Department:	{{#input:type=text|name=Department}}
Postal address 1:	{{#input:type=text|name=Postal address 1}}
Postal address 2:	{{#input:type=text|name=Postal address 2}}
Town/City:	{{#input:type=text|name=Town/City}}
Postal code:	{{#input:type=text|name=Postal code}}
State:	{{#input:type=text|name=State}}
Country:	{{#input:type=text|name=Country}}
Email address:	{{#input:type=text|name=Email address}}
Phone:	{{#input:type=text|name=Phone}}
Fax:	{{#input:type=text|name=Fax}}
Choose workgroup: More than one option possible	{{#input:type=checkbox|name=terrestrial}} Terrestrial
	{{#input:type=checkbox|name=Coastal}} Coastal
	{{#input:type=checkbox|name=Marine}} Marine
	{{#input:type=checkbox|name=EKT}} Coastal
	{{#input:type=checkbox|name=Cyberinformatics}} Cyberinformatics
Description of your CSDMS-related interests: (max 300 characters)	{{#input:type=textarea|cols=40|rows=4|name=interest}}
	{{#input:type=submit|value=Submit}}