Terry's Sandbox

^*Fields marked with an asterisk are required

BRIEF SUMMARY
If a user is logged into Blesta, the logged_in field will auto-set to 'Yes', all contact fields will auto-populate with data from the logged in user, and the login form will NOT be visible.

If a user is NOT logged in, the logged_in field will auto-set to 'No', all contact fields will be shown ready for user to change status or fill out fields, and the login form will NOT be visible.

Selection of either 'yes' or 'no' will toggle hiding the contact fields and showing login form or showing the contact fields and hiding the login form.

NOTE: The option to change status is disabled if a user is logged in. This is because this form template always uses contact data from logged in user and does not permit status change.

Contact Information

Prefix/Salutation

Possible values for this field might be Dr., Mr. Ms., etc.

First Name^*

Different First Name on your name tag?

If you would prefer a different first name on your name tag other than your registered First Name, please enter it here.

Middle Name

Last Name^*

Suffix

Possible values for this field might be Jr., Sr., MD, CBE, etc.

Address^*

Apt/Suite/Unit

City^*

State^*

Zip Code^*

Country^*

Telephone Number

Enter your preferred phone number where we can reach you should we have any questions or need further information from you when processing your submission.

Email Address^*

Please enter the email address where you would like to be notified of this form submission. We will also send event updates to this address so please be sure it is a working email address.

Delano Kindred Membership Status

Are you a Delano Kindred member?^*

No, I am not a Delano Kindred member.
Yes, I am a Delano Kindred member.

Direct Descendant

This shows the child of Philippe from whom this member is descended as recorded in the membership database.

Ancestor listed on name tag

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General Information

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