{"id":1836,"date":"2025-11-24T07:31:27","date_gmt":"2025-11-24T07:31:27","guid":{"rendered":"https:\/\/www.axesome.com\/genoscope-doctors-club-application-form\/"},"modified":"2025-11-27T12:56:57","modified_gmt":"2025-11-27T12:56:57","slug":"genoscope-doctors-club-application-form","status":"publish","type":"page","link":"https:\/\/www.axesome.com\/en\/genoscope-doctors-club-application-form\/","title":{"rendered":"GENOSCOPE DOCTOR\u2019S CLUB APPLICATION FORM"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1836\" class=\"elementor elementor-1836 elementor-1782\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3a0c987 e-flex e-con-boxed e-con e-parent\" data-id=\"3a0c987\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-3a7bbd5 e-con-full e-flex e-con e-child\" data-id=\"3a7bbd5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-da9a449 elementor-widget elementor-widget-image\" data-id=\"da9a449\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"500\" height=\"50\" src=\"https:\/\/www.axesome.com\/wp-content\/uploads\/2025\/11\/genoscope-logo.png\" class=\"attachment-large size-large wp-image-1615\" alt=\"\" srcset=\"https:\/\/www.axesome.com\/wp-content\/uploads\/2025\/11\/genoscope-logo.png.webp 500w, https:\/\/www.axesome.com\/wp-content\/uploads\/2025\/11\/genoscope-logo-300x30.png.webp 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ada1799 elementor-widget elementor-widget-heading\" data-id=\"ada1799\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Doctor's Club Application Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-56fa338 elementor-widget elementor-widget-text-editor\" data-id=\"56fa338\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Genoscope Doctor&#8217;s Club &#8211; Physician Membership Application Form<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fb2ca26 genoscope-form-2 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"fb2ca26\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" aria-label=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1836\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"fb2ca26\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"GENOSCOPE DOCTOR\u2019S CLUB APPLICATION FORM - Axesome\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1836\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<h2>Personal Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFull Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Full Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_e6637b5 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e6637b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_e6637b5]\" id=\"form-field-field_e6637b5\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\" min=\"1900-11-05\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNational ID \/ Passport No\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"National ID \/ Passport No\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_758cc7d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_758cc7d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_758cc7d]\" id=\"form-field-field_758cc7d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_6d78bff elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6d78bff\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tE-Mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_6d78bff]\" id=\"form-field-field_6d78bff\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d37d9cb elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d37d9cb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d37d9cb]\" id=\"form-field-field_d37d9cb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adress\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a206863 elementor-col-100\">\n\t\t\t\t\t<h2>Professional Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_4374126 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4374126\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSpecialty\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Dermatology\" id=\"form-field-field_4374126-0\" name=\"form_fields[field_4374126]\" required=\"required\"> <label for=\"form-field-field_4374126-0\">Dermatology<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Plastic Surgery\" id=\"form-field-field_4374126-1\" name=\"form_fields[field_4374126]\" required=\"required\"> <label for=\"form-field-field_4374126-1\">Plastic Surgery<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Medical Aesthetics\" id=\"form-field-field_4374126-2\" name=\"form_fields[field_4374126]\" required=\"required\"> <label for=\"form-field-field_4374126-2\">Medical Aesthetics<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Genetics\" id=\"form-field-field_4374126-3\" name=\"form_fields[field_4374126]\" required=\"required\"> <label for=\"form-field-field_4374126-3\">Genetics<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Other\" id=\"form-field-field_4374126-4\" name=\"form_fields[field_4374126]\" required=\"required\"> <label for=\"form-field-field_4374126-4\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_161591e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_161591e]\" id=\"form-field-field_161591e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Other Specialty\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_953d518 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_953d518\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInstitution \/ Clinic Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_953d518]\" id=\"form-field-field_953d518\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Institution Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_49ab119 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_49ab119\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPosition \/ Title\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_49ab119]\" id=\"form-field-field_49ab119\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Position \/ Title\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_016237b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_016237b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInstitution Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_016237b]\" id=\"form-field-field_016237b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Institution Address\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_8e11df8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8e11df8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInstitution Phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_8e11df8]\" id=\"form-field-field_8e11df8\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Institution Phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_38bebb6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_38bebb6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProfessional Registration No \/ Medical Chamber No\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_38bebb6]\" id=\"form-field-field_38bebb6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Professional Registration No \/ Medical Chamber No\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3814033 elementor-col-100\">\n\t\t\t\t\t<h2>Clinical Activities and Practices<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3e36669 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3e36669\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you apply exosome or biotechnological treatments?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes&lt;br&gt;No\" id=\"form-field-field_3e36669-0\" name=\"form_fields[field_3e36669]\" required=\"required\"> <label for=\"form-field-field_3e36669-0\">Yes<br>No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4f19489 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4f19489\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf Yes:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4f19489]\" id=\"form-field-field_4f19489\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_66f97e2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_66f97e2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have experience with skin or hair treatments based on genetic analysis?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes&lt;br&gt;No\" id=\"form-field-field_66f97e2-0\" name=\"form_fields[field_66f97e2]\" required=\"required\"> <label for=\"form-field-field_66f97e2-0\">Yes<br>No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_28e35e0 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_28e35e0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhich area within Genoscope are you interested in?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Clinical Practice\" id=\"form-field-field_28e35e0-0\" name=\"form_fields[field_28e35e0]\" required=\"required\"> <label for=\"form-field-field_28e35e0-0\">Clinical Practice<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Academic Research\" id=\"form-field-field_28e35e0-1\" name=\"form_fields[field_28e35e0]\" required=\"required\"> <label for=\"form-field-field_28e35e0-1\">Academic Research<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Product Development\" id=\"form-field-field_28e35e0-2\" name=\"form_fields[field_28e35e0]\" required=\"required\"> <label for=\"form-field-field_28e35e0-2\">Product Development<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e11ce7d elementor-col-100\">\n\t\t\t\t\t<h2>Scientific and Academic Interests<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_14d4c5f elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Exosome-Based Therapies\" id=\"form-field-field_14d4c5f-0\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-0\">Exosome-Based Therapies<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" RNA \/ mRNA Analysis\" id=\"form-field-field_14d4c5f-1\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-1\"> RNA \/ mRNA Analysis<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Personalized Skin Genetics\" id=\"form-field-field_14d4c5f-2\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-2\"> Personalized Skin Genetics<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Anti-Aging and Regenerative Medicine\" id=\"form-field-field_14d4c5f-3\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-3\"> Anti-Aging and Regenerative Medicine<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Cosmetic Biotechnology\" id=\"form-field-field_14d4c5f-4\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-4\"> Cosmetic Biotechnology<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Clinical Research \/ Patient Case Studies\" id=\"form-field-field_14d4c5f-5\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-5\"> Clinical Research \/ Patient Case Studies<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Genetic Data Interpretation\" id=\"form-field-field_14d4c5f-6\" name=\"form_fields[field_14d4c5f][]\"> <label for=\"form-field-field_14d4c5f-6\"> Genetic Data Interpretation<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0fe4b5f elementor-col-100\">\n\t\t\t\t\t<h2>Membership Preferences<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a61bdd7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a61bdd7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tParticipation Type\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Individual Membership\" id=\"form-field-field_a61bdd7-0\" name=\"form_fields[field_a61bdd7]\"> <label for=\"form-field-field_a61bdd7-0\">Individual Membership<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Corporate Membership\" id=\"form-field-field_a61bdd7-1\" name=\"form_fields[field_a61bdd7]\"> <label for=\"form-field-field_a61bdd7-1\">Corporate Membership<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_b8371c2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b8371c2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCommunication Preference\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"E-mail\" id=\"form-field-field_b8371c2-0\" name=\"form_fields[field_b8371c2][]\"> <label for=\"form-field-field_b8371c2-0\">E-mail<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Tel\" id=\"form-field-field_b8371c2-1\" name=\"form_fields[field_b8371c2][]\"> <label for=\"form-field-field_b8371c2-1\"> Tel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Message\" id=\"form-field-field_b8371c2-2\" name=\"form_fields[field_b8371c2][]\"> <label for=\"form-field-field_b8371c2-2\"> Message<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Whatsapp\" id=\"form-field-field_b8371c2-3\" name=\"form_fields[field_b8371c2][]\"> <label for=\"form-field-field_b8371c2-3\"> Whatsapp<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3b3e1db elementor-col-100\">\n\t\t\t\t\t<h2>Privacy and Ethical Declaration<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_514d41b elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"I confirm that all information provided in this form is accurate.\" id=\"form-field-field_514d41b-0\" name=\"form_fields[field_514d41b]\" required=\"required\"> <label for=\"form-field-field_514d41b-0\">I confirm that all information provided in this form is accurate.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7603be3 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Scientific studies conducted by Genoscope Doctor&#039;s Club will be shared in compliance with patient confidentiality, data protection, and ethical standards. \" id=\"form-field-field_7603be3-0\" name=\"form_fields[field_7603be3]\" required=\"required\"> <label for=\"form-field-field_7603be3-0\">Scientific studies conducted by Genoscope Doctor's Club will be shared in compliance with patient confidentiality, data protection, and ethical standards. <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_33d83a2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"I acknowledge that my membership is subject to the approval of Genoscope Academicians.\" id=\"form-field-field_33d83a2-0\" name=\"form_fields[field_33d83a2]\" required=\"required\"> <label for=\"form-field-field_33d83a2-0\">I acknowledge that my membership is subject to the approval of Genoscope Academicians.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e8e9eaa elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"I have read and accept the &lt;a href=&quot;https:\/\/www.axesome.com\/en\/kvkk-clarification-text\/&quot; target=&quot;_blank&quot;&gt;KVKK Clarification Text&lt;\/a&gt;. \" id=\"form-field-field_e8e9eaa-0\" name=\"form_fields[field_e8e9eaa]\" required=\"required\"> <label for=\"form-field-field_e8e9eaa-0\">I have read and accept the <a href=\"https:\/\/www.axesome.com\/en\/kvkk-clarification-text\/\" target=\"_blank\">KVKK Clarification Text<\/a>. <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Doctor&#8217;s Club Application Form Genoscope Doctor&#8217;s Club &#8211; Physician Membership Application Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1836","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages\/1836","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/comments?post=1836"}],"version-history":[{"count":7,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages\/1836\/revisions"}],"predecessor-version":[{"id":2232,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages\/1836\/revisions\/2232"}],"wp:attachment":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/media?parent=1836"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}