{"id":3470,"date":"2013-09-02T12:37:12","date_gmt":"2013-09-02T12:37:12","guid":{"rendered":"http:\/\/profconsure.co.za\/?page_id=3470"},"modified":"2013-09-02T12:37:12","modified_gmt":"2013-09-02T12:37:12","slug":"discovery-application-page","status":"publish","type":"page","link":"http:\/\/profconsure.co.za\/?page_id=3470","title":{"rendered":"Discovery Application Page"},"content":{"rendered":"<p><strong><strong>Please Note:<\/strong><\/strong><\/p>\n<p>Profcon is required to consult and advise clients according to their individual needs.\u00a0 Therefore we ask that anyone interested in any medical plan, fill out the form below so that an advisor may contact and advise you accordingly.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Please fill in the form below:<\/strong><\/p>\n\n\t\t<div id=\"usermessage17a\" class=\"cf_info \"><\/div>\n\t\t<form enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F3470#usermessage17a\" method=\"post\" class=\"cform\" id=\"cforms17form\">\n\t\t<fieldset class=\"cf-fs1\">\n\t\t<legend>My personal details:<\/legend>\n\t\t<ol class=\"cf-ol\">\n\t\t\t<li id=\"li-17-2\"><label for=\"cf17_field_2\"><span>Your Name<\/span><\/label><input type=\"text\" name=\"cf17_field_2\" id=\"cf17_field_2\" class=\"single fldrequired\" value=\"Your Name\" onfocus=\"clearField(this)\" onblur=\"setField(this)\"\/><span class=\"reqtxt\">(required)<\/span><\/li>\n\t\t\t<li id=\"li-17-3\"><label for=\"cf17_field_3\"><span>City or Town in which you reside?<\/span><\/label><input type=\"text\" name=\"cf17_field_3\" id=\"cf17_field_3\" class=\"single fldrequired\" value=\"\" onfocus=\"clearField(this)\" onblur=\"setField(this)\"\/><span class=\"reqtxt\">(required)<\/span><\/li>\n\t\t\t<li id=\"li-17-4\"><label for=\"cf17_field_4\"><span>Email<\/span><\/label><input type=\"text\" name=\"cf17_field_4\" id=\"cf17_field_4\" class=\"single fldemail fldrequired\" value=\"\"\/><span class=\"emailreqtxt\">(valid email required)<\/span><\/li>\n\t\t\t<li id=\"li-17-5\"><label for=\"cf17_field_5\"><span>Contact Number<\/span><\/label><input type=\"text\" name=\"cf17_field_5\" id=\"cf17_field_5\" class=\"single\" value=\"\"\/><\/li>\n\t\t\t<li id=\"li-17-6\"><label for=\"cf17_field_6\"><span>Who Referred You?<\/span><\/label><input type=\"text\" name=\"cf17_field_6\" id=\"cf17_field_6\" class=\"single\" value=\"\"\/><\/li>\n\t\t\t<li id=\"li-17-7\"><label for=\"cf17_field_7\"><span>Are you interested in a new policy?<\/span><\/label><select name=\"cf17_field_7\" id=\"cf17_field_7\" class=\"cformselect\" >\n\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t<\/select><\/li>\n\t\t\t<li id=\"li-17-8\"><label for=\"cf17_field_8\"><span>Query (State to which Medical aid you belong & your membership No)<\/span><\/label><textarea cols=\"30\" rows=\"8\" name=\"cf17_field_8\" id=\"cf17_field_8\" class=\"area\"><\/textarea><\/li>\n\t\t\t<li id=\"li-17-9\"><label for=\"cf17_field_9\" class=\"cf-before\"><span>I have read and understand the disclaimer as listed at the bottom of this website.<\/span><\/label><input type=\"checkbox\" name=\"cf17_field_9\" id=\"cf17_field_9\" class=\"cf-box-b fldrequired\"\/><\/li>\n\t\t\t<li id=\"li-17-10\"><label for=\"cf17_field_10\"><span>May we contact you? <\/span><\/label><select name=\"cf17_field_10\" id=\"cf17_field_10\" class=\"cformselect fldrequired\" >\n\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t<\/select><span class=\"reqtxt\">(required)<\/span><\/li>\n\t\t<\/ol>\n\t\t<\/fieldset>\n\t\t<fieldset class=\"cf_hidden\">\n\t\t\t<legend>&nbsp;<\/legend>\n\t\t\t<input type=\"hidden\" name=\"cf_working17\" id=\"cf_working17\" value=\"One%20moment%20please...\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_failure17\" id=\"cf_failure17\" value=\"Please%20fill%20in%20all%20the%20required%20fields.\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_codeerr17\" id=\"cf_codeerr17\" value=\"Please%20double-check%20your%20verification%20code.\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_customerr17\" id=\"cf_customerr17\" value=\"yyy\"\/>\n\t\t\t<input type=\"hidden\" name=\"cf_popup17\" id=\"cf_popup17\" value=\"nn\"\/>\n\t\t<\/fieldset>\n\t\t<p class=\"cf-sb\"><input type=\"submit\" name=\"sendbutton17\" id=\"sendbutton17\" class=\"sendbutton\" value=\"Submit\"\/><\/p>\n\t\t<\/form>\n\t\t<p class=\"linklove\" id=\"ll17\"><a href=\"http:\/\/www.deliciousdays.com\/cforms-plugin\"><em>cforms<\/em> contact form by delicious:days<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Please Note: Profcon is required to consult and advise clients according to their individual needs.\u00a0 Therefore we ask that anyone interested in any medical plan, fill out the form below so that an advisor may contact and advise you accordingly. \u00a0 Please fill in the form below: My personal details: Your Name(required) City or Town [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":352,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3470"}],"collection":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3470"}],"version-history":[{"count":1,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3470\/revisions"}],"predecessor-version":[{"id":3471,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3470\/revisions\/3471"}],"up":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/352"}],"wp:attachment":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3470"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}