{"id":1711,"date":"2020-04-05T11:01:28","date_gmt":"2020-04-05T03:01:28","guid":{"rendered":"http:\/\/localhost:8000\/wp1balimed\/?page_id=1711"},"modified":"2025-03-26T20:48:24","modified_gmt":"2025-03-26T12:48:24","slug":"prudential-agent-sign-up","status":"publish","type":"page","link":"https:\/\/balimedhospital.co.id\/id\/prudential-agent-sign-up\/","title":{"rendered":"Prudential Agent Sign Up"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1711\" class=\"elementor elementor-1711\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-284c8df elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"284c8df\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-d41c306\" data-id=\"d41c306\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-408bc17 elementor-widget elementor-widget-text-editor\" data-id=\"408bc17\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>Sign Up<\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fc677cd elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"fc677cd\" 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<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"prusignupform\" aria-label=\"prusignupform\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1711\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"fc677cd\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Prudential Agent Sign Up\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1711\"\/>\n\t\t\t\n\t\t\t<div class=\"ele-extensions-hide-form elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-full_name elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-full_name\" 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[full_name]\" id=\"form-field-full_name\" class=\"elementor-field elementor-size-md  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-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required elementor-mark-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\tEmail\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[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"email\" 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-tel elementor-field-group elementor-column elementor-field-group-phone1 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-phone1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMobile Phone 1\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[phone1]\" id=\"form-field-phone1\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"mobile phone 1\" required=\"required\" 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-tel elementor-field-group elementor-column elementor-field-group-phone2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-phone2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMobile Phone 2\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[phone2]\" id=\"form-field-phone2\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"mobile phone 2\" 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-password elementor-field-group elementor-column elementor-field-group-password1 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-password1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPassword\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=\"password\" name=\"form_fields[password1]\" id=\"form-field-password1\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"password\" 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-password elementor-field-group elementor-column elementor-field-group-password2 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-password2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRe-Type Password\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=\"password\" name=\"form_fields[password2]\" id=\"form-field-password2\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"password\" 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-textarea elementor-field-group elementor-column elementor-field-group-note elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-note\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdditional Information\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[note]\" id=\"form-field-note\" rows=\"4\" placeholder=\"note\"><\/textarea>\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-md\" 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\">Sign Up<\/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<div class=\"elementor-element elementor-element-63f9ab7 elementor-widget elementor-widget-text-editor\" data-id=\"63f9ab7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><a href=\"https:\/\/balimedhospital.co.id\/prudential-agent-login\">Click here to login.<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5f4d9e4 elementor-widget elementor-widget-text-editor\" data-id=\"5f4d9e4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><em><strong>This form is intended only for Prudential Agents who already have an agreement with BaliM\u00e9d Hospital Denpasar.<\/strong><\/em><\/p><p><em>Please fill all the field correctly. We will have to verify your account after you sign up before you can use your account.<\/em><\/p><p><em>To follow up after sign up, or if<\/em><em> you have any questions, please call our person in charge, <strong>Gusde<\/strong> at +62 851 0310 9103.\u00a0<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-113d715\" data-id=\"113d715\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Sign Up Click here to login. This form is intended only for Prudential Agents who already have an agreement with BaliM\u00e9d Hospital Denpasar. Please fill all the field correctly. We will have to verify your account after you sign up before you can use your account. To follow up after sign up, or if you [&hellip;]<\/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-1711","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/pages\/1711","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/comments?post=1711"}],"version-history":[{"count":16,"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/pages\/1711\/revisions"}],"predecessor-version":[{"id":2881,"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/pages\/1711\/revisions\/2881"}],"wp:attachment":[{"href":"https:\/\/balimedhospital.co.id\/id\/wp-json\/wp\/v2\/media?parent=1711"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}