response.stericycle.com Open in urlscan Pro
130.35.203.128  Public Scan

Form analysis
1 forms found in the DOM

Name: 405750556059-638115282507981870-638163965464670435 — POST http://response.stericycle.com/e/f2?LP=899

<form method="post" name="405750556059-638115282507981870-638163965464670435" action="http://response.stericycle.com/e/f2?LP=899" onsubmit="return handleFormSubmit(this)" id="form551" class="elq-form"><input
    value="405750556059-638115282507981870-638163965464670435" type="hidden" name="elqFormName"><input value="1365454607" type="hidden" name="elqSiteId"><input name="elqCampaignId" type="hidden" value="2477">
  <div class="layout container-fluid">
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement0" class="elq-field-style form-element-layout row">
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-12">
                  <div style="text-align:left;">
                    <h4 class="elq-heading form-element-form-text">Contact Info</h4>
                  </div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement1" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7746">First Name</label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-12">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="firstName" id="fe7746" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement2" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7747">Last Name</label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-12">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="lastName" id="fe7747" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement3" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7748">Email Address<span class="elq-required">*</span></label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-12">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="emailAddress" id="fe7748" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement4" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7749">Company<span class="elq-required">*</span></label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-8">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="company" id="fe7749" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement5" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7750">Zip Code<span class="elq-required">*</span></label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-8">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="zipPostal" id="fe7750" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement6" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7751">Title</label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-8">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="title" id="fe7751" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement7" class="elq-field-style form-element-layout row">
            <div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe7752">Business Phone<span class="elq-required">*</span></label></div>
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-8">
                  <div class="field-control-wrapper"><input type="text" class="elq-item-input" name="busPhone" id="fe7752" value="" style="width:100%;"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="grid-layout-col">
        <div class="layout-col col-sm-12 col-xs-12">
          <div id="formElement8" class="elq-field-style form-element-layout row">
            <div class="col-sm-12 col-xs-12">
              <div class="row">
                <div class="col-xs-12">
                  <div><input type="Submit" class="submit-button-style " value="Submit" id="fe7761"></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div><input type="hidden" name="hiddenField" id="fe7753" value=""><input type="hidden" name="hiddenCampaignId" id="fe7754" value="2305_EPA Requirements Waste Management"><input type="hidden" name="GTW_ID" id="fe7755"
      value="7567864195601975640"><input type="hidden" name="UC" id="fe7756" value=""><input type="hidden" name="utm_source" id="fe7757" value=""><input type="hidden" name="utm_medium" id="fe7758" value=""><input type="hidden" name="utm_content"
      id="fe7759" value=""><input type="hidden" name="utm_campaign" id="fe7760" value="">
  </div>
</form>

Text Content

866-783-6275
Join Timothy Staiano, Director of Materials Management, on May 17 at 1pm CST/2pm
EST as he presents EPA Requirements for Healthcare Waste Management Plans. Learn
about regulated guidelines and how to keep your organization compliant.


Wednesday, May 17, 2023 at 1:00 p.m. (CT), 2:00 p.m. (ET), 11:00 a.m. (PT)
Duration: 30-45 minutes

CONTACT INFO

First Name

Last Name

Email Address*

Company*

Zip Code*

Title

Business Phone*