{"id":2090,"date":"2025-10-06T23:37:52","date_gmt":"2025-10-06T23:37:52","guid":{"rendered":"https:\/\/www.medicinadeltrabajo.org\/2025\/?page_id=2090"},"modified":"2025-10-07T00:05:17","modified_gmt":"2025-10-07T00:05:17","slug":"form-registro","status":"publish","type":"page","link":"https:\/\/www.medicinadeltrabajo.org\/2025\/form-registro\/","title":{"rendered":"FORM REGISTRO"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2090\" class=\"elementor elementor-2090\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7d2e524 e-flex e-con-boxed e-con e-parent\" data-id=\"7d2e524\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-35b67d6 elementor-widget elementor-widget-heading\" data-id=\"35b67d6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SOCIEDAD COLOMBIANA DE MEDICINA DEL TRABAJO<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9d83121 elementor-widget elementor-widget-heading\" data-id=\"9d83121\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SOLICITUD DE INGRESO ASOCIADOS<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f0d8e65 e-flex e-con-boxed e-con e-parent\" data-id=\"f0d8e65\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aebebdc elementor-widget elementor-widget-shortcode\" data-id=\"aebebdc\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class='fluentform ff-default fluentform_wrapper_6 ffs_default_wrap'><form data-form_id=\"6\" id=\"fluentform_6\" class=\"frm-fluent-form fluent_form_6 ff-el-form-top ff_form_instance_6_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_6_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Contact Form Demo (#6)<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='2090' \/><input type=\"hidden\" id=\"_fluentform_6_fluentformnonce\" name=\"_fluentform_6_fluentformnonce\" value=\"72f1fc99bf\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/2025\/wp-json\/wp\/v2\/pages\/2090\" \/><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_first_name_' >Nombres <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_6_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Nombres\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_last_name_' >Apellidos<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_6_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Apellidos\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_datetime' aria-label=\"Fecha de nacimiento\">Fecha de nacimiento<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Fecha de nacimiento Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_6_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_multi_select' aria-label=\"Estado civil\">Estado civil<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select[]\" id=\"ff_6_multi_select\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"Soltero\"  >Soltero<\/option><option value=\"Casado\"  >Casado<\/option><option value=\"Otro\"  >Otro<\/option><\/select><\/div><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_1_first_name_' >Registro m\u00e9dico<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_6_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"#\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_1_last_name_' >Expedido en <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_6_names_1_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_2\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_2_first_name_' >Registro salud ocupacional<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[first_name]\" id=\"ff_6_names_2_first_name_\" class=\"ff-el-form-control\" placeholder=\"#\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_2_last_name_' >Expedido en <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[last_name]\" id=\"ff_6_names_2_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_3\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_3_first_name_' >Direcci\u00f3n de residencia <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_3[first_name]\" id=\"ff_6_names_3_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_3_last_name_' >Ciudad<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_3[last_name]\" id=\"ff_6_names_3_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_4\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_4_first_name_' >Direcci\u00f3n de consultorio<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_4[first_name]\" id=\"ff_6_names_4_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_4_last_name_' >Tel\u00e9fono<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_4[last_name]\" id=\"ff_6_names_4_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_input_text' aria-label=\"Fax\">Fax<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_6_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_6_email\" class=\"ff-el-form-control\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_1\" ><h6>ESTUDIOS REALIZADOS<\/h6><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_subject' aria-label=\"Facultad de medicina\">Facultad de medicina <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"subject\" class=\"ff-el-form-control\" placeholder=\"Universidad\" data-name=\"subject\" id=\"ff_6_subject\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-type=\"name-element\" data-name=\"names_5\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_5_first_name_' >Lugar <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_5[first_name]\" id=\"ff_6_names_5_first_name_\" class=\"ff-el-form-control\" placeholder=\"Ciudad\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_5_last_name_' >Fecha de graduaci\u00f3n<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_5[last_name]\" value=\"(dd\/mm\/aaaa)\" id=\"ff_6_names_5_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_subject_1' aria-label=\"Estudios de posgrado\">Estudios de posgrado<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"subject_1\" class=\"ff-el-form-control\" placeholder=\"Universidad\" data-name=\"subject_1\" id=\"ff_6_subject_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-type=\"name-element\" data-name=\"names_6\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_6_first_name_' >Lugar <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_6[first_name]\" id=\"ff_6_names_6_first_name_\" class=\"ff-el-form-control\" placeholder=\"Ciudad\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_names_6_last_name_' >Fecha de graduaci\u00f3n<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_6[last_name]\" value=\"(dd\/mm\/aaaa)\" id=\"ff_6_names_6_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_message' aria-label=\"Otros estudios realizados\">Otros estudios realizados<\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=true name=\"message\" id=\"ff_6_message\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_message_1' aria-label=\"\u00bfPor qu\u00e9 desea vincularse a la Sociedad Colombiana de Medicina del Trabajo?\">\u00bfPor qu\u00e9 desea vincularse a la Sociedad Colombiana de Medicina del Trabajo?<\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=true name=\"message_1\" id=\"ff_6_message_1\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message_1\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown' aria-label=\"\u00bfPertenece a otra sociedad cient\u00edfica?\">\u00bfPertenece a otra sociedad cient\u00edfica?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_6_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">- Seleccione -<\/option><option value=\"Si\"  >Si<\/option><option value=\"No\"  >No<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_message_2' aria-label=\"\u00bfCu\u00e1l?\">\u00bfCu\u00e1l?<\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=true name=\"message_2\" id=\"ff_6_message_2\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message_2\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown_1' aria-label=\"\u00bfHa realizado investigaciones en el campo de la salud ocupacional?\">\u00bfHa realizado investigaciones en el campo de la salud ocupacional?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_6_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">- Seleccione -<\/option><option value=\"Si\"  >Si<\/option><option value=\"No\"  >No<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_message_3' aria-label=\"Describa el t\u00edtulo, fecha y lugar de la investigaci\u00f3n\">Describa el t\u00edtulo, fecha y lugar de la investigaci\u00f3n <\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=true name=\"message_3\" id=\"ff_6_message_3\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message_3\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_dropdown_2' aria-label=\"\u00bfHa realizado publicaciones sobre trabajos cient\u00edficos o revisiones bibliogr\u00e1ficas en el campo de la salud ocupacional?\">\u00bfHa realizado publicaciones sobre trabajos cient\u00edficos o revisiones bibliogr\u00e1ficas en el campo de la salud ocupacional?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_6_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">- Seleccione -<\/option><option value=\"Si\"  >Si<\/option><option value=\"No\"  >No<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_message_4' aria-label=\"Describa el t\u00edtulo, fecha, lugar y n\u00famero de la edici\u00f3n\">Describa el t\u00edtulo, fecha, lugar y n\u00famero de la edici\u00f3n <\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=true name=\"message_4\" id=\"ff_6_message_4\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message_4\" ><\/textarea><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_2\" ><h6><em><span style=\"font-size: 16px\">Recuerde que vincularse a una Sociedad Cienti\u0301fica significa tener el firme propo\u0301sito de participar en sus actividades y apoyarla para su progreso y mutuo beneficio.<\/span><\/em><\/h6><\/div><div class='ff-el-group ff-text-center ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" 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