Medical Mosaic - Sydney Medical School Image Library

From Faculty of Medicine Online Museum and Archive

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<span class="asterisk">*</span>Denotes mandatory fields
<span class="asterisk">*</span>Denotes mandatory fields
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<form name="medicalmosaic" method="post" action="/museum/" onSubmit="return validateForm(medicalmosaic);">
+
<form name="medicalmosaic" method="post" action="/museum/mosaicadd.php" onSubmit="return validateForm(medicalmosaic);">
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           <option value="Artifacts">&nbsp;&nbsp;&nbsp;Artifacts</option>
           <option value="Artifacts">&nbsp;&nbsp;&nbsp;Artifacts</option>
           <option value="BuildingExterior">&nbsp;&nbsp;&nbsp;Buildings/Exterior</option>
           <option value="BuildingExterior">&nbsp;&nbsp;&nbsp;Buildings/Exterior</option>
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           <option value="BuildingInterior">&nbsp;&nbsp;&nbsp;Buildings Interior</option>
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           <option value="BuildingInterior">&nbsp;&nbsp;&nbsp;Buildings/Interior</option>
           <option value="Documents">&nbsp;&nbsp;&nbsp;Documents</option>
           <option value="Documents">&nbsp;&nbsp;&nbsp;Documents</option>
           <option value="GroupPhoto">&nbsp;&nbsp;&nbsp;Group Photo</option>
           <option value="GroupPhoto">&nbsp;&nbsp;&nbsp;Group Photo</option>
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     <tr>
     <tr>
     <td colspan="3">
     <td colspan="3">
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<input name="agreed[]" type="checkbox">I have read, and agree, to the <a href="https://www.sydney.edu.au/medicine/museum/" title="Rules and Regulations" target="_blank">Copyright & Usage terms </a>of the Sydney Medical School Online Musuem & Archive.</td>
+
<input name="agreed[]" type="checkbox">I have read, and agree, to the <a href="https://www.sydney.edu.au/medicine/museum/" title="Rules and Regulations" target="_blank">Copyright & Usage terms </a>of the Sydney Medical School Online Museum & Archive.</td>
     </tr>
     </tr>
     <tr>
     <tr>

Revision as of 03:56, 26 November 2009

*Denotes mandatory fields

Personal Details:
First Name:*
Last Name:*
Daytime Phone:*
Mobile:*
Email Address:*
Street Address:*
City:*
Postcode:*
State:*
Country:*
Image Details:
Caption:*
Photographer: (if known)
Date taken: (if known)
Description of Image:*
Historical Information:
Known Subjects:
Relevant Field or Discipline:e.g. Public health, Pharmacology etc
Category:*
Additional Category:
Other:

Upload Image:
I have read, and agree, to the Copyright & Usage terms of the Sydney Medical School Online Museum & Archive.