/survival_kids/application/index.asp
https://github.com/evizitei/bcfpd_asp · ASP · 135 lines · 116 code · 16 blank · 3 comment · 3 complexity · 611f32ffc1b2020f5b429532dfed01e2 MD5 · raw file
- <!--#include virtual="/include/templates/sk_top.asa"-->
- <!--#include virtual="/include/constants/database.asa"-->
- <!--#include virtual="/members_only/include/common_functions.asa"-->
- <%
- Dim Applicant_ID
- Applicant_ID = GetVal("Applicant_ID", "")
-
- ' 2. Create a Recordset Object
- Set rsApplicant = Server.CreateObject("ADODB.Recordset")
-
-
- ' 4. If there is a request to update the new record, update the new record
- If Request.Form("Submit") = "Submit" Then
- rsApplicant.Open "Application_SK", cnnMain,3,3
- rsApplicant.AddNew
- For Each Item in Request.Form
- if trim(Request.Form(Item)) <> "" and Item <> "Submit" then
- rsApplicant(Item) = Request.Form(Item)
- End If
- Next
- rsApplicant.Update
- rsApplicant.Close
-
- ' Send e-mail notification to BCFPD
- Dim servMess
- Dim servBody
-
- servBody = "A Request for Additional Survival Kids Information has been submitted."
-
- Set servMess = Server.CreateObject("JMail.Message")
-
- servMess.AddRecipient "rstephens@bcfdmo.com"
- servMess.Logging = true
- servMess.FromName = Request.Form("Namereq")
- servMess.From = Request.Form("Email")
- servMess.Subject = "BCFPD Web Site - Survival Kids Additional Info Request Application"
-
- servMess.Body = servBody
- servMess.Send("server2.bcfdmo.com")
-
-
- Set servMess = Nothing
- End If
-
-
-
- %>
- <table cellpadding="5" cellspacing="0" border="0" width="98%" ID="Table1">
- <tr>
- <td class="PageTitle">Survival Kids Information Request Application</td>
- </tr>
- <tr>
- <td><font size="1"><strong>Items in bold are required.</strong></font></td>
- </tr>
- <tr>
- <td>
- <form method="post" action="index.asp" id="form1" name="form1" onsubmit="return ValidateApp(document.form1.elements, 'You must enter a ');">
- <table border="1" cellpadding="3" cellspacing="0" bordercolor="#f2f2f2" ID="Table2">
- <tr>
- <td class="AppLabel"><b>Name:</b></td>
- <td><input type="text" name="Namereq" size="50" maxlength="100" ID="Text1"></td>
- </tr>
- <tr>
- <td class="AppLabel">Title:</td>
- <td><input type="text" name="Title" size="50" maxlength="100" ID="Text2"></td>
- </tr>
- <tr>
- <td class="AppLabel"><b>Address 1:</b></td>
- <td><input type="text" name="Address1req" size="50" maxlength="100" ID="Text3"></td>
- </tr>
- <tr>
- <td class="AppLabel">Address 2:</td>
- <td><input type="text" name="Address2" size="50" maxlength="100" ID="Text4"></td>
- </tr>
-
- <tr>
- <td class="AppLabel"><b>City:</b></td>
- <td><input type="text" name="Cityreq" size="50" maxlength="100" ID="Text5"></td>
- </tr>
- <tr>
- <td class="AppLabel"><b>State:</b></td>
- <td><input type="text" name="Statereq" value="MO" size="2" Maxlength="2" ID="Text6"></td>
- </tr>
- <tr>
- <td class="AppLabel"><b>Zip:</b></td>
- <td><input type="text" name="Zipreq" size="5" maxlength="5" ID="Text7"></td>
- </tr>
- </tr>
- <tr>
- <td class="AppLabel"><b>Day Time Phone:</b></td>
- <td><input type="text" name="Day_Phonereq" size="15" maxlength="15" ID="Text8"></td>
- </tr>
- <tr>
- <td class="AppLabel">Home Phone:</td>
- <td><input type="text" name="Night_Time_Phone" size="15" maxlength="15" ID="Text9"></td>
- </tr>
- <tr>
- <td class="AppLabel">Fax:</td>
- <td><input type="text" name="Fax" size="15" maxlength="15" ID="Text10"></td>
- </tr>
- <tr>
- <td class="AppLabel">E-mail:</td>
- <td><input type="text" name="Email" size="50" maxlength="100" ID="Text11"></td>
- </tr>
- <tr>
- <td class="AppLabel"><b>Your Department <br>or School Name:</b></td>
- <td><input type="text" name="DeptNamereq" size="50" maxlength="100" ID="Text12"></td>
- </tr>
- <tr>
- <td class="AppLabel">Fire Chief Name <font size="1">(if applicable)</font></td>
- <td><input type="text" name="FireChief" size="50" maxlength="100" ID="Text13"></td>
- </tr>
- </table>
- </td>
- </tr>
- <tr>
- <td align="center">
- <a href="javascript:submitPlus(document.form1, 'Submit');"><img SRC="/images/buttons/Submit.gif" border="0"></a>
- <input type="Hidden" name="Submit" ID="Hidden1">
- </td>
- </tr>
-
- <tr>
- <td class="Content">To Contact us for more information....<br>
- 573-447-5000<br>
- khines@bcfdmo.com
- </td>
- </tr>
- </table>
- </form>
-
- <%
- set rsApplicant = Nothing
- %>
- <!--#include virtual="/include/templates/sk_bottom.asa"-->