/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

  1. <!--#include virtual="/include/templates/sk_top.asa"-->
  2. <!--#include virtual="/include/constants/database.asa"-->
  3. <!--#include virtual="/members_only/include/common_functions.asa"-->
  4. <%
  5. Dim Applicant_ID
  6. Applicant_ID = GetVal("Applicant_ID", "")
  7. ' 2. Create a Recordset Object
  8. Set rsApplicant = Server.CreateObject("ADODB.Recordset")
  9. ' 4. If there is a request to update the new record, update the new record
  10. If Request.Form("Submit") = "Submit" Then
  11. rsApplicant.Open "Application_SK", cnnMain,3,3
  12. rsApplicant.AddNew
  13. For Each Item in Request.Form
  14. if trim(Request.Form(Item)) <> "" and Item <> "Submit" then
  15. rsApplicant(Item) = Request.Form(Item)
  16. End If
  17. Next
  18. rsApplicant.Update
  19. rsApplicant.Close
  20. ' Send e-mail notification to BCFPD
  21. Dim servMess
  22. Dim servBody
  23. servBody = "A Request for Additional Survival Kids Information has been submitted."
  24. Set servMess = Server.CreateObject("JMail.Message")
  25. servMess.AddRecipient "rstephens@bcfdmo.com"
  26. servMess.Logging = true
  27. servMess.FromName = Request.Form("Namereq")
  28. servMess.From = Request.Form("Email")
  29. servMess.Subject = "BCFPD Web Site - Survival Kids Additional Info Request Application"
  30. servMess.Body = servBody
  31. servMess.Send("server2.bcfdmo.com")
  32. Set servMess = Nothing
  33. End If
  34. %>
  35. <table cellpadding="5" cellspacing="0" border="0" width="98%" ID="Table1">
  36. <tr>
  37. <td class="PageTitle">Survival Kids Information Request Application</td>
  38. </tr>
  39. <tr>
  40. <td><font size="1"><strong>Items in bold are required.</strong></font></td>
  41. </tr>
  42. <tr>
  43. <td>
  44. <form method="post" action="index.asp" id="form1" name="form1" onsubmit="return ValidateApp(document.form1.elements, 'You must enter a ');">
  45. <table border="1" cellpadding="3" cellspacing="0" bordercolor="#f2f2f2" ID="Table2">
  46. <tr>
  47. <td class="AppLabel"><b>Name:</b></td>
  48. <td><input type="text" name="Namereq" size="50" maxlength="100" ID="Text1"></td>
  49. </tr>
  50. <tr>
  51. <td class="AppLabel">Title:</td>
  52. <td><input type="text" name="Title" size="50" maxlength="100" ID="Text2"></td>
  53. </tr>
  54. <tr>
  55. <td class="AppLabel"><b>Address 1:</b></td>
  56. <td><input type="text" name="Address1req" size="50" maxlength="100" ID="Text3"></td>
  57. </tr>
  58. <tr>
  59. <td class="AppLabel">Address 2:</td>
  60. <td><input type="text" name="Address2" size="50" maxlength="100" ID="Text4"></td>
  61. </tr>
  62. <tr>
  63. <td class="AppLabel"><b>City:</b></td>
  64. <td><input type="text" name="Cityreq" size="50" maxlength="100" ID="Text5"></td>
  65. </tr>
  66. <tr>
  67. <td class="AppLabel"><b>State:</b></td>
  68. <td><input type="text" name="Statereq" value="MO" size="2" Maxlength="2" ID="Text6"></td>
  69. </tr>
  70. <tr>
  71. <td class="AppLabel"><b>Zip:</b></td>
  72. <td><input type="text" name="Zipreq" size="5" maxlength="5" ID="Text7"></td>
  73. </tr>
  74. </tr>
  75. <tr>
  76. <td class="AppLabel"><b>Day Time Phone:</b></td>
  77. <td><input type="text" name="Day_Phonereq" size="15" maxlength="15" ID="Text8"></td>
  78. </tr>
  79. <tr>
  80. <td class="AppLabel">Home Phone:</td>
  81. <td><input type="text" name="Night_Time_Phone" size="15" maxlength="15" ID="Text9"></td>
  82. </tr>
  83. <tr>
  84. <td class="AppLabel">Fax:</td>
  85. <td><input type="text" name="Fax" size="15" maxlength="15" ID="Text10"></td>
  86. </tr>
  87. <tr>
  88. <td class="AppLabel">E-mail:</td>
  89. <td><input type="text" name="Email" size="50" maxlength="100" ID="Text11"></td>
  90. </tr>
  91. <tr>
  92. <td class="AppLabel"><b>Your Department <br>or School Name:</b></td>
  93. <td><input type="text" name="DeptNamereq" size="50" maxlength="100" ID="Text12"></td>
  94. </tr>
  95. <tr>
  96. <td class="AppLabel">Fire Chief Name <font size="1">(if applicable)</font></td>
  97. <td><input type="text" name="FireChief" size="50" maxlength="100" ID="Text13"></td>
  98. </tr>
  99. </table>
  100. </td>
  101. </tr>
  102. <tr>
  103. <td align="center">
  104. <a href="javascript:submitPlus(document.form1, 'Submit');"><img SRC="/images/buttons/Submit.gif" border="0"></a>
  105. <input type="Hidden" name="Submit" ID="Hidden1">
  106. </td>
  107. </tr>
  108. <tr>
  109. <td class="Content">To Contact us for more information....<br>
  110. 573-447-5000<br>
  111. khines@bcfdmo.com
  112. </td>
  113. </tr>
  114. </table>
  115. </form>
  116. <%
  117. set rsApplicant = Nothing
  118. %>
  119. <!--#include virtual="/include/templates/sk_bottom.asa"-->