All pastes #476336 Raw Edit

Someone

public text v1 · immutable
·published 2007-05-08 00:41 UTC
rendered paste body
<?php

if($_POST['Submit'])
{
	$v_nam=$HTTP_POST_VARS['name'];
	$v_ema=$HTTP_POST_VARS['email'];
	$v_add=$HTTP_POST_VARS['address'];
	$v_cit=$HTTP_POST_VARS['city'];
	$v_dph=$HTTP_POST_VARS['D-Phone'];
	$v_eph=$HTTP_POST_VARS['E-Phone'];
	$v_arc=$HTTP_POST_VARS['archl'];
	$v_ana=$HTTP_POST_VARS['AddNames'];

    $recipient = 'oakwood@oakwoodcemetery.org';
    $subject = 'Design Comp Signup';

   	$pre="Name: ".$v_nam."\n";
   	$pre.="Email: ".$v_ema."\n";
   	$pre.="Day Phone: ".$v_dph."\n";
   	$pre.="Evening Phone: ".$v_eph."\n";
   	$pre.="Address: ".$v_add."\n";
   	$pre.="City,St,Zip: ".$v_cit."\n";
   	$pre.="Arch #: ".	$v_arc."\n";
   	$pre.="Addional Names ".	$v_ana."\n";

    mail($recipient, $subject, $pre);
    header("Location: index.php");
?>

<html>
<head>
<title>Uncle Sam Gravesite Design Competition</title>
<?php
require ('top.html');
?>

<!-- Uncle sam Navigation Block BEGIN-->
<map name="sam_nav">
<area shape="rect" coords="189,95,264,109" title="Rectangle_Shape1" href="u_intr.php" alt="introduction">
<area shape="rect" coords="271,93,334,109" title="Rectangle_Shape2" href="u_obje.php">
<area shape="rect" coords="344,94,451,110" title="Rectangle_Shape4" href="u_fee.php" alt="Fees">
<area shape="rect" coords="460,94,513,111" title="Rectangle_Shape5" href="u_sche.php">
<area shape="rect" coords="523,94,638,109" title="Rectangle_Shape6" href="u_dreq.php">
<area shape="rect" coords="215,120,358,134" title="Rectangle_Shape7" href="u_sreq.php" alt="Submission Requirements">
<area shape="rect" coords="367,119,453,133" title="Rectangle_Shape8" href="u_jury.php">
<area shape="rect" coords="463,119,550,134" title="Rectangle_Shape9" href="u_mapa.php" alt="Maps & Photos">
<area shape="rect" coords="558,116,644,132" title="Rectangle_Shape10" href="u_pdf.php">
</map>
<img src="images/samnav.jpg" width="650" height="150" usemap="#sam_nav" border="0">
<!-- Uncle sam Navigation block END -->
<!-- Main Content Area -->
<h1>Application</h1>
<!-- applicaiton form begin--><center>
						<form method="post" id="usreg" name="usreg">
						<INPUT TYPE="hidden" NAME="recipient" VALUE="oakwood@oakwoodcemetery.org">
						<INPUT TYPE="hidden" NAME="subject" VALUE="US Design Application">
						<INPUT TYPE="hidden" NAME="redirect" VALUE="http://oakwoodcemetery.org">
						<center>
						<table border="0" cellspacing="0" cellpadding="2" width="550">
						  <tr>
						     <td width="300" align="left">Name of competitor or team leader : </td>
						     <td width="250"><input name="name" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">E-mail: </td>
						    <td width="250"><input name="email" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">Address: </td>
						    <td width="250"><input name="address" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">City, State, Zip: </td>
						    <td width="250"><input name="city" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">Day Phone: </td>
						    <td width="250"><input name="D-Phone" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">Evening Phone: </td>
						    <td width="250"><input name="E-Phone" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">Architecture License (if Applicable): </td>
						    <td width="250"><input name="archl" value=""></td>
						  </tr>
						  <tr>
						    <td width="300" align="left">Additional Names IF nessassary: </td>

						    <td width="250"><textarea name="AddNames" rows="8" cols="30"></textarea><br /></td>
						  </tr>
						  <tr>
						  	<td>By sending this application along with payment of entry fee, I/we  agree to comply with all of the competition rules and terms.</td>
						    <td><input type="submit" action="u_app.php"  name="Submit" value="Submit" ></td>
						  </tr>
						</table></center>
						   </form>
						 <!-- Application end-->

<!-- End Main Content Area -->

<?php require ('bottom.html'); ?>