\"ECRI
   

Exemplary Center for Reading Instruction (ECRI)

A validated reading/language arts staff-development program designed to prevent student failure.

About Us Articles Seminars Streaming Video Catalogue The Reader
    ECRI Seminar Registration Form
Home
Seminars at Ranch
Required Texts
Registration
Contact Us
 
"; }; function printfooter() { Print "
  © Copyright 2010, Exemplary Center for Reading Instruction (ECRI), Salt Lake City, Utah.
"; }; ######################################################################### ## Decode the form, e-mail, display sent: ############################### ######################################################################### if ($p_send == "1") { #print header information (same as all web pages) printheader(); #strip any possible slashes out of the form data. $s_name = stripslashes($p_name); $s_position = stripslashes($p_position); $s_address1 = stripslashes($p_address1); $s_city = stripslashes($p_city); $s_state = stripslashes($p_state); $s_zip = stripslashes($p_zip); $s_phone = stripslashes($p_phone); $s_homePhone = stripslashes($p_homePhone); $s_seminar = stripslashes($p_seminar); $s_dates = stripslashes($p_dates); #$to should be formatted "Display Name " #but $to will work with just an email address. $to = "Ethna R. Reid "; #Create appropraite header $headers = "From: $s_name on ecri.cc \n"; $headers .= "Reply-To: \n"; $headers .= "Return-Path: \n"; $headers .= "Content-type: text/plain; charset=iso-8859-1\n"; $headers .= "MIME-Version: 1.0\n"; $headers .= "X-Mailer: Postfix Mail Service\n"; #Set the subject line $subj = "ECRI Seminar Reservation (www.ecri.cc)"; #Set the message based on the form. #If you make changes here remember to chage the message # that is displayed formatted HTML below $message = "Dear Dr. Reid,\n\n"; $message .= " $s_name would like to register for the $s_seminar "; $message .= "on $s_dates. His/Her position is: $s_position.\n\n"; $message .= " $s_name's contact information was specified as:\n"; $message .= "$s_address1\n"; $message .= "$s_city, $s_state $s_zip\n"; $message .= "Phone: $s_phone\n"; $message .= "Home Phone: $s_homePhone\n\n"; $message .= " Please contact $s_name to pay the $50 reservation "; $message .= "fee to hold the reservation.\n\n"; $ip = getenv("REMOTE_ADDR"); $message .= "------------------------------------------\n"; $message .= "If you feel the use of this online form has been abused, "; $message .= "please report the IP address of $ip "; $message .= "to the ecri.cc Web Master."; #temporary IP address block on 188.143.232.xxx (Russia) $ipblock = strpos($ip, "188.143.232"); if ($ipblock === false) { #Ok send the message mail($to, $subj, $message, $headers); } #Display the message sent to the user. Print"

The following e-mail was sent on your behalf:


Subject:

$subj


Message:

Dear Dr. Reid,

$s_name would like to register for the $s_seminar on $s_dates.  His/Her position is:  $s_position.

$s_name’s contact information was specified as:

$s_address1

$s_city, $s_state $s_zip

Phone:  $s_phone

Home Phone:  $s_homePhone

Please contact $s_name to pay the $50 reservation fee to hold the reservation.

------------------------------------------

If you feel the use of this online form has been abused, please report the IP address of $ip to the ecri.cc Web Master.

"; #print footer information same as all web pages printfooter(); } else { ######################################################################### ## Display the form: #################################################### ######################################################################### #print header information (same as all web pages) printheader(); Print "
Name:
Position:
Address (School, District, or Home):
City*:
State:
Zip Code:
Phone:
Home Phone:
Name of Seminar:
Dates Attending:

A $50 reservation fee is required to reserve your place.  You will be contacted for payment.

* For educators residing outside of the United States, please enter the city as well as the rest of the mailing information on this line.

"; #print footer information (same as all web pages) printfooter(); } ?>