% if Request("submit") <> "" then Dim objCDO Set objCDO = Server.CreateObject("CDO.Message") Dim objCDOConf Set objCDOConf = Server.CreateObject("CDO.Configuration") With objCDOConf.Fields .Item(cdoSendUsingMethod) = 2 .Item(cdoSMTPServer) = "mail-fwd" .Item(cdoSMTPServerPort) = 25 .Item(cdoSMTPconnectiontimeout) = 10 .Update End With Set objCDO.Configuration = objCDOConf ' Be sure to use a valid email addresses below: objCDO.From = "info@abnm.info" objCDO.To = "info@abnm.info" objCDO.Subject = "FormMail from " & Request.ServerVariables("URL") objCDO.TextBody = "FormMail from " & Request.ServerVariables("URL") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "First Name: " objCDO.TextBody = objCDO.TextBody & Request("First Name") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Last Name: " objCDO.TextBody = objCDO.TextBody & Request("Last Name") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Degree: " objCDO.TextBody = objCDO.TextBody & Request("Degree") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Home Street Address: " objCDO.TextBody = objCDO.TextBody & Request("Home Street Address") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Business Street Address: " objCDO.TextBody = objCDO.TextBody & Request("Business Street Address") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Insitution: " objCDO.TextBody = objCDO.TextBody & Request("Insitution") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Mail Stop: " objCDO.TextBody = objCDO.TextBody & Request("Mail Stop") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Home City: " objCDO.TextBody = objCDO.TextBody & Request("Home City") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Business City: " objCDO.TextBody = objCDO.TextBody & Request("Business City") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Home State: " objCDO.TextBody = objCDO.TextBody & Request("Home State") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Business State: " objCDO.TextBody = objCDO.TextBody & Request("Business State") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Home Zip Code: " objCDO.TextBody = objCDO.TextBody & Request("Home Zip Code") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Business Zip Code: " objCDO.TextBody = objCDO.TextBody & Request("Business Zip Code") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Home Country: " objCDO.TextBody = objCDO.TextBody & Request("Home Country") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Business Country: " objCDO.TextBody = objCDO.TextBody & Request("Business Country") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Home Phone Number: " objCDO.TextBody = objCDO.TextBody & Request("Home Phone Number") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Business Phone Number: " objCDO.TextBody = objCDO.TextBody & Request("Business Phone Number") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Fax Number: " objCDO.TextBody = objCDO.TextBody & Request("Fax Number") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Cell Number: " objCDO.TextBody = objCDO.TextBody & Request("Cell Number") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Pager: " objCDO.TextBody = objCDO.TextBody & Request("Pager") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Email Address 1: " objCDO.TextBody = objCDO.TextBody & Request("Email Address 1") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Email Address 2: " objCDO.TextBody = objCDO.TextBody & Request("Email Address 2") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Diplomat Number: " objCDO.TextBody = objCDO.TextBody & Request("Diplomat Number") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Type of Practice: " objCDO.TextBody = objCDO.TextBody & Request("Type of Practice") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Description of Practice: " objCDO.TextBody = objCDO.TextBody & Request("Description of Practice") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Years in IONM: " objCDO.TextBody = objCDO.TextBody & Request("Years in IONM") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Training Neurophysiologist: " objCDO.TextBody = objCDO.TextBody & Request("Training Neurophysiologist") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Percent of Practice devited to IONM: " objCDO.TextBody = objCDO.TextBody & Request("Percent of Practice devited to IONM") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "IONM Supervision percent: " objCDO.TextBody = objCDO.TextBody & Request("IONM Supervision percent") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "IONM technologist percent: " objCDO.TextBody = objCDO.TextBody & Request("IONM technologist percent") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "percent of research time: " objCDO.TextBody = objCDO.TextBody & Request("percent of research time") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Comments: " objCDO.TextBody = objCDO.TextBody & Request("Comments") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.Send 'Clean-up Set objCDO = Nothing Set objCDOConf = Nothing ' Happy response. If you would rather, ' change the following to Response.Redirect "thanks.html" ' Response.Write "Your Message has been sent. Thank you!" Response.End end if %>
American Board of
| |