"First Name",
"last"=>"Last Name",
"address1"=>"Street Address 1",
"address2"=>"Street Address 2",
"city"=>"City",
"state"=>"State",
"zip"=>"Zip/Postal Code",
"country"=>"Country",
"phone"=>"Telephone",
"fax"=>"Fax",
"email"=>"Email Address",
"referredby"=>"Referred By",
"ifother"=>"Referred By Other",
"comments1"=>"Comments");
if ($submit){
$bvalid = IsValid();
if ($bvalid){
$message = "An information request has been submitted.\n\n";
$message .= "_______________________\n";
$message .= "Contact Details:\n\n";
foreach($fieldcaptions as $field=>$caption){
if (trim($HTTP_POST_VARS[$field])!=""){
$message .= $caption . ": " . stripslashes($HTTP_POST_VARS[$field]) . "\n";
}
}
$subject = "Information Request";
$header = "From: $email\r\nReply-To: $email\r\n";
$to = "gina@ifp.org, EIEinformation@aol.com";
$redirectlink = "Location: /infoconfirm.html";
header($redirectlink);
mail(trim($to), $subject, $message,$header);
}
}
?>
Homeschooling Information
Request Info
Please Note: we have created a new site, www.eieacademy.com specifically dedicated to keeping you up to date on the happenings of our ISP.
For information on products or homeschooling in the state of California, please do one of the following:
| 1. |
Fill in this
form, print out, and mail to: EIE, 2640-A7 S. Myrtle Ave, Monrovia, CA 91016 |
2. |
Fill in this
form, print out, and FAX to: (626) 821-0216 |
3. |
To request info online, fill in the form and click "submit." |
* denotes a required field
|
There was an error in submitting the form.
The following field(s) cannot be blank:
";
}
}
?>
|