<% @LANGUAGE="VBSCRIPT" %> <% Response.Expires=-1 %> <% if Request.Form("FFSubmitted") = "yes" then Dim BodyString Dim objCDO Dim RedirectURL Dim FormFields Dim arrFormFields FormFields = "First~Last~Degree~Title~Organization~Department~Street1~Street2~City~state~Zip~Country~WorkPhone~HomePhone~Fax~Email~Level~OtherAmount~CardType~CreditCardNum~CCExpDate~SecurityCode~NameOnCard" If FormFields <> "" Then arrFormFields = split(FormFields,"~") End If Set objCDO = Server.CreateObject("CDONTS.NewMail") objCDO.From = "chadd@isbd.org" objCDO.To = "daversacd@upmc.edu" 'objCDO.Cc = "sevet@aol.com" objCDO.To = "meg@isbd.org" objCDO.Subject = "test donation" BodyString = Replace("New donation form has been recieved.","~",chr(13) & chr(10) )& chr(13) If FormFields <> "" Then For Each item In arrFormFields BodyString = BodyString & item & ": " & Request.Form(item) & chr(13) Next End If objCDO.Body = BodyString objCDO.BodyFormat = 1 objCDO.MailFormat = 1 objCDO.Send Set objCDO = Nothing RedirectURL = "/donation_thanks.htm" If RedirectURL <> "" then If Request.QueryString <> "" Then response.redirect(RedirectURL & "?" & Request.QueryString) else response.redirect(RedirectURL) end If end if end if %> <% MM_EditAction = CStr(Request("URL")) If (Request.QueryString <> "") Then MM_EditAction = MM_EditAction & "?" & Request.QueryString End If %>

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First Name:

 

Last Name:

 

Degree:

 

Title:

 

Affiliation:

 

Department:

 

Street Address:

 

Street Address:

 

City:

 

State/Province:

 

Zip:

 

Country:

 

Work Phone:

 

Home Phone:

 

Fax:

 

E-Mail Address:

 
     
Donation Information


Donation Level:

 
Platinum $5,000
Gold $1,000
Silver $500
Bronze $300
Other Amount $

 
     
THANK YOU FOR YOUR CONTINUED SUPPORT!