File: /home/awaldron/www/archive/holidayhealthclub/evaluation.php
<?php
error_reporting(E_ALL ^ (E_NOTICE | E_WARNING));
function error($mesg) {
return "<center><table border=0><tr><td><img src=\"gui/error.gif\"> </td><td valign=\"middle\" class=\"error\">ERROR: ".$mesg."</td></tr></table></center>\n";
}
function notice($mesg) {
return "<center><table border=0><tr><td valign=\"middle\" class=\"error\">SUCCESS! ".$mesg."</td></tr></table></center>\n";
}
$page_title = "Free Personal Evaluation";
include("_header.php");
$errors = 1;
if (isset($_POST["sendform"])) {
$errors = 0;
if ($_POST["name"] == "") { echo error("'Your Name' is a required field."); $errors = 1; }
if ($_POST["email"] == "") { echo error("'Your Email' is a required field."); $errors = 1; }
if ($_POST["phone"] == "") { echo error("'Phone #' is a required field."); $errors = 1; }
if ($errors == 0) {
$message = $_POST["name"]." has completed a Free Personal Evalution.\n\n";
$message .= "Name : ".$_POST["name"]."\n";
$message .= "Email : ".$_POST["email"]."\n";
$message .= "Phone : ".$_POST["phone"]."\n\n";
$message .= "Address 1 : ".$_POST["add1"]."\n";
if ($_POST["add2"] != "") $message .= "Address 2 : ".$_POST["add2"]."\n";
$message .= "City : ".$_POST["city"]."\n";
$message .= "State : ".$_POST["state"]."\n";
$message .= "Zip Code : ".$_POST["zip"]."\n\n";
$message .= "Personal Goals:\n";
if ($_POST["feel_better"] == 1) $message .= " - Feel Better\n";
if ($_POST["look_better"] == 1) $message .= " - Look Better\n";
if ($_POST["lose_weight"] == 1) $message .= " - Lose Weight\n";
if ($_POST["condition"] == 1) $message .= " - Maintain Your Condition\n";
if ($_POST["gain_weight"] == 1) $message .= " - Gain Weight\n";
if ($_POST["endurance"] == 1) $message .= " - Improve Endurance\n";
if ($_POST["strength"] == 1) $message .= " - Increase Strength\n";
if ($_POST["rehabilitate"] == 1) $message .= " - Rehabilitate\n";
$message .= "\nAreas of Interest:\n";
if ($_POST["weight_training"] == 1) $message .= " - Resistance Weight Training\n";
if ($_POST["free_weights"] == 1) $message .= " - Free Weights\n";
if ($_POST["personal_training"] == 1) $message .= " - Personal Training\n";
if ($_POST["cardio"] == 1) $message .= " - Cardiovascular\n";
if ($_POST["aerobics"] == 1) $message .= " - Aerobics\n";
if ($_POST["pilates"] == 1) $message .= " - Pilates\n";
if ($_POST["kickboxing"] == 1) $message .= " - Executive Kickboxing\n";
if ($_POST["boxing"] == 1) $message .= " - Boxing\n";
if ($_POST["martial_arts"] == 1) $message .= " - Martial Arts\n";
if ($_POST["racquetball"] == 1) $message .= " - Racquetball\n";
if ($_POST["nutrition"] == 1) $message .= " - Nutrition\n";
if ($_POST["massage"] == 1) $message .= " - Massage\n";
if ($_POST["tanning"] == 1) $message .= " - Tanning\n";
if ($_POST["rental"] == 1) $message .= " - Facility Rental\n";
$to = "hhrc@alltel.net";
$subject = "Free Personal Evaluation";
$additional_headers = "From: ".$_POST["name"]." <".$_POST["email"].">\n" . "Reply-To: ".$_POST["email"]."";
mail($to, $subject, $message, $additional_headers);
echo "<br><br>".notice("Your Free Personal Evaluation has been submitted. You should be hearing from us soon!<P>Thank you and have a great day!")."<br><br><br>\n";
}
}
if ($errors != 0) {
echo "<form action=\"evaluation.php\" method=\"post\">\n";
echo "<P>Submit this form for a FREE personalized review of programs designed especially for you by the Holiday Health & Racquetball Club.\n";
echo "<P><b>* Items in Bold are required.</b>\n";
echo "<ul><table border=0 width=80% id=\"xtable\">\n";
echo "<tr><td><b>Your Name:</b></td><td><input type=\"text\" size=40 name=\"name\" value=\"".$_POST["name"]."\"></td></tr>\n";
echo "<tr><td><b>Your Email:</b></td><td><input type=\"text\" size=40 name=\"email\" value=\"".$_POST["email"]."\"></td></tr>\n";
echo "<tr><td><b>Phone #:</b></td><td><input type=\"text\" size=15 name=\"phone\" value=\"".$_POST["phone"]."\"></td></tr>\n";
echo "<tr><td colspan=2> </td></tr>\n";
echo "<tr><td>Address 1:</td><td><input type=\"text\" size=40 name=\"add1\" value=\"".$_POST["add1"]."\"></td></tr>\n";
echo "<tr><td>Address 2:</td><td><input type=\"text\" size=40 name=\"add2\" value=\"".$_POST["add2"]."\"></td></tr>\n";
echo "<tr><td>City:</td><td><input type=\"text\" size=40 name=\"city\" value=\"".$_POST["city"]."\"></td></tr>\n";
echo "<tr><td>State:</td><td><input type=\"text\" size=5 name=\"state\" value=\"".$_POST["state"]."\"></td></tr>\n";
echo "<tr><td>Zip Code:</td><td><input type=\"text\" size=8 name=\"zip\" value=\"".$_POST["zip"]."\"></td></tr>\n";
echo "<tr><td colspan=2> </td></tr>\n";
echo "</table>\n";
echo "<table border=0 width=80% id=\"xtable\">\n";
echo "<tr><td colspan=2><b>Your Personal Goals:</b></td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"feel_better\" value=1".($_POST["feel_better"]==1?" CHECKED":"")."> Feel Better</td>\n";
echo " <td><input type=\"checkbox\" name=\"gain_weight\" value=1".($_POST["gain_weight"]==1?" CHECKED":"")."> Gain Weight</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"look_better\" value=1".($_POST["look_better"]==1?" CHECKED":"")."> Look Better</td>\n";
echo " <td><input type=\"checkbox\" name=\"endurance\" value=1".($_POST["endurance"]==1?" CHECKED":"")."> Improve Endurance</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"lose_weight\" value=1".($_POST["lose_weight"]==1?" CHECKED":"")."> Lose Weight</td>\n";
echo " <td><input type=\"checkbox\" name=\"strength\" value=1".($_POST["strength"]==1?" CHECKED":"")."> Increase Strength</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"condition\" value=1".($_POST["condition"]==1?" CHECKED":"")."> Maintain Your Condition</td>\n";
echo " <td><input type=\"checkbox\" name=\"rehabilitate\" value=1".($_POST["rehabilitate"]==1?" CHECKED":"")."> Rehabilitate</td></tr>\n";
echo "<tr><td colspan=2> </td></tr>\n";
echo "<tr><td colspan=2><b>Your Areas of Interest:</b></td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"weight_training\" value=1".($_POST["weight_training"]==1?" CHECKED":"")."> Resistance Weight Training</td>\n";
echo " <td><input type=\"checkbox\" name=\"martial_arts\" value=1".($_POST["martial_arts"]==1?" CHECKED":"")."> Martial Arts</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"free_weights\" value=1".($_POST["free_weights"]==1?" CHECKED":"")."> Free Weights</td>\n";
echo " <td><input type=\"checkbox\" name=\"racquetball\" value=1".($_POST["racquetball"]==1?" CHECKED":"")."> Racquetball</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"personal_training\" value=1".($_POST["personal_training"]==1?" CHECKED":"")."> Personal Training</td>\n";
echo " <td><input type=\"checkbox\" name=\"nutrition\" value=1".($_POST["nutrition"]==1?" CHECKED":"")."> Nutrition</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"cardio\" value=1".($_POST["cardio"]==1?" CHECKED":"")."> Cardiovascular</td>\n";
echo " <td><input type=\"checkbox\" name=\"massage\" value=1".($_POST["massage"]==1?" CHECKED":"")."> Massage</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"aerobics\" value=1".($_POST["aerobics"]==1?" CHECKED":"")."> Aerobics</td>\n";
echo " <td><input type=\"checkbox\" name=\"tanning\" value=1".($_POST["tanning"]==1?" CHECKED":"")."> Tanning</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"pilates\" value=1".($_POST["pilates"]==1?" CHECKED":"")."> Pilates</td>\n";
echo " <td><input type=\"checkbox\" name=\"rental\" value=1".($_POST["rental"]==1?" CHECKED":"")."> Facility Rental</td></tr>\n";
echo "<tr><td><input type=\"checkbox\" name=\"kickboxing\" value=1".($_POST["kickboxing"]==1?" CHECKED":"")."> Executive Kickboxing</td>\n";
echo " <td> </td></tr>\n";
echo "<tr><td colspan=2> </td></tr>\n";
echo "<tr><td colspan=2 align=\"center\"><input type=\"submit\" value=\"Submit\" name=\"sendform\"></td></tr>\n";
echo "</table></ul>\n";
}
include("_footer.php");
?>