International Directory of Homeopaths

<%Dim strFirstName, strLastName, strQualification, strRegistration, strAddress, strCity, strState, strCountry, strPin Dim strDate, strMonth, strYear, strTele1, strTele2, strFax, strEmail, strWebsite, strVet%> <% strFirstName=Request("txtFirstName") strLastName=Request("txtLastName") If not strFirstname="" And Not strLastname="" then %>
<% strQualification=Request("txtQualification") strRegistration=Request("txtRegistration") strAddress=Request("txtAddress") strCity=Request("txtCity") strState=Request("txtState") strCountry=Request("lstCountry") strPin=Request("txtPin") strDate=Request("lstDate") strMonth=Request("lstMonth") strYear=Request("lstYear") strTele1=Request("txtTele1") strTele2=Request("txtTele2") strFax=Request("txtFax") strEmail=Request("txtEmail") strWebsite=Request("txtWebsite") strVet=Request("chkVet") If strVet="" then strVet="False" end if If not strFirstName="" and not strLastName="" and not strAddress="" and not strCity="" then Dim objConn Set objConn= Server.CreateObject("ADODB.Connection") objConn.Connectionstring="DSN=dirhomeopaths.dsn" objConn.open Dim objRS Set objRS = Server.CreateObject("ADODB.Recordset") objRS.Open "Directory",objConn, 3, 3, cmdTable objRS.Addnew ObjRS("LastName")=strLastName ObjRS("FirstName")=strFirstName ObjRS("DoB")=strDate & "," & strMonth & "," & strYear ObjRS("RegNo")=strRegistration ObjRS("Address")=strAddress ObjRS("City")=strCity ObjRS("State")=strState ObjRS("Country")=strCountry ObjRS("Pin")=strPin ObjRS("Tele1")=strTele1 ObjRS("Tele2")=strTele2 ObjRS("Fax")=strFax ObjRS("email")=strEmail ObjRS("website")=strWebsite ObjRS("Qualification")=strQualification objRS("Vet")=strVet ObjRS.Update Response.Write "

Congratulations!! You have successfully registered." & "

" Response.write "Your name will appear in the directory listing within 7 working days. Thank you.

" If not email="" then End If End If EmailCode="homeopathSubmit" %>
<%End If%>
  Membership Form
   
Last Name *  
First Name *  
Date of Birth *  
Registration Number  
Qualification   
Street Address *  
City *  
State/Province  
Country *  
Pin/ Zip   
Tele1  
Tele2  
Fax  
e-mail  
web-site  
Are you a Homeopathic Vet?   Yes (select only if you are a qualified veterinary doctor)
Before submitting the form, please ensure that you have followed the submission guidelines properly. Otherwise your listing will not be approved.