<% if (Request.QueryString = "go") then Set Mailer = Server.CreateObject("SMTPsvg.Mailer") Mailer.FromName = "Child Defender - New York Sign Up Form" Mailer.FromAddress= "signupform@cdfny.org" Mailer.RemoteHost = "mail.psnyc.com" Mailer.AddRecipient Request.Form("firstname") & " " & Request.Form("lastname"), "edavis@cdfny.org" Mailer.AddRecipient Request.Form("firstname") & " " & Request.Form("lastname"), "ogonzalez@cdfny.org" Mailer.Subject = "Child Defender - New York Sign Up" Mailer.BodyText = "First Name: " & Request.Form("firstname") & VbCrLf & "Last Name: " & Request.Form("lastname") & VbCrLf & "Organization: " & Request.Form("organization") & VbCrLf & "Title: " & Request.Form("title") & VbCrLf & "Address: " & Request.Form("streetaddress") & VbCrLf & "City: " & Request.Form("city") & VbCrLf & "State: " & Request.Form("state") & VbCrLf & "Zip Code: " & Request.Form("zipcode") & VbCrLf & "Phone: " & Request.Form("phone") & VbCrLf & "Fax: " & Request.Form("fax") & VbCrLf & "Email: " & Request.Form("emailaddress1") & VbCrLf & "Preferred Method: " & Request.Form("preferredmethod") & VbCrLf & "Comments: " & Request.Form("comments") if Mailer.SendMail then Response.Write "" Response.Write "

" & Request.Form("firstname") & " " & Request.Form("lastname") & ",

" Response.Write "

Thank you for signing up for the Child Defender - New York!

" Response.Write "

You should receive your first edition via email or fax in the next two weeks.
" Response.Write "Please feel free to contact us with any questions at (212) 697-2323 or messages@cdfny.org.

" Response.Write "

 

Return to CDF NY Home Page

" Response.Write "" else Response.Write "Mail send failure. Error was " & Mailer.Response end if else %> Child Defender NY - Sign Up Form!

I WANT TO LEARN MORE ABOUT ISSUES
AFFECTING CHILDREN IN NEW YORK!

SIGN ME UP!

First Name:*
Last Name:*
Organization:
Title:
Address:*
City:*
State:*
Zip:*
Prefered Method of Contact:
Email Address:*
Retype your Email Address:*
Phone:
Fax:
Questions/Comments:
   
 
   
  * Required Field
  You can always unsubscribe by letting us know at messages@cdfny.org
   

 

<% end if %>