CINXE.COM
Success Story - created by phpFormGenerator
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html> <head> <title>Success Story - created by phpFormGenerator</title> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"><link href="style.css" rel="stylesheet" type="text/css"> <!-- calendar stuff --> <link rel="stylesheet" type="text/css" href="calendar/calendar-blue2.css" /> <script type="text/javascript" src="calendar/calendar.js"></script> <script type="text/javascript" src="calendar/calendar-en.js"></script> <script type="text/javascript" src="calendar/calendar-setup.js"></script> <!-- END calendar stuff --> <!-- expand/collapse function --> <SCRIPT type=text/javascript> <!-- function collapseElem(obj) { var el = document.getElementById(obj); el.style.display = 'none'; } function expandElem(obj) { var el = document.getElementById(obj); el.style.display = ''; } //--> </SCRIPT> <!-- expand/collapse function --> <!-- expand/collapse function --> <SCRIPT type=text/javascript> <!-- // collapse all elements, except the first one function collapseAll() { var numFormPages = 1; for(i=2; i <= numFormPages; i++) { currPageId = ('mainForm_' + i); collapseElem(currPageId); } } //--> </SCRIPT> <!-- expand/collapse function --> <!-- validate --> <SCRIPT type=text/javascript> <!-- function validateField(fieldId, fieldBoxId, fieldType, required) { fieldBox = document.getElementById(fieldBoxId); fieldObj = document.getElementById(fieldId); if(fieldType == 'text' || fieldType == 'textarea' || fieldType == 'password' || fieldType == 'file' || fieldType == 'phone' || fieldType == 'website') { if(required == 1 && fieldObj.value == '') { fieldObj.setAttribute("class","mainFormError"); fieldObj.setAttribute("className","mainFormError"); fieldObj.focus(); return false; } } else if(fieldType == 'menu' || fieldType == 'country' || fieldType == 'state') { if(required == 1 && fieldObj.selectedIndex == 0) { fieldObj.setAttribute("class","mainFormError"); fieldObj.setAttribute("className","mainFormError"); fieldObj.focus(); return false; } } else if(fieldType == 'email') { if((required == 1 && fieldObj.value=='') || (fieldObj.value!='' && !validate_email(fieldObj.value))) { fieldObj.setAttribute("class","mainFormError"); fieldObj.setAttribute("className","mainFormError"); fieldObj.focus(); return false; } } } function validate_email(emailStr) { apos=emailStr.indexOf("@"); dotpos=emailStr.lastIndexOf("."); if (apos<1||dotpos-apos<2) { return false; } else { return true; } } function validateDate(fieldId, fieldBoxId, fieldType, required, minDateStr, maxDateStr) { retValue = true; fieldBox = document.getElementById(fieldBoxId); fieldObj = document.getElementById(fieldId); dateStr = fieldObj.value; if(required == 0 && dateStr == '') { return true; } if(dateStr.charAt(2) != '/' || dateStr.charAt(5) != '/' || dateStr.length != 10) { retValue = false; } else // format's okay; check max, min { currDays = parseInt(dateStr.substr(0,2),10) + parseInt(dateStr.substr(3,2),10)*30 + parseInt(dateStr.substr(6,4),10)*365; //alert(currDays); if(maxDateStr != '') { maxDays = parseInt(maxDateStr.substr(0,2),10) + parseInt(maxDateStr.substr(3,2),10)*30 + parseInt(maxDateStr.substr(6,4),10)*365; //alert(maxDays); if(currDays > maxDays) retValue = false; } if(minDateStr != '') { minDays = parseInt(minDateStr.substr(0,2),10) + parseInt(minDateStr.substr(3,2),10)*30 + parseInt(minDateStr.substr(6,4),10)*365; //alert(minDays); if(currDays < minDays) retValue = false; } } if(retValue == false) { fieldObj.setAttribute("class","mainFormError"); fieldObj.setAttribute("className","mainFormError"); fieldObj.focus(); return false; } } //--> </SCRIPT> <!-- end validate --> <style type="text/css"> <!-- body { background-color: #ffffff; } --> </style></head> <body onLoad="collapseAll()"> <div id="mainForm"> <div id="formHeader"> <h2 class="formInfo">InnerPowerment Success Story</h2> <p class="formInfo">How has InnerPowerment helped you? Share your success story with Dr. M.</p> </div> <BR/><!-- begin form --> <form method=post enctype=multipart/form-data action=processor.php onSubmit="return validatePage1();"><ul class=mainForm id="mainForm_1"> <li class="mainForm" id="fieldBox_1"> <label class="formFieldQuestion">First Name</label><input class=mainForm type=text name=field_1 id=field_1 size='20' value=''></li> <li class="mainForm" id="fieldBox_2"> <label class="formFieldQuestion">Last Name</label><input class=mainForm type=text name=field_2 id=field_2 size='20' value=''></li> <li class="mainForm" id="fieldBox_3"> <label class="formFieldQuestion">Occupation or Title</label><input class=mainForm type=text name=field_3 id=field_3 size='20' value=''></li> <li class="mainForm" id="fieldBox_8"> <label class="formFieldQuestion">Company/Organization<br> (if this success story involves your organization)</label> <input class=mainForm type=text name=field_8 id=field_8 size='20' value=''></li> <li class="mainForm" id="fieldBox_4"> <label class="formFieldQuestion">Industry</label><input class=mainForm type=text name=field_4 id=field_4 size='20' value=''></li> <li class="mainForm" id="fieldBox_5"> <label class="formFieldQuestion">Location (City, State/Province)</label><input class=mainForm type=text name=field_5 id=field_5 size='20' value=''></li> <li class="mainForm" id="fieldBox_7"> <label class="formFieldQuestion">Country</label> <select class=mainForm name=field_7 id=field_7> <option value=''> </option> <option value="Abkhazia">Abkhazia</option> <option value="Afghanistan">Afghanistan</option> <option value="Aland">Aland</option> <option value="Albania">Albania</option> <option value="Algeria">Algeria</option> <option value="American Samoa">American Samoa</option> <option value="Andorra">Andorra</option> <option value="Angola">Angola</option> <option value="Anguilla">Anguilla</option> <option value="Antarctica">Antarctica</option> <option value="Antigua and Barbuda">Antigua and Barbuda</option> <option value="Argentina">Argentina</option> <option value="Armenia">Armenia</option> <option value="Aruba">Aruba</option> <option value="Ascension">Ascension</option> <option value="Ashmore and Cartier Islands">Ashmore and Cartier Islands</option> <option value="Australia">Australia</option> <option value="Australian Antarctic Territory">Australian Antarctic Territory</option> <option value="Austria">Austria</option> <option value="Azerbaijan">Azerbaijan</option> <option value="Bahamas, The">Bahamas, The</option> <option value="Bahrain">Bahrain</option> <option value="Baker Island">Baker Island</option> <option value="Bangladesh">Bangladesh</option> <option value="Barbados">Barbados</option> <option value="Belarus">Belarus</option> <option value="Belgium">Belgium</option> <option value="Belize">Belize</option> <option value="Benin">Benin</option> <option value="Bermuda">Bermuda</option> <option value="Bhutan">Bhutan</option> <option value="Bolivia">Bolivia</option> <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option> <option value="Botswana">Botswana</option> <option value="Bouvet Island">Bouvet Island</option> <option value="Brazil">Brazil</option> <option value="British Antarctic Territory">British Antarctic Territory</option> <option value="British Indian Ocean Territory">British Indian Ocean Territory</option> <option value="British Sovereign Base Areas">British Sovereign Base Areas</option> <option value="British Virgin Islands">British Virgin Islands</option> <option value="Brunei">Brunei</option> <option value="Bulgaria">Bulgaria</option> <option value="Burkina Faso">Burkina Faso</option> <option value="Burundi">Burundi</option> <option value="Cambodia">Cambodia</option> <option value="Cameroon">Cameroon</option> <option value="Canada">Canada</option> <option value="Cape Verde">Cape Verde</option> <option value="Cayman Islands">Cayman Islands</option> <option value="Central African Republic">Central African Republic</option> <option value="Chad">Chad</option> <option value="Chile">Chile</option> <option value="China, People's Republic of">China, People's Republic of</option> <option value="China, Republic of (Taiwan)">China, Republic of (Taiwan)</option> <option value="Christmas Island">Christmas Island</option> <option value="Clipperton Island">Clipperton Island</option> <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option> <option value="Colombia">Colombia</option> <option value="Comoros">Comoros</option> <option value="Congo, Democratic Republic of the (Congo Kinshasa)">Congo, Democratic Republic of the (Congo Kinshasa)</option> <option value="Congo, Republic of the (Congo Brazzaville)">Congo, Republic of the (Congo Brazzaville)</option> <option value="Cook Islands">Cook Islands</option> <option value="Coral Sea Islands">Coral Sea Islands</option> <option value="Costa Rica">Costa Rica</option> <option value="Cote d'Ivoire (Ivory Coast)">Cote d'Ivoire (Ivory Coast)</option> <option value="Croatia">Croatia</option> <option value="Cuba">Cuba</option> <option value="Cyprus">Cyprus</option> <option value="Czech Republic">Czech Republic</option> <option value="Denmark">Denmark</option> <option value="Djibouti">Djibouti</option> <option value="Dominica">Dominica</option> <option value="Dominican Republic">Dominican Republic</option> <option value="Ecuador">Ecuador</option> <option value="Egypt">Egypt</option> <option value="El Salvador">El Salvador</option> <option value="Equatorial Guinea">Equatorial Guinea</option> <option value="Eritrea">Eritrea</option> <option value="Estonia">Estonia</option> <option value="Ethiopia">Ethiopia</option> <option value="Falkland Islands (Islas Malvinas)">Falkland Islands (Islas Malvinas)</option> <option value="Faroe Islands">Faroe Islands</option> <option value="Fiji">Fiji</option> <option value="Finland">Finland</option> <option value="France">France</option> <option value="French Guiana">French Guiana</option> <option value="French Polynesia">French Polynesia</option> <option value="French Scattered Islands in the Indian Ocean">French Scattered Islands in the Indian Ocean</option> <option value="French Southern and Antarctic Lands">French Southern and Antarctic Lands</option> <option value="Gabon">Gabon</option> <option value="Gambia, The">Gambia, The</option> <option value="Georgia">Georgia</option> <option value="Germany">Germany</option> <option value="Ghana">Ghana</option> <option value="Gibraltar">Gibraltar</option> <option value="Greece">Greece</option> <option value="Greenland">Greenland</option> <option value="Grenada">Grenada</option> <option value="Guadeloupe">Guadeloupe</option> <option value="Guam">Guam</option> <option value="Guatemala">Guatemala</option> <option value="Guernsey">Guernsey</option> <option value="Guinea">Guinea</option> <option value="Guinea-Bissau">Guinea-Bissau</option> <option value="Guyana">Guyana</option> <option value="Haiti">Haiti</option> <option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option> <option value="Honduras">Honduras</option> <option value="Hong Kong">Hong Kong</option> <option value="Howland Island">Howland Island</option> <option value="Hungary">Hungary</option> <option value="Iceland">Iceland</option> <option value="India">India</option> <option value="Indonesia">Indonesia</option> <option value="Iran">Iran</option> <option value="Iraq">Iraq</option> <option value="Ireland">Ireland</option> <option value="Isle of Man">Isle of Man</option> <option value="Israel">Israel</option> <option value="Italy">Italy</option> <option value="Jamaica">Jamaica</option> <option value="Japan">Japan</option> <option value="Jarvis Island">Jarvis Island</option> <option value="Jersey">Jersey</option> <option value="Johnston Atoll">Johnston Atoll</option> <option value="Jordan">Jordan</option> <option value="Kazakhstan">Kazakhstan</option> <option value="Kenya">Kenya</option> <option value="Kingman Reef">Kingman Reef</option> <option value="Kiribati">Kiribati</option> <option value="Korea, Democratic People's Republic of (North Korea)">Korea, Democratic People's Republic of (North Korea)</option> <option value="Korea, Republic of (South Korea)">Korea, Republic of (South Korea)</option> <option value="Kosovo">Kosovo</option> <option value="Kuwait">Kuwait</option> <option value="Kyrgyzstan">Kyrgyzstan</option> <option value="Laos">Laos</option> <option value="Latvia">Latvia</option> <option value="Lebanon">Lebanon</option> <option value="Lesotho">Lesotho</option> <option value="Liberia">Liberia</option> <option value="Libya">Libya</option> <option value="Liechtenstein">Liechtenstein</option> <option value="Lithuania">Lithuania</option> <option value="Luxembourg">Luxembourg</option> <option value="Macau">Macau</option> <option value="Macedonia">Macedonia</option> <option value="Madagascar">Madagascar</option> <option value="Malawi">Malawi</option> <option value="Malaysia">Malaysia</option> <option value="Maldives">Maldives</option> <option value="Mali">Mali</option> <option value="Malta">Malta</option> <option value="Marshall Islands">Marshall Islands</option> <option value="Martinique">Martinique</option> <option value="Mauritania">Mauritania</option> <option value="Mauritius">Mauritius</option> <option value="Mayotte">Mayotte</option> <option value="Mexico">Mexico</option> <option value="Micronesia">Micronesia</option> <option value="Midway Islands">Midway Islands</option> <option value="Moldova">Moldova</option> <option value="Monaco">Monaco</option> <option value="Mongolia">Mongolia</option> <option value="Montenegro">Montenegro</option> <option value="Montserrat">Montserrat</option> <option value="Morocco">Morocco</option> <option value="Mozambique">Mozambique</option> <option value="Myanmar (Burma)">Myanmar (Burma)</option> <option value="Nagorno-Karabakh">Nagorno-Karabakh</option> <option value="Namibia">Namibia</option> <option value="Nauru">Nauru</option> <option value="Navassa Island">Navassa Island</option> <option value="Nepal">Nepal</option> <option value="Netherlands">Netherlands</option> <option value="Netherlands Antilles">Netherlands Antilles</option> <option value="New Caledonia">New Caledonia</option> <option value="New Zealand">New Zealand</option> <option value="Nicaragua">Nicaragua</option> <option value="Niger">Niger</option> <option value="Nigeria">Nigeria</option> <option value="Niue">Niue</option> <option value="Norfolk Island">Norfolk Island</option> <option value="Northern Cyprus">Northern Cyprus</option> <option value="Northern Mariana Islands">Northern Mariana Islands</option> <option value="Norway">Norway</option> <option value="Oman">Oman</option> <option value="Pakistan">Pakistan</option> <option value="Palau">Palau</option> <option value="Palestine">Palestine</option> <option value="Palmyra Atoll">Palmyra Atoll</option> <option value="Panama">Panama</option> <option value="Papua New Guinea">Papua New Guinea</option> <option value="Paraguay">Paraguay</option> <option value="Peru">Peru</option> <option value="Peter I Island">Peter I Island</option> <option value="Philippines">Philippines</option> <option value="Pitcairn Islands">Pitcairn Islands</option> <option value="Poland">Poland</option> <option value="Portugal">Portugal</option> <option value="Pridnestrovie (Transnistria)">Pridnestrovie (Transnistria)</option> <option value="Puerto Rico">Puerto Rico</option> <option value="Qatar">Qatar</option> <option value="Queen Maud Land">Queen Maud Land</option> <option value="Reunion">Reunion</option> <option value="Romania">Romania</option> <option value="Ross Dependency">Ross Dependency</option> <option value="Russia">Russia</option> <option value="Rwanda">Rwanda</option> <option value="Saint Helena">Saint Helena</option> <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option> <option value="Saint Lucia">Saint Lucia</option> <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option> <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option> <option value="Samoa">Samoa</option> <option value="San Marino">San Marino</option> <option value="Sao Tome and Principe">Sao Tome and Principe</option> <option value="Saudi Arabia">Saudi Arabia</option> <option value="Senegal">Senegal</option> <option value="Serbia">Serbia</option> <option value="Seychelles">Seychelles</option> <option value="Sierra Leone">Sierra Leone</option> <option value="Singapore">Singapore</option> <option value="Slovakia">Slovakia</option> <option value="Slovenia">Slovenia</option> <option value="Solomon Islands">Solomon Islands</option> <option value="Somalia">Somalia</option> <option value="Somaliland">Somaliland</option> <option value="South Africa">South Africa</option> <option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option> <option value="South Ossetia">South Ossetia</option> <option value="Spain">Spain</option> <option value="Sri Lanka">Sri Lanka</option> <option value="Sudan">Sudan</option> <option value="Suriname">Suriname</option> <option value="Svalbard">Svalbard</option> <option value="Swaziland">Swaziland</option> <option value="Sweden">Sweden</option> <option value="Switzerland">Switzerland</option> <option value="Syria">Syria</option> <option value="Tajikistan">Tajikistan</option> <option value="Tanzania">Tanzania</option> <option value="Thailand">Thailand</option> <option value="Timor-Leste (East Timor)">Timor-Leste (East Timor)</option> <option value="Togo">Togo</option> <option value="Tokelau">Tokelau</option> <option value="Tonga">Tonga</option> <option value="Trinidad and Tobago">Trinidad and Tobago</option> <option value="Tristan da Cunha">Tristan da Cunha</option> <option value="Tunisia">Tunisia</option> <option value="Turkey">Turkey</option> <option value="Turkmenistan">Turkmenistan</option> <option value="Turks and Caicos Islands">Turks and Caicos Islands</option> <option value="Tuvalu">Tuvalu</option> <option value="U.S. Virgin Islands">U.S. Virgin Islands</option> <option value="Uganda">Uganda</option> <option value="Ukraine">Ukraine</option> <option value="United Arab Emirates">United Arab Emirates</option> <option value="United Kingdom">United Kingdom</option> <option value="United States" selected>United States</option> <option value="Uruguay">Uruguay</option> <option value="Uzbekistan">Uzbekistan</option> <option value="Vanuatu">Vanuatu</option> <option value="Vatican City">Vatican City</option> <option value="Venezuela">Venezuela</option> <option value="Viet Nam">Viet Nam</option> <option value="Wake Island">Wake Island</option> <option value="Wallis and Futuna">Wallis and Futuna</option> <option value="Western Sahara">Western Sahara</option> <option value="Yemen">Yemen</option> <option value="Zambia">Zambia</option> <option value="Zimbabwe">Zimbabwe</option> </select> </li> <li class="mainForm" id="fieldBox_6"> <label class="formFieldQuestion">Month, Year your success story occurred</label> <li class="mainForm" id="fieldBox_14"> <label class="formFieldQuestion"></label><select class=mainForm name=field_14 id=field_14><option value=''></option><option value="January">January</option><option value="February">February</option><option value="March">March</option><option value="April">April</option><option value="May">May</option><option value="June">June</option><option value="July">July</option><option value="August">August</option><option value="September">September</option><option value="November">November</option><option value="December">December</option><option value="October">October</option></select> <select class=mainForm name=field_15 id=field_15> <option value=''></option> <option value="2004">2004</option> <option value="2005">2005</option> <option value="2006">2006</option> <option value="2007">2007</option> <option value="2008">2008</option> <option value="2009">2009</option> <option value="2010">2010</option> <option value="2011">2011</option> <option value="2012">2012</option> <option value="2013">2013</option> <option value="2014">2014</option> <option value="2015">2015</option> <option value="2016">2016</option> <option value="2017">2017</option> <option value="2018">2018</option> <option value="2019">2019</option> <option value="2020">2020</option> <option value="2021">2021</option> <option value="2022">2022</option> <option value="2023">2023</option> <option value="2024">2024</option> </select> <label class="formFieldQuestion"></label> </li> <li class="mainForm" id="fieldBox_9"> <label class="formFieldQuestion">Abstract: Please give a 1 or 2-sentence summary of your success story</label><textarea class=mainForm name=field_9 id=field_9 rows=2 cols=50></textarea> </li> <li class="mainForm" id="fieldBox_19"> <label class="formFieldQuestion">The Challenge: Please describe the challenge you were having before you achieved success.</label> <textarea class=mainForm name=field_19 id=field_19 rows=10 cols=50></textarea></li> <li class="mainForm" id="fieldBox_20"> <label class="formFieldQuestion">The Solution: Please list the specific InnerPowerment workshops, techniques etc. you used to approach your situation.</label> <textarea class=mainForm name=field_20 id=field_20 rows=10 cols=50></textarea></li> <li class="mainForm" id="fieldBox_21"> <label class="formFieldQuestion">The Approach: Please describe why and how you selected your solutions, and described how you used them approach your situation.</label> <textarea class=mainForm name=field_21 id=field_21 rows=10 cols=50></textarea></li> <li class="mainForm" id="fieldBox_22"> <label class="formFieldQuestion">Results: What was the outome of using the above solutions and approach?</label> <textarea class=mainForm name=field_22 id=field_22 rows=10 cols=50></textarea></li> <li class="mainForm" id="fieldBox_23"> <label class="formFieldQuestion">Additonal Comment: Please add any additional comments, quotes, testimonials or other information you would like to include.</label> <textarea class=mainForm name=field_23 id=field_2 rows=10 cols=50></textarea></li> <li class="mainForm" id="fieldBox_10"> <label class="formFieldQuestion">Confidentiality - Personal and company names are kept confidential unless otherwised indicated below. Success stories may be shared on the InnerPowerment website, in the newsletter or other materials, or they may be used for study and training purposes. Dr. M will use a fictitious name to protect confidentiality unless you select one or more of the options below. Journalists who visit the web site or subscribe to the newsletter may express interest in reprinting a success story or interviewing people named in the stories.<br> </label> <span><input class=mainForm type=checkbox name=field_10[] id=field_10_option_6 value="Use My Full Name" /> <label class=formFieldOption for="field_10_option_6">Use my real, full name in my story</label><input class=mainForm type=checkbox name=field_10[] id=field_10_option_1 value="Use My First Name and Last Initial" /> <label class=formFieldOption for="field_10_option_1">Use my first name and last initial in my story</label> <input class=mainForm type=checkbox name=field_10[] id=field_10_option_4 value="First Name or Initials Only" /> <label class=formFieldOption for="field_10_option_4">Use my first name only or my initials only</label><input class=mainForm type=checkbox name=field_10[] id=field_10_option_3 value="Contact Me if There is Media Interest in My Story" /><label class=formFieldOption for="field_10_option_3">Keep my name confidential but contact me if there is media interest in my story</label> <input class=mainForm type=checkbox name=field_10[] id=field_10_option_2 value="Allow Media to Contact Me Directly for a Story" /><label class=formFieldOption for="field_10_option_2">Allow the media to contact me directly for an interview</label></span></li> <li class="mainForm" id="fieldBox_11"> <label class="formFieldQuestion">E-mail Address</label><input class=mainForm type=email name=field_11 id=field_11 size=20 value="" style="background-image:url(imgs/email.png); background-repeat: no-repeat; padding: 2px 2px 2px 25px;"></li> <li class="mainForm" id="fieldBox_12"> <label class="formFieldQuestion">Telephone</label><input class=mainForm type=phone name=field_12 id=field_12 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat; padding: 2px 2px 2px 25px;"></li> <li class="mainForm" id="fieldBox_13"> <label class="formFieldQuestion">Alternate Telephone</label><input class=mainForm type=phone name=field_13 id=field_13 size=20 value="" style="background-image:url(imgs/phone.png); background-repeat: no-repeat; padding: 2px 2px 2px 25px;"></li> <!-- end of this page --> <!-- page validation --> <SCRIPT type=text/javascript> <!-- function validatePage1() { retVal = true; if (validateField('field_1','fieldBox_1','text',0) == false) retVal=false; if (validateField('field_2','fieldBox_2','text',0) == false) retVal=false; if (validateField('field_3','fieldBox_3','text',0) == false) retVal=false; if (validateField('field_4','fieldBox_4','text',0) == false) retVal=false; if (validateField('field_5','fieldBox_5','text',0) == false) retVal=false; if (validateField('field_6','fieldBox_6','text',0) == false) retVal=false; if (validateField('field_7','fieldBox_7','country',0) == false) retVal=false; if (validateField('field_8','fieldBox_8','text',0) == false) retVal=false; if (validateField('field_9','fieldBox_9','textarea',0) == false) retVal=false; if (validateField('field_10','fieldBox_10','checkbox',0) == false) retVal=false; if (validateField('field_11','fieldBox_11','email',0) == false) retVal=false; if (validateField('field_12','fieldBox_12','phone',0) == false) retVal=false; if (validateField('field_13','fieldBox_13','phone',0) == false) retVal=false; if (validateField('field_14','fieldBox_14','menu',0) == false) retVal=false; if (validateField('field_15','fieldBox_15','menu',0) == false) retVal=false; if (validateField('field_16','fieldBox_16','checkbox',0) == false) retVal=false; if (validateField('field_17','fieldBox_17','text',0) == false) retVal=false; if (validateField('field_18','fieldBox_18','state',0) == false) retVal=false; if(retVal == false) { alert('Please correct the errors. Fields marked with an asterisk (*) are required'); return false; } return retVal; } //--> </SCRIPT> <!-- end page validaton --> <!-- next page buttons --><li class="mainForm"> <label class="formFieldQuestion"> Type the following: <a class=info href=#><img src=imgs/tip_small.png border=0><span class=infobox>For security purposes, please type the letters in the image.</span></a><BR><img src="CaptchaSecurityImages.php" /> </label> <input id="captchaForm" name="security_code" class="mainForm" type="text"/> </li><li class="mainForm"> <input id="saveForm" class="mainForm" type="submit" value="Submit" /> </li> </form> <!-- end of form --> <!-- close the display stuff for this page --></div> <div id="footer"><p class="footer"><a class=footer href=http://phpformgen.sourceforge.net>Generated by phpFormGenerator</a></p></div> </body> </html>