Give To Medcen Hospice

<% If Not Request.Form("email") = "" then email = Request.Form("email") vn = Request.Form("volname") Addr=Request.Form("add") city=Request.Form("city") st=Request.Form("st") zip=Request.Form("zip") hp=Request.Form("homeph") wp=Request.Form("workph") bc=Request.Form("bestcontact") dl=Request.Form("GA_DL") edu=Request.Form("edu") sk=Request.Form("skills") aoi=Request.Form("AOI") comm=Request.Form("comments") Set objMessage = CreateObject("CDO.Message") objMessage.from = email objMessage.To = "baisden.marsha@mccg.org;hill.cindy@mccg.org;aulds.laura@mccg.org" 'objMessage.To = "baisden.marsha@mccg.org;hill.cindy@mccg.org;sandoval.cathy@mccg.org" 'objMessage.BCC = "acortez@mansellgroup.com" objMessage.Subject = "Medcen Hospice Referral" objMessage.htmlBody = "" objMessage.htmlBody = objMessage.htmlBody & "The following volunteer information was sent from the Medcen web site" & "

" objMessage.htmlBody = objMessage.htmlBody & "Volunteer Name" & " " & vn & "
" objMessage.htmlBody = objMessage.htmlBody & "Email:" & " " & email & "
" objMessage.htmlBody = objMessage.htmlBody & "Address:" & " " & addr & " " objMessage.htmlBody = objMessage.htmlBody & city & ", " & st & " " & zip & "
" objMessage.htmlBody = objMessage.htmlBody & "Home Phone: " & " " & hp & "
" objMessage.htmlBody = objMessage.htmlBody & "Work Phone: " & " " & wp & "
" objMessage.htmlBody = objMessage.htmlBody & "Best Time to Contact: " & " " & bc & "
" objMessage.htmlBody = objMessage.htmlBody & "Driver's License: " & " " & dl & "
" objMessage.htmlBody = objMessage.htmlBody & "Education: " & " " & edu & "
" objMessage.htmlBody = objMessage.htmlBody & "Special Skills: " & " " & edu & "
" objMessage.htmlBody = objMessage.htmlBody & "Area of Interest: " & " " & aoi & "

" objMessage.Configuration.Fields.Item _ ("http://schemas.microsoft.com/cdo/configuration/sendusing") = 2 'Name or IP of Remote SMTP Server objMessage.Configuration.Fields.Item _ ("http://schemas.microsoft.com/cdo/configuration/smtpserver") = "xx.xx.xx.xx" 'Server port (typically 25) objMessage.Configuration.Fields.Item _ ("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25 objMessage.Configuration.Fields.Update '==End remote SMTP server configuration section== objMessage.Send 'Display message Response.Write "

" Response.Write "Your information has been submitted.
Thank you.

" Else %>

Volunteer Application

" method="post" name="vol">

Name:*
Email:*
Address:
City:
State:	Zip:
Home Phone:
Work Phone:
Best Time to Contact:
Do you have a valid GA Drivers License? Yes No
Education:
Specialized Training or Skills:
Areas of Interest:
*required

<% End if%>