Last Name: $_POST[last]
Degree: $_POST[degree]
Title: $_POST[title]
Institution: $_POST[org]
Department: $_POST[department]
Link: $_POST[link]
Address1: $_POST[add1]
Address2: $_POST[add2]
City: $_POST[city]
State: $_POST[state]
Zip: $_POST[zip]
Email: $_POST[email]
Phone: $_POST[phone]
Fax: $_POST[fax]
Info: $_POST[textarea]
Scanner: $_POST[scanner]
Field: $_POST[field]
IDEA Version: $_POST[idea_version]
Syngo Version: $_POST[syngo_version]
Transmitter: $_POST[transmitter]
Receiver: $_POST[receiver]
Special Request: $_POST[transmitter]"); $subject = "Application for Sequence"; $headers .= "MIME-Version: 1.0\r\n"; $headers .= "Content-type: text/html; charset=iso-8859-1\r\n"; $headers .= "From: ".$myname." <".$myemail.">\r\n"; $headers .= "To: ".$contactname." <".$contactemail.">\r\n"; $headers .= "Reply-To: ".$myname." <$myreplyemail>\r\n"; $headers .= "X-Priority: 1\r\n"; $headers .= "X-MSMail-Priority: High\r\n"; $headers .= "X-Mailer: Just My Server"; ?>
Please use your browser
BACK
button and correctly fill in these form fields.
Your SEQUENCE FORM has been submitted. You will be contacted shortly. Thank you!
<< Home
