We appreciate your interest in becoming an Opheliate. Our experience has shown us that it takes passion and community resources to establish a successful Opheliate. Please complete this Opheliate Interest Survey online or click here to download a PDF version, so that we may add you to our database. Our Director of Opheliates will be in touch with you in the near future. Thank you.
<%
If Request("Submit") <> "" Then
DIM strfirstname, strlastname, stremailaddress, phone1, phone2, phone3, address1, address2, city, state, zipcode
DIM skills, groupquestion1, groupquestion2, groupquestion3, elements1, elements2, elements3, elements4, elements5
DIM elements6, elements7, learncheck, other, errorMessage
strfirstname = Request.Form("firstname")
strlastname= Request.Form("lastname")
stremailaddress = Request.Form("emailaddress")
phone1 = Request.Form("phone1")
phone2 = Request.Form("phone2")
phone3 = Request.Form("phone3")
address1 = Request.Form("address1")
address2 = Request.Form("address2")
city = Request.Form("city")
state = Request.Form("state")
zipcode = Request.Form("zipcode")
skills = Request.Form("skills")
groupquestion1 = Request.Form("groupquestion1")
groupquestion2 = Request.Form("groupquestion2")
groupquestion3 = Request.Form("groupquestion3")
elements1 = Request.Form("elements1")
elements2 = Request.Form("elements2")
elements3 = Request.Form("elements3")
elements4 = Request.Form("elements4")
elements5 = Request.Form("elements5")
elements6 = Request.Form("elements6")
elements7 = Request.Form("elements7")
learncheck = Request.Form("learncheck")
newspaper = Request.Form("newspaper")
other = Request.Form("other")
errorMessage = ""
' Error Check
IF strfirstname = "" THEN errorMessage = errorMessage & "First Name" END IF
IF strlastname = "" THEN errorMessage = errorMessage & "Last Name" END IF
IF stremailaddress = "" THEN errorMessage = errorMessage & "Email Address" END IF
IF phone1 = "" OR phone2 = "" OR phone3 = "" THEN
errorMessage = errorMessage & "Phone"
END IF
IF address1 = "" THEN errorMessage = errorMessage & "Address" END IF
IF city = "" THEN errorMessage = errorMessage & "City" END IF
IF state = "" THEN errorMessage = errorMessage & "State" END IF
IF zipcode = "" THEN errorMessage = errorMessage & "Zip Code" END IF
IF groupquestion1 = "" THEN errorMessage = errorMessage & "Community/Group Question #1" END IF
IF groupquestion2 = "" THEN errorMessage = errorMessage & "Community/Group Question #2" END IF
IF groupquestion3 = "" THEN errorMessage = errorMessage & "Community/Group Question #3" END IF
IF learncheck = "" THEN errorMessage = errorMessage & "How did you learn about the Ophelia Project?" END IF
IF learncheck = "Newspaper" AND newspaper = "" THEN errorMessage = errorMessage & "Newspaper Name" END IF
IF learncheck = "Other" AND other = "" THEN errorMessage = errorMessage & "The Other way you learned about the Ophelia Project" END IF
'If there is an error, display the error, else, submit the email
IF errorMessage <> "" THEN
Response.Write "Please complete the following fields before submitting the form:" & errorMessage & "
"
ELSE
On error resume next
Dim bodyText
bodyText = bodyText & ""
bodyText = bodyText & "Opheliate Interest Survey Submission
"
bodyText = bodyText & "Contact Information
"
bodyText = bodyText & "Name: " & strfirstname & " " & strlastname & "
"
bodyText = bodyText & "Email: " & stremailaddress & "
"
bodyText = bodyText & "Phone: (" & phone1 & ") " & phone2 & "-" & phone3 & "
"
bodyText = bodyText & "Address: " & address1 & "
"
IF address2 <> "" THEN bodyText = bodyText & " " & address2 & "
" END IF
bodyText = bodyText & " " & city & ", " & state & " " & zipcode & "
"
bodyText = bodyText & "Occupation/Skills: " & skills & "
"
bodyText = bodyText & "Community/Group Questions
"
bodyText = bodyText & "Please describe your community (or group) and your relationship to your community:
" & groupquestion1 & "
"
bodyText = bodyText & "Please describe your role in the community/organization, i.e. parent, educator, administrator, director, volunteer, etc.?
" & groupquestion2 & "
"
bodyText = bodyText & "What do you see as the major needs/concerns in your community or group and how are you willing to bring that vision alive?
" & groupquestion3 & "
"
bodyText = bodyText & "Below are some elements that we have found to be critical in the development of an Opheliate.
"
bodyText = bodyText & "Awareness of a need for change:
" & elements1 & "
"
bodyText = bodyText & "Community leaders willing to address the challenge of changing the climate:
" & elements2 & "
"
bodyText = bodyText & "Ability to create/support a strong volunteer network:
" & elements3 & "
"
bodyText = bodyText & "Network of community members or organizations:
" & elements4 & "
"
bodyText = bodyText & "Relationship to local community leaders, organizations, media, etc.
" & elements5 & "
"
bodyText = bodyText & "Relationship to schools in the area:
" & elements6 & "
"
bodyText = bodyText & "Possible Funding Sources:
" & elements7 & "
"
bodyText = bodyText & "How did you learn about The Ophelia Project®? " & learncheck & " "
IF other <> "" THEN bodyText = bodyText & "(" & other & ") " END IF
IF newspaper <> "" THEN bodyText = bodyText & "(" & newspaper & ") " END IF
'Dim mySmartMail
Set mySmartMail = Server.CreateObject("aspSmartMail.SmartMail")
'Mail Server
mySmartMail.Server = "mail.opheliaproject.org"
'From
mySmartMail.SenderAddress = "do_not_reply@opheliaproject.org"
'To - manderson@opheliaproject.org
mySmartMail.Recipients.Add "manderson@opheliaproject.org"
'Parameter
'mySmartMail.Priority = Request("Priority")
'Content Type
mySmartMail.ContentType = "text/html"
'Message
mySmartMail.Subject = "Opheliate Interest Survey Submission"
mySmartMail.Body = bodyText
'Send the message
mySmartMail.SendMail
if err.number <> 0 then
response.write("Unfortunately an error occurred while trying to submit the form. If the problem persists, download the PDF version to email or send back to us via mail so that we may add you to our database.
")
else
Response.redirect ("main/opheliates_thanks.htm")
end if
set mySmartMail = nothing
END IF
End If
%>
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