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Registration

 

Participants of the National Cancer Patient Registry (NCPR):

 

REGISTER TODAY

Kindly complete the form below to register your centre.

* = required field

*Name:

*Designation:

*Center:

*Sector:

If Others (please specify):

*Discipline:

If Others (please specify):

*Address (office):

*Postal Code:

*City/Town:

*State:

*Telephone No:

-

Fax No:

-

Handphone No:

-

Email Address:

   

  

 

<% else 'INSERT SQL STAMENT iSQLstmt = "INSERT INTO Registration " + "(NAMEINCHARGE,DESIGNATION,CENTRENAME,SECTOR,SECOTHERS,DISCIPLINE,DISOTHERS,ADDRESS,POSTALCODE,TOWN,STATE,TEL1,TEL2,FAX1,FAX2,MOBILE1,MOBILE2,EMAIL)" + " VALUES (" + "'" + Request.Form("NameInCharge") + "'," + "'" + Request.Form("Designation") + "'," + "'" + Request.Form("CentreName") + "'," + "'" + Request.Form("Sector") + "'," + "'" + Request.Form("SecOthers") + "'," + "'" + Request.Form("Discipline") + "'," + "'" + Request.Form("DisOthers") + "'," + "'" + Request.Form("Address") + "'," + "'" + Request.Form("PostalCode") + "'," + "'" + Request.Form("Town") + "'," + "'" + Request.Form("State") + "'," + "'" + Request.Form("Tel1") + "'," + "'" + Request.Form("Tel2") + "'," + "'" + Request.Form("Fax1") + "'," + "'" + Request.Form("Fax2") + "'," + "'" + Request.Form("Mobile1") + "'," + "'" + Request.Form("Mobile2") + "'," + "'" + Request.Form("Email") + "')" set CONN = server.createobject("adodb.connection") MdbFilePath = Server.MapPath("..\..\data\ncpr.mdb") 'MdbFilePath = Server.MapPath("..\data\ncpr.mdb") CONN.Open "Driver={Microsoft Access Driver (*.mdb)}; DBQ=" & MdbFilePath & ";" 'StrDSN = "DRIVER={Microsoft Access Driver (*.mdb)}; " 'If you are going to use a password on the database you will need this next line 'StrDSN = StrDSN & "PASSWORD=; " 'StrDSN = StrDSN & "DBQ=" & server.mappath("/data/ncpr.mdb") 'CONN.Open StrDSN Set RS = CONN.execute(iSQLstmt) %>

 

 

Thank you. Your application has been submitted for processing and we will get in touch with you as soon as possible.
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