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Registration

<% Dim MyBody Dim MyCDONTSMail %> <% Set MyCDONTSMail = CreateObject("CDONTS.NewMail") MyCDONTSMail.From= "CRC" MyCDONTSMail.To= "azizah@datamed.com.my" MyCDONTSMail.Subject="New registration of National Trauma Database" MyBody = "Hi Azizah. We have a new registration for the National Trauma Database. " & vbCrLf MyBody = MyBody & "Please check at www.acrm.gov.my/ntrd/registrationNTrD.asp" & vbCrLf MyBody = MyBody & "Have a nice day. Thank you." MyCDONTSMail.Body= MyBody MyCDONTSMail.Send set MyCDONTSMail=nothing %>

 

Online registration to become participants of the National Trauma Database.
Register Today!


Kindly complete the form below to register your centre.
 

* = required field

 

*Name:

*Designation:

*Institution:

*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 " + "(NAME,DESIGNATION,INSTITUTION,SECTOR,SECOTHERS,DISCIPLINE,DISOTHERS,ADDRESS,POSTALCODE,TOWN,STATE,TEL1,TEL2,FAX1,FAX2,MOBILE1,MOBILE2,EMAIL)" + " VALUES (" + "'" + Request.Form("Name") + "'," + "'" + Request.Form("Designation") + "'," + "'" + Request.Form("Institution") + "'," + "'" + 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\ntrd.mdb") 'MdbFilePath = Server.MapPath("..\data\ntrd.mdb") 'Local Server CONN.Open "Driver={Microsoft Access Driver (*.mdb)}; DBQ=" & MdbFilePath & ";" 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.   <% end if %>