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<?PHP
include("../../campuslife/library/inc/_app_space.php");
require("../../lib/inc/hostconfig.php");
require("../../lib/inc/siteconfig.php");
opendatabase($dbc,$dbprefix);
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html lang="en-US">
<head>
<title><?= $sitetitle ?> - Professional Development Registration</title>
<?PHP require("../../lib/inc/meta.php"); ?>
<link type="text/css" rel="stylesheet" href="/lib/css/screen/layout.css" media="screen" />
<link type="text/css" rel="stylesheet" href="/lib/css/screen/content.css" media="screen" />
<link type="text/css" rel="stylesheet" href="/lib/css/screen/theme.css" media="screen" />
<link type="text/css" rel="stylesheet" href="/lib/css/print/all.css" media="print" />
<script type="text/javascript" src="/lib/js/common.js"></script>
<script language="javascript">
var defaultRegistrationType = 0;
var selectedRegistrationType;
function setItemCode(userChoice) {
document.poppedLayer1 = eval('document.getElementById("disc-code1")');
document.poppedLayer2 = eval('document.getElementById("disc-code2")');
switch(userChoice){
case "":
document.pdreg.itemcode1.value="";
document.pdreg.amount1.value="";
document.poppedLayer1.style.visibility = "hidden";
document.poppedLayer2.style.visibility = "hidden";
break;
case "CPLP course registration: $1065":
document.pdreg.itemcode1.value="NT-LT101";
document.pdreg.amount1.value="$1065";
document.pdreg.programdate.value="Sept 15 – Oct 27, 2010"
document.poppedLayer1.style.visibility = "hidden";
document.poppedLayer2.style.visibility = "hidden";
break;
case "CPLP course early-registration: $1015 *":
document.pdreg.itemcode1.value="NT-LT101DIS";
document.pdreg.amount1.value="$1015";
document.pdreg.programdate.value="Sept 15 – Oct 27, 2010"
document.poppedLayer1.style.visibility = "hidden";
document.poppedLayer2.style.visibility = "hidden";
break;
/* case "Project Leadership Forum - Early Bird Reg: $325":
//HU Flash Film Fest – Early Bird Conference Pass
//document.pdreg.itemcode1.value="NT-LT101";
//document.pdreg.amount1.value="$1065";
document.pdreg.itemcode1.value="PLF-001";
document.pdreg.amount1.value="$325";
break;*/
/* case "Project Leadership Forum - Early Bird Reg PMI: $295":
document.pdreg.itemcode1.value="PLF-002";
document.pdreg.amount1.value="$295";
document.poppedLayer1.style.visibility = "visible";
document.poppedLayer2.style.visibility = "visible";
break;
case "Project Leadership Forum - Registration: $425":
document.pdreg.itemcode1.value="PLF-003";
document.pdreg.amount1.value="$425";
break;*/
case "HACCP Manager 2-day: $695":
document.pdreg.itemcode1.value="NT-HACCP";
document.pdreg.amount1.value="$695";
document.pdreg.programdate.value="October 5 & 6, 2010"
document.poppedLayer1.style.visibility = "hidden";
document.poppedLayer2.style.visibility = "hidden";
break;
case "Implementing SQF – 2-day: $600":
document.pdreg.itemcode1.value="NT-SQF";
document.pdreg.amount1.value="$600";
document.pdreg.programdate.value="October 28 & 29, 2010"
document.poppedLayer1.style.visibility = "hidden";
document.poppedLayer2.style.visibility = "hidden";
break;
case "HACCP Manager 2-day govt, acad, sanit, disct: $395":
document.pdreg.itemcode1.value="NT-HACCPD";
document.pdreg.amount1.value="$395";
document.pdreg.programdate.value="October 5 & 6, 2010"
document.poppedLayer1.style.visibility = "visible";
document.poppedLayer2.style.visibility = "visible";
break;
/* case "Project Leadership Forum - Registration PMI: $395":
document.pdreg.itemcode1.value="PLF-004";
document.pdreg.amount1.value="$395";
document.poppedLayer1.style.visibility = "visible";
document.poppedLayer2.style.visibility = "visible";
break;*/
}
}
function validate_required(field,alerttxt)
{
with (field)
{
if (value==null||value=="")
{
alert(alerttxt);return false;
}
else
{
return true;
}
}
}
function validate_email(field,alerttxt)
{
with (field)
{
apos=value.indexOf("@");
dotpos=value.lastIndexOf(".");
if (apos<1||dotpos-apos<2)
{alert(alerttxt);return false;}
else {return true;}
}
}
function validate_form(thisform){
with (thisform)
{
if(dummyfield.value.length > 1) {
alert("There is a problem with the form, your data cannot be submitted at this time!");
return false;
}
if (validate_email(ref11val1,"Not a valid e-mail address!")==false)
{ref11val1.focus();return false;}
if (validate_required(ref1val1,"Please provide information for all the required fields!")==false)
{ref1val1.focus();return false;}
if (validate_required(ref2val1,"Please provide information for all the required fields!")==false)
{ref2val1.focus();return false;}
if (validate_required(ref7val1,"Please provide information for all the required fields!")==false)
{ref7val1.focus();return false;}
if (validate_required(ref9val1,"Please provide information for all the required fields!")==false)
{ref9val1.focus();return false;}
if (validate_required(ref13val1,"Please provide information for all the required fields!")==false)
{ref13val1.focus();return false;}
if (validate_required(ref10val1,"Please provide information for all the required fields!")==false)
{ref10val1.focus();return false;}
if (validate_required(ref14val1,"Please provide information for all the required fields!")==false)
{ref14val1.focus();return false;}
if (validate_required(ref15val1,"Please provide information for all the required fields!")==false)
{ref15val1.focus();return false;}
if (validate_required(ref16val1,"Please provide information for all the required fields!")==false)
{ref16val1.focus();return false;}
if (validate_required(ref17val1,"Please provide information for all the required fields!")==false)
{ref17val1.focus();return false;}
if (validate_required(ref18val1,"Please provide information for all the required fields!")==false)
{ref18val1.focus();return false;}
if (ref6val1.value=="" && ref5val1.value=="") {
validate_required(ref5val1,"Please provide informaiton for all the required fields!");
ref5val1.focus();
return false; }
if (ref15val1.value=="Other" && ref12val1.value==""){
validate_required(ref12val1,"Please provide information for the Other field!");
ref12val1.focus();
return false;
}
}
}
</script>
</head>
<body id="b_academics">
<?PHP require("../../lib/inc/header1.php"); ?>
<?PHP include("../../lib/inc/left/nav.php"); ?>
<?PHP require("../../lib/inc/header2.php"); ?>
<?PHP include("../../lib/inc/left/callouts.php"); ?>
<?PHP require("../../lib/inc/header3.php"); ?>
<?PHP require("../../lib/inc/header4.php"); ?>
<?PHP
$selectedState = "PA";
$selectedAddressType = "Work Address";
function showOptionsDrop($array, $active, $echo=true){
$string = '';
foreach($array as $k => $v){
$s = ($active == $k)? ' selected="selected"' : '';
$string .= '<option value="'.$k.'"'.$s.'>'.$v.'</option>'."\n";
}
if($echo) echo $string;
else return $string;
}
$states_arr = array('AL'=>"Alabama",'AK'=>"Alaska",'AZ'=>"Arizona",'AR'=>"Arkansas",'CA'=>"California",'CO'=>"Colorado",'CT'=>"Connecticut",'DE'=>"Delaware",'DC'=>"District Of Columbia",'FL'=>"Florida",'GA'=>"Georgia",'HI'=>"Hawaii",'ID'=>"Idaho",'IL'=>"Illinois", 'IN'=>"Indiana", 'IA'=>"Iowa", 'KS'=>"Kansas",'KY'=>"Kentucky",'LA'=>"Louisiana",'ME'=>"Maine",'MD'=>"Maryland", 'MA'=>"Massachusetts",'MI'=>"Michigan",'MN'=>"Minnesota",'MS'=>"Mississippi",'MO'=>"Missouri",'MT'=>"Montana",'NE'=>"Nebraska",'NV'=>"Nevada",'NH'=>"New Hampshire",'NJ'=>"New Jersey",'NM'=>"New Mexico",'NY'=>"New York",'NC'=>"North Carolina",'ND'=>"North Dakota",'OH'=>"Ohio",'OK'=>"Oklahoma", 'OR'=>"Oregon",'PA'=>"Pennsylvania",'RI'=>"Rhode Island",'SC'=>"South Carolina",'SD'=>"South Dakota",'TN'=>"Tennessee",'TX'=>"Texas",'UT'=>"Utah",'VT'=>"Vermont",'VA'=>"Virginia",'WA'=>"Washington",'WV'=>"West Virginia",'WI'=>"Wisconsin",'WY'=>"Wyoming");
$addresstype_arr = array('Work Address'=>"Work Address",'Home Address'=>"Home Address");
$source_arr = array('Harrisburg University email'=>"Harrisburg University email",'Email from Professional Assocation'=>"Email from Professional Assocation",'Friend or Colleague'=>"Friend or Colleague",'Social Network'=>"Social Network",'Web search'=>"Web search",'Mailing'=>"Mailing",'News Post'=>"News Post",'Other'=>"Other");
$program_arr = array('CPLP'=>"CPLP",'HACCP Manager – 2-day'=>"HACCP Manager – 2-day",'Implementing SQF – 2-day'=>"Implementing SQF – 2-day");
$programdate_arr = array('Sept 15 – Oct 27, 2010'=>"Sept 15 – Oct 27, 2010",'October 5 & 6, 2010'=>"October 5 & 6, 2010",'October 28 & 29, 2010'=>"October 28 & 29, 2010");
/*'Project Leadership Forum - Early Bird Reg: $325'=>"Project Leadership Forum - Early Bird Reg: $325",'Project Leadership Forum - Early Bird Reg PMI: $295'=>"Project Leadership Forum - Early Bird Reg PMI: $295",'Project Leadership Forum - Registration: $425'=>"Project Leadership Forum - Registration: $425",'Project Leadership Forum - Registration PMI: $395'=>"Project Leadership Forum - Registration PMI: $395"*/
$progtype_arr = array('CPLP course registration: $1065'=>"CPLP course registration: $1065",'CPLP course early-registration: $1015 *'=>"CPLP course early-registration: $1015 *",'HACCP Manager 2-day: $695'=>"HACCP Manager 2-day: $695",'Implementing SQF – 2-day: $600'=>"Implementing SQF – 2-day: $600",'HACCP Manager 2-day govt, acad, sanit, disct: $395'=>"HACCP Manager 2-day govt, acad, sanit, disct: $395");
$regtype_arr = array('By Credit'=>"By Credit",'By Phone'=>"By Phone");
?>
<h2>Professional Development Registration</h2>
<hr />Use this form to register for professional development courses such as CPLP on Campus, HACCP Manager Certification, or Implementing SQF Systems Training.<br />
<br />
<form method="post" action="prof-dev-registration-verify.php" name="pdreg" id="pdreg" enctype="application/x-www-form-urlencoded" onsubmit="return validate_form(this);">
<table><tbody>
<tr><td><strong>First Name*:</strong> </td><td>
<input name="ref1type1" type="hidden" id="ref1type1" value="C-FNAME" />
<input name="ref1val1" type="text" id="ref1val1" size="40" value="<?php echo("$sFirstName");?>" />
</td><td> </td><td><strong>Last Name*:</strong> </td><td>
<input name="ref2type1" type="hidden" id="ref2type1" value="C-LNAME" />
<input name="ref2val1" type="text" id="ref2val1" size="40" value="<?php echo("$sLastName");?>" />
<tr><td>Title: </td><td>
<input name="ref3type1" type="hidden" id="ref3type1" value="C-TITLE" />
<input name="ref3val1" type="text" id="ref3val1" size="40" value="<?php echo("$sTitle");?>" />
</td><td> </td><td>Employer: </td><td>
<input name="ref4type1" type="hidden" id="ref4type1" value="employer" />
<input name="ref4val1" type="text" id="ref4val1" size="40" value="<?php echo("$sEmployer");?>" />
</td></tr>
<tr><td colspan="4"> </td></tr>
<tr><td>Work Phone: </td><td colspan="3">
<input name="ref5type1" type="hidden" id="ref5type1" value="workphone" />
<input name="ref5val1" type="text" id="ref5val1" size="40" value="<?php echo("$sWorkPhone");?>" />
</td></tr>
<tr><td>Cell Phone: </td><td colspan="3">
<input name="ref6type1" type="hidden" id="ref6type1" value="cellphone" />
<input name="ref6val1" type="text" id="ref6val1" size="40" value="<?php echo("$sCellPhone");?>" />
</td></tr>
<tr><td colspan="4"><strong>*Either a Work or Cell Phone number is required for submission.</strong></td></tr>
<tr><td colspan="4"> </td></tr>
<tr><td><strong>Address 1*:</strong> </td><td>
<input name="ref7type1" type="hidden" id="ref7type1" value="C-ADDR" />
<input name="ref7val1" type="text" id="ref7val1" size="40" value="<?php echo("$sAddress1");?>" />
</td><td> </td><td>Address 2: </td><td>
<input name="ref8type1" type="hidden" id="ref8type1" value="address2" />
<input name="ref8val1" type="text" id="ref8val1" size="40" value="<?php echo("$sAddress2");?>" />
</td></tr>
<tr><td><strong>City*: </strong></td><td>
<input name="ref9type1" type="hidden" id="ref9type1" value="C-CITY" />
<input name="ref9val1" type="text" id="ref9val1" size="40" value="<?php echo("$sCity");?>" />
</td><td> </td><td><strong>State*: </strong></td><td>
<input name="ref13type1" type="hidden" id="ref13type1" value="C-STATE" />
<select name="ref13val1" id="ref13val1">
<option value="" selected></option>
<?php showOptionsDrop($states_arr, $selectedState, true); ?>
</select>
</td></tr>
<tr><td><strong>Zip*:</strong> </td><td>
<input name="ref10type1" type="hidden" id="ref10type1" value="C-ZIP" />
<input name="ref10val1" type="text" id="ref10val1" size="40" value="<?php echo("$sZip");?>" />
</td><td> </td></tr>
<tr><td><strong>Address Type*:</strong> </td><td>
<input name="ref14type1" type="hidden" id="ref14type1" value="addrtype" />
<select name="ref14val1" id="ref14val1">
<?php showOptionsDrop($addresstype_arr, $selectedAddressType, true); ?>
</select>
</td><td> </td></tr>
<tr><td colspan="4"> </td></tr>
<tr><td><strong>E-mail*:</strong> </td><td colspan="3">
<input name="ref11type1" type="hidden" id="ref11type1" value="C-EMAIL" />
<input name="ref11val1" type="text" id="ref11val1" size="40" value="<?php echo("$sEmailAddress");?>" />
</td></tr>
<tr><td colspan="4"> </td></tr>
<tr><td colspan="5"><strong>How did you learn about this program?*</strong>
<input name="ref15type1" type="hidden" id="ref15type1" value="source" />
<select name="ref15val1" id="ref15val1">
<option value="" selected>-- Select --</option>
<?php showOptionsDrop($source_arr, $selectedSource, true); ?>
</select> Other:
<input name="ref12type1" type="hidden" id="ref12type1" value="sourceother" />
<input name="ref12val1" type="text" id="ref12val1" size="30" value="<?php echo("$sSourceOther");?>" />
</td>
</tr>
<tr><td colspan="4"> </td></tr>
<tr><td><strong>Program*:</strong> </td><td>
<input name="ref16type1" type="hidden" id="ref16type1" value="program" />
<select name="ref16val1" id="ref16val1" style="width:200px" >
<option value="" selected>-- Select --</option>
<?php showOptionsDrop($program_arr, $selectedProgram, true); ?>
</select>
<tr><td colspan="4"> </td></tr><td colspan="8">
<tr><td><strong>Registration Type*:</strong> </td><td>
<input name="ref19type1" type="hidden" id="ref19type1" value="progtype" />
<select name="ref19val1" id="ref19val1" style="width:375px" onchange="setItemCode(this.value);">
<!--<select name="program" id="program" style="width:200px" onchange="setItemCode(this.value);">-->
<option value="" selected>-- Select --</option>
<?php showOptionsDrop($progtype_arr, $selectedProgramtype, true); ?>
</select>
</td><td> </td></tr>
<tr><td><strong>Program Date*: </strong></td><td>
<input name="ref17val1" type="hidden" id="ref17val1" value="programdate" />
<select name="ref17val1" id="ref17val1" style="width:200px">
<option value="" selected>-- Select --</option>
<?php showOptionsDrop($programdate_arr, $selectedProgramDate, true); ?>
</select>
</td><td> </td></tr>
<tr><td colspan="5"> </td></tr>
<tr><td><strong>Payment Method*:</strong> </td><td colspan="6">
<input name="ref18val1" type="hidden" id="ref18val1" value="registrationtype" />
<select name="ref18val1" id="ref18val11">
<option value="" selected>-- Select --</option>
<?php showOptionsDrop($regtype_arr, $selectedRegistrationType, true); ?>
</td><td> </td></tr>
</select>
</td>
<div style="visibility:hidden">
<tr><td nowrap="nowrap">
<div id="disc-code1" style="visibility:hidden">
<strong>Discount Code*:</strong>
</div>
</td><td>
<div id="disc-code2" style="visibility:hidden">
<input name="ref24type1" type="hidden" id="ref24type1" value="discountcode" />
<input name="ref24val1" type="text" id="ref24val1" size="15" value="" />
</div>
</td><td> </td></tr>
<div style="visibility:hidden"><input name="dummyfield" type="text" id="dummyfield" /></div>
<input name="itemcode1" type="hidden" id="itemcode1" value="" />
<input name="amount1" type="hidden" id="amount1" value="" />
</tr>
<tr><td colspan="4"> </td></tr>
</tbody></table>
<table width="100%"><tbody>
<?php
if (!$submitted) { ?>
<tr align="center" height="50px"><td bgcolor="#DBCDA8"><br /><font color="#004E35" style="font-weight:bold">If you selected "By Credit Card" as your Registration Type,<br />you will need to complete the payment process by clicking on the "<strong>Make Payment</strong>" button on the confirmation screen.</font><br /><br /><!--<input type="reset" name="reset" id="reset" value="Reset" /> --><input type="submit" name="submit" id="submit" value="Submit Registration" /><br /> </td></tr>
<? } ?>
</tbody></table>
</form>
<p style="font-size:10px">
Cancellation and Refunds: Harrisburg University reserves the right to cancel or reschedule events and courses at its own discretion. Should a program be cancelled by the university for any reason, a full refund will be issued. Cancellations received in writing to <a href="mailto:[email protected]">[email protected]</a> from individual registrants more than 7 days prior to the start of a program or event are eligible for a 50% refund of fees paid. No refunds will be issued for cancellations received from individual registrants 6 or less days prior to the start of the event.
</p>
<?PHP require("../../lib/inc/footer.php"); ?>
</body>
</html>
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