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| <html> | |
| <head> | |
| <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> | |
| <title>registration page</title> | |
| <meta name="GENERATOR" content="Microsoft FrontPage 3.0"> | |
| <meta name="Microsoft Theme" content="blends 011, default"><meta name="Microsoft Border" content="tl, default"></head> | |
| <body background="_themes/blends/blegtext.gif" bgcolor="#CCCCCC" text="#000000" link="#990000" vlink="#666666" alink="#CC9900"><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><td><!--mstheme--><font face="trebuchet ms, arial, helvetica"> | |
| <p align="left"><strong><font face="Arial"><b>The Endometriosis Association, International | |
| Headquarters<br> | |
| </b><small>8585 N. 76th Place, Milwaukee, WI 53223 USA<br> | |
| Phone: (414) 355-2200</small></font></strong><img src="images/Endo_small.gif" alt="Endo_small.gif (10423 bytes)" align="right" WIDTH="231" HEIGHT="169"><strong><font face="Arial"><br> | |
| <small>Fax: (414) 355-6065</small><br> | |
| <small>Toll Free: (800) 992-3636 | |
| | |
| </small></font></strong></p> | |
| <p align="left"><strong><font color="#000000">Analognet wuz here.. Happy Holidays!</font></strong></p> | |
| <p align="left"><strong><font face="Arial"><a href="mailto:endo@endometriosisassn.org"><small>Member | |
| Inquiries</small></a><br> | |
| <a href="registration.htm"><small>Non-member Inquiries</small></a></font></strong></p> | |
| <!--mstheme--></font></td></tr><!--msnavigation--></table><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><td valign="top" width="1%"><!--mstheme--><font face="trebuchet ms, arial, helvetica"> | |
| <p align="left"><font face="Arial"><small><nobr><a href="./">Home</a></nobr><br><nobr><a href="endo.html">What is Endometriosis?</a></nobr><br><nobr><a href="symptoms.html">Symptoms of Endometriosis</a></nobr><br><nobr><a href="causes.html">What Causes Endometriosis?</a></nobr><br><nobr><a href="treatment.html">Treatment Options</a></nobr><br><nobr><a href="help.html">How the EA can help</a></nobr><br><nobr><a href="press.htm">Research</a></nobr><br><nobr><a href="States.htm">Support Groups/Chapters</a></nobr><br><nobr><a href="gift.htm">Gift Memberships</a></nobr><br><nobr><a href="Benefits.htm">Benefits of Membership</a></nobr><br><nobr><a href="family.htm">Family/Teen Program</a></nobr><br><nobr><a href="books.htm">The Endometriosis Sourcebook</a></nobr><br><nobr><a href="ChatRooms.htm">EA Chat Room</a></nobr><br><nobr><a href="table.htm">Catalog</a></nobr><br><nobr><a href="brochures.htm">Free Brochures</a></nobr><br><nobr><a href="guestboo.htm">Guestbook</a></nobr><br><nobr><a href="jobs.htm">Job Openings</a></nobr><br><nobr><a href="environment.htm">Endo and the Environment</a></nobr><br><nobr><a href="endonow.htm">End Endo Now Club</a></nobr><br><nobr><a href="index.htm">Home</a></nobr><br><nobr><a href="endowalk.htm">Endo Awareness Walk</a></nobr></small><img src="images/new2.gif" alt="new2.gif (304 bytes)" WIDTH="30" HEIGHT="15"><small><br> | |
| <a href="https://www2.security-one.com:2001/home/endo/MemForm.HTM">Membership & | |
| Donation Form</a><br> | |
| <a href="https://www2.security-one.com:2001/home/endo/Order.htm">Literature Order Form </a></small></font></p> | |
| <!--mstheme--></font></td><td valign="top" width="24"></td><!--msnavigation--><td valign="top"><!--mstheme--><font face="trebuchet ms, arial, helvetica"> | |
| <p><!--webbot bot="PurpleText" Preview="NOTE: Some web servers do not allow self-registration. When you save this page to a web, the FrontPage Explorer will test for this capability, and flag the page with a red triangle in the Hyperlink view if there is a problem." --></p> | |
| <p><!--webbot bot="PurpleText" PREVIEW="User Registration Form - This page must be saved into the Root Web in order to function properly. After users fill out and submit the form on this page, they will become registered users of another web on the server. The target web must already exist before you save this page. First edit the form's properties to set the name of the target web, which cannot be the Root Web. Then use the Search/Replace feature to change all instances of the text [OtherWeb] on this page with the title of the target web, such as "New Ideas Web" or "Employee Discussion Web"." --></p> | |
| <!--webbot BOT="GeneratedScript" PREVIEW=" " startspan --><script Language="JavaScript"><!-- | |
| function FrontPage_Form1_Validator(theForm) | |
| { | |
| if (theForm.Contact_First_Name_Last_Name.value == "") | |
| { | |
| alert("Please enter a value for the \"Contact_First_Name_Last_Name\" field."); | |
| theForm.Contact_First_Name_Last_Name.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contact_StreetAddress_No1.value == "") | |
| { | |
| alert("Please enter a value for the \"Contact_StreetAddress_No1\" field."); | |
| theForm.Contact_StreetAddress_No1.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contacts_City_Shipping_To.value == "") | |
| { | |
| alert("Please enter a value for the \"Contacts_City_Shipping_To\" field."); | |
| theForm.Contacts_City_Shipping_To.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contact_State_Postal_Abrv.value == "") | |
| { | |
| alert("Please enter a value for the \"Contact_State_Postal_Abrv\" field."); | |
| theForm.Contact_State_Postal_Abrv.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contacts_Postal_Zip_Code.value == "") | |
| { | |
| alert("Please enter a value for the \"Contacts_Postal_Zip_Code\" field."); | |
| theForm.Contacts_Postal_Zip_Code.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contacts_Postal_Zip_Code.value.length > 12) | |
| { | |
| alert("Please enter at most 12 characters in the \"Contacts_Postal_Zip_Code\" field."); | |
| theForm.Contacts_Postal_Zip_Code.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contact_Phone_and_Areacode.value == "") | |
| { | |
| alert("Please enter a value for the \"Contact_Phone_and_Areacode\" field."); | |
| theForm.Contact_Phone_and_Areacode.focus(); | |
| return (false); | |
| } | |
| if (theForm.Contact_Phone_and_Areacode.value.length > 25) | |
| { | |
| alert("Please enter at most 25 characters in the \"Contact_Phone_and_Areacode\" field."); | |
| theForm.Contact_Phone_and_Areacode.focus(); | |
| return (false); | |
| } | |
| return (true); | |
| } | |
| //--></script><!--webbot BOT="GeneratedScript" endspan --><form method="POST" action="_vti_bin/shtml.exe/registration.htm" onsubmit="return FrontPage_Form1_Validator(this)" name="FrontPage_Form1" webbot-action="--WEBBOT-SELF--"> | |
| <!--webbot bot="SaveResults" S-Email-Format="TEXT/PRE" S-Email-Address="endo@endometriosisassn.org" B-Email-Label-Fields="TRUE" S-Builtin-Fields U-Confirmation-Url="thankyou.htm" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" endspan i-checksum="43374" --><div align="center"><center><h2><!--mstheme--><font color="#330099"><font face="Arial">EA Registration</font><!--mstheme--></font></h2> | |
| </center></div><blockquote> | |
| <p><font face="Arial" size="4"> In order for us to respond to your | |
| inquiries, please provide the following information:</font></p> | |
| </blockquote> | |
| <div align="left"><!--mstheme--></font><table border="0"> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><div align="right"><p><small><font face="Arial"><em>Name</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><!--webbot bot="Validation" B-Value-Required="TRUE" --><input type="text" size="45" name="Contact_First_Name_Last_Name"> </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>Street address</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><!--webbot bot="Validation" B-Value-Required="TRUE" --><input type="text" size="45" name="Contact_StreetAddress_No1"> | |
| </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>Address (cont.)</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><input type="text" size="45" name="Contact_OptionalAddress_2"> </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>City</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><!--webbot bot="Validation" b-value-required="TRUE" --><input type="text" size="45" name="Contacts_City_Shipping_To"> | |
| </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>State/Province</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><!--webbot bot="Validation" b-value-required="TRUE" --><input type="text" size="45" name="Contact_State_Postal_Abrv"> | |
| </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>Zip/Postal code</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><!--webbot bot="Validation" b-value-required="TRUE" i-maximum-length="12" --><input type="text" size="45" maxlength="12" name="Contacts_Postal_Zip_Code"> </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>Country</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><input type="text" size="45" name="Contact_Country_or_Abbrev"> </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>Phone</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><!--webbot bot="Validation" b-value-required="TRUE" i-maximum-length="25" --><input type="text" size="45" maxlength="25" name="Contact_Phone_and_Areacode"> </font><!--mstheme--></font></td> | |
| </tr> | |
| <tr> | |
| <td align="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><small><font face="Arial"><em>E-mail</em></font></small><!--mstheme--></font></td> | |
| <td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><font face="Arial"><input type="text" size="45" name="Contact_Email_InetAddress"> </font><!--mstheme--></font></td> | |
| </tr> | |
| </table><!--mstheme--><font face="trebuchet ms, arial, helvetica"> | |
| </div><div align="center"><center><h2><!--mstheme--><font color="#330099"><font face="Arial"><input type="submit" value="Submit Form"> <input type="reset" value="Clear Form"></font><!--mstheme--></font></h2> | |
| </center></div> | |
| </form> | |
| <h5><!--mstheme--><font color="#330099"><font face="Arial">Designed by: Theresa Thompson, Web Designer<br> | |
| Copyright © 1998 Endometriosis Association. All rights reserved.<br> | |
| Revised: <!--webbot bot="TimeStamp" S-Type="EDITED" S-Format="%B %d, %Y" startspan -->September 30, 1999<!--webbot bot="TimeStamp" endspan i-checksum="39062" -->.</font><!--mstheme--></font></h5> | |
| <!--mstheme--></font><!--msnavigation--></td></tr><!--msnavigation--></table></body> | |
| </html> |