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<?php
$MM_editAction = $PHP_SELF;
if ($QUERY_STRING) {
$MM_editAction = $MM_editAction . "?" . $QUERY_STRING;
}
$MM_abortEdit = 0;
$MM_editQuery = "";
if (isset($MM_insert)){
$MM_editTable = "tookaction";
$MM_editRedirectUrl = "http://www.congressmerge.com/onlinedb/cgi-bin//addrseek.cgi?site=$CM_site&bccok=on&bccemail=$CM_bccaddress&issuecode=$issuecode&name_prefix=$ame_prefix&name_first=$name_first&name_mi=$name_mi&name_last=$name_last&address=$address&city=$city&state=$state&zipcode=$zipcode&email=$email&phone=$phone&Submit=Review+Letter&name_prefix=$name_prefix";
$MM_fieldsStr = "name_first|value|name_last|value|address|value|city|value|zipcode|value|email|value|phone|value|actionid|value|state|value";
$MM_columnsStr = "firstname|',none,''|lastname|',none,''|address|',none,''|city|',none,''|zip|',none,''|email|',none,''|phone|',none,''|actionid|',none,''|state|',none,''";
require ("DBConnections/insetstuff.php");
require ("DBConnections/dataactions.php");
}
$item = $Recordset1->Fields("actionlink");
$sendfax=$dbcon->Execute("SELECT * FROM sendfax WHERE id = $item and emailfax = 0") or DIE($dbcon->ErrorMsg());
$issuecode = $sendfax->Fields("issuecode");
?>
<form method="POST" action="<?php echo $MM_editAction?>" class="form">
<TABLE BORDER=0 class="text"><TR>
<TD COLSPAN=2 class="text"><hr>
Enter your <I>home address</I> below and our database will automatically
determine who represents you in Congress. Where electronic access is possible,
you can send an e-mail directly to your Senators and Representative. In
cases where a member of Congress does not accept electronic communications,
you will be provided with their ground mail address. Currently, about
97% of members of Congress accept electronic communications of some sort.
<p><b><?php echo $sendfax->Fields("subject")?></b><br>
<BR>
</p>
</TD></TR> <TR>
<TD ALIGN=RIGHT VALIGN=TOP><font color="#000000">Your Name:</font></TD>
<TD>
<TABLE BORDER=0>
<TR>
<TD><SELECT NAME="name_prefix">
<OPTION VALUE="Mr" SELECTED>Mr.
<OPTION VALUE="Mrs">Mrs.
<OPTION VALUE="Miss">Miss
<OPTION VALUE="Ms">Ms.
<OPTION VALUE="Dr">Dr.
</SELECT></TD>
<TD><INPUT TYPE=text NAME="name_first" VALUE="" SIZE=20 MAXLENGTH=20></TD>
<TD ALIGN=CENTER><INPUT TYPE=text NAME="name_mi" VALUE="" SIZE=1 MAXLENGTH=1></TD>
<TD><INPUT TYPE=text NAME="name_last" VALUE="" SIZE=30 MAXLENGTH=30></TD>
</TR>
<TR VALIGN=TOP>
<TD>&nbsp;</TD>
<TD class="text">(first name)</TD>
<TD ALIGN=CENTER class="text">(middle initial)</TD> <TD class="text">(last/family name)</TD>
</TR>
</TABLE>
</TD>
</TR>
<TR>
<TD ALIGN=RIGHT><font color"#000000">Street Address:</FONT></TD>
<TD>
<INPUT TYPE=text NAME="address" VALUE="" SIZE=30 MAXLENGTH=30>
</TD>
</TR>
<TR>
<TD ALIGN=RIGHT><font color"#000000">City:</FONT></TD>
<TD>
<INPUT TYPE=text NAME="city" VALUE="" SIZE=30 MAXLENGTH=30>
</TD>
</TR>
<TR>
<TD ALIGN=RIGHT><font color"#000000">State:</font></TD>
<TD>
<SELECT NAME="state">
<OPTION VALUE="AL">Alabama
<OPTION VALUE="AK">Alaska
<OPTION VALUE="AS">American Samoa
<OPTION VALUE="AZ">Arizona
<OPTION VALUE="AR">Arkansas
<OPTION VALUE="CA">California
<OPTION VALUE="CO">Colorado
<OPTION VALUE="CT">Connecticutt
<OPTION VALUE="DE">Delaware
<OPTION VALUE="DC">District of Columbia
<OPTION VALUE="FL">Florida
<OPTION VALUE="GA">Georgia
<OPTION VALUE="GU">Guam
<OPTION VALUE="HI">Hawaii
<OPTION VALUE="ID">Idaho
<OPTION VALUE="IL">Illinois
<OPTION VALUE="IN">Indiana
<OPTION VALUE="IA">Iowa
<OPTION VALUE="KS">Kansas
<OPTION VALUE="KY">Kentucky
<OPTION VALUE="LA">Louisiana
<OPTION VALUE="ME">Maine
<OPTION VALUE="MD">Maryland
<OPTION VALUE="MA">Masschusetts
<OPTION VALUE="MI">Michigan
<OPTION VALUE="MN">Minnesota
<OPTION VALUE="MS">Mississippi
<OPTION VALUE="MO">Missouri
<OPTION VALUE="MT">Montana
<OPTION VALUE="NE">Nebraska
<OPTION VALUE="NV">Nevada
<OPTION VALUE="NH">New Hampshire
<OPTION VALUE="NJ">New Jersey
<OPTION VALUE="NM">New Mexico
<OPTION VALUE="NY">New York
<OPTION VALUE="NC">North Carolina
<OPTION VALUE="ND">North Dakota
<OPTION VALUE="OH">Ohio
<OPTION VALUE="OK">Oklahoma
<OPTION VALUE="OR">Oregon
<OPTION VALUE="PA">Pennsylvania
<OPTION VALUE="PR">Puerto Rico
<OPTION VALUE="RI">Rhode Island
<OPTION VALUE="SC">South Carolina
<OPTION VALUE="SD">South Dakota
<OPTION VALUE="TN">Tennesse
<OPTION VALUE="TX">Texas
<OPTION VALUE="UT">Utah
<OPTION VALUE="VT">Vermont
<OPTION VALUE="VI">Virgin Islands
<OPTION VALUE="VA">Virginia
<OPTION VALUE="WA">Washington
<OPTION VALUE="WV">West Virginia
<OPTION VALUE="WI">Wisconsin
<OPTION VALUE="WY">Wyoming
</SELECT>
</TD>
</TR>
<TR>
<TD ALIGN=RIGHT><font color"#000000">Zip Code:</FONT></TD>
<TD>
<INPUT TYPE=text NAME="zipcode" VALUE="" SIZE=5 MAXLENGTH=5>
</TD>
<TR>
<TR VALIGN="TOP">
<TD ALIGN=RIGHT><font color"#000000">E-mail Address:</FONT></TD>
<TD>
<INPUT TYPE=text NAME="email" VALUE="" SIZE=30>
<BR>
(This email address is used to send a copy of your message to you.)</TD>
<TR>
<TR VALIGN="TOP">
<TD ALIGN=RIGHT><font color"#000000">Phone Number: </FONT></TD>
<TD>
<INPUT TYPE=text NAME="phone" VALUE="" SIZE=15 MAXLENGTH=15>
<BR>
<FONT color"#000000">(Your phone number is necessary to allow clearance on some House email addresses.)</FONT></TD>
<TR>
</TABLE>
<INPUT TYPE=submit NAME="Submit" VALUE="Review Letter" onClick = "setUpCookies()" ><INPUT TYPE=reset NAME="Reset" VALUE="Clear Form and Start Over">
<input type="hidden" name="actionid" value="<?php echo $item; ?>">
<input type="hidden" name="MM_insert" value="true">
<input type="hidden" name="issuecode" value="<?php echo $issuecode; ?>">
<input type="hidden" name="CM_bccaddress" value="<?php echo $sendfax->Fields("bcc") ?>">
<input type="hidden" name="CM_site" value="<?php echo $sendfax->Fields("site") ?>">
</form>
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