<?php
$error = ''; // error message
$name = '';
$dni = ''; // sender's dni
$dire = ''; // sender's dire
$tele = ''; // sender's tele
$uni = ''; // sender's uni
$carre = ''; // sender's carre
$email = ''; // sender's email address
$tula = ''; // subject
$message = ''; // the message itself
$spamcheck = ''; // Spam check
if(isset($_POST['send'])) {
$name = $_POST['name'];
$dni = $_POST['dni'];
$dire = $_POST['dire'];
$tele = $_POST['tele'];
$uni = $_POST['uni'];
$carre = $_POST['carre'];
$email = $_POST['email'];
$tula = $_POST['tula'];
$message = $_POST['message'];
$spamcheck = $_POST['spamcheck'];
{
$error = '<div class="errormsg">Por favor escriba su fecha de postulacion!</div>';
}
else if(trim($name) == '') {
$error = '<div class="errormsg">Por favor escriba su nombre!</div>';
}
else if(trim($email) == '') {
$error = '<div class="errormsg">POr favor indique su direccion Email!</div>';
}
else if(!isEmail($email))
{
$error = '<div class="errormsg">Su Email no es valido, por favor intente de nuevo!!</div>';
}
/*if(trim($subject) == '')
{
$error = '<div class="errormsg">Indique el asunto del mensaje!</div>';
}
else if(trim($message) == '')
{
$error = '<div class="errormsg">Escriba su mensaje!</div>';
}*/
else if(trim($spamcheck) == '') {
$error = '<div class="errormsg">REalice la suma para controlar el Spam!</div>';
}
else if(trim($spamcheck) != '5') {
$error = '<div class="errormsg">Control Spam: El resultado de la suma no es correcta! 2 + 3 = ???</div>';
}
if($error == '')
{
{
}
// the email will be sent here
// make sure to change this to be your e-mail
$to = "info@vicion.com.ar";
// the email subject
// '[Contact Form] :' will appear automatically in the subject.
// You can change it as you want
$subject = '[Contacto web] : ' . $subject;
// the mail message ( add any additional information if you want )
$msg = "\n\nENVIADO POR: [ $name ] \r\nEMAIL : [ $email ] \r\nFecha Postulacion : [ $tula ] \r\nDNI : [ $dni ] \r\nDOMICILIO : [ $dire ] \r\nLOCALIDAD : [ $uni ] \r\nCARRERA : [ $carre ] \r\nTELEFONO : [ $tele ] \n\n";
mail($to, $msg, "From: $email\r\nReply-To: $email\r\nReturn-Path: $email\r\n"); ?>
<!-- Message sent! (change the text below as you wish)-->
<div style="text-align:center;">
<h1>Enviado</h1>
<p>Gracias <b><?=$name;?></b>, se envio la informacion correctamente!<br />
Si usted cree que ingreso algunos de los campos mal por favor envienos los mismos datos al siguiente correo <a href="mailto:info@agrupacioncerca.com.ar">info@agrupacioncerca.com.ar </a><br />
</p>
</div>
<p>
<!--End Message Sent-->
<?php
}
}
if(!isset($_POST['send']) || $error != '') {
?>
<br />
<br />
<strong><font size="3">Formulario de inscripción</font></strong><br />
Todos los campos son obligatorios</p>
<p><br />
</p>
<!--Error Message-->
<?=$error;?>
<form method="post" name="contFrm" id="contFrm" action="">
<p>
<label><span class="required">*</span> Fecha Postulacion:</label>
<input name="name" type="text" class="box" id="name" size="19" value="<?=$tula;?>" />
dd/mm/aaaa (ej: 25/09/2010)
<label><span class="required">*</span> Nombre y apellido:</label>
<input name="name" type="text" class="box" id="name" size="50" value="<?=$name;?>" />
<label><span class="required">*</span> Domicilio:</label>
<input name="dire" type="text" class="box" id="name" size="50" value="<?=$dire;?>" />
<label><span class="required">*</span> Localidad:</label>
<input name="uni" type="text" class="box" id="name" size="50" value="<?=$uni;?>" />
<span class="required">*</span> Codigo Postal
<input name="carre" type="text" class="box" id="name2" size="10" value="<?=$carre;?>" />
<br />
<p> </p>
<p>-----------------------------------------------------------------------------------------------------------------------------------------------------------------</p>
<p> </p>
<p><span class="required">*</span> Documento: Tipo
<select name="tipodoc2" id="tipodoc2">
<option value="dni">DNI</option>
<option value="CI">CI</option>
<option value="LC">LC</option>
</select>
N°
<input name="dni" type="text" class="box" id="name" size="20" value="<?=$dni;?>" />
<br />
<span class="required">*</span> Fecha de Nacimiento:
<input name="tele" type="text" class="box" id="name" size="10" value="<?=$tele;?>" />
dd/mm/aaaa (ej: 25/09/2010)</p>
<p>
<label><span class="required">*</span> Edad:</label>
<input name="name2" type="text" class="box" id="name3" size="25" value="<?=$tele;?>" />
</p>
<p>
<label><span class="required">*</span> Nacionalidad:</label>
<input name="name2" type="text" class="box" id="name3" size="25" value="<?=$tele;?>" />
</p><p>
<label><span class="required">*</span> Estado Civil:</label>
<input name="name2" type="text" class="box" id="name3" size="25" value="<?=$tele;?>" />
</p><p>
<label><span class="required">*</span> Cuit:</label>
<input name="name2" type="text" class="box" id="name3" size="25" value="<?=$tele;?>" />
</p>
<p>
<label><span class="required">*</span> Telefono Particular:</label>
<input name="name2" type="text" class="box" id="name3" size="25" value="<?=$tele;?>" />
<span class="required">*</span> Telefono Celular
<input name="name3" type="text" class="box" id="name4" size="25" value="<?=$tele;?>" />
</p>
<p><label><span class="required">*</span> Email: </label>
<input name="email" type="text" class="box" id="email" size="50" value="<?=$email;?>" />
<br />
<br />
<label><span class="required">*</span>Control spam: <b>2 + 3=</b></label>
<input name="spamcheck" type="text" class="box" id="spamcheck" size="4" value="<?=$spamcheck;?>" /><br /><br />
<!-- Submit Button-->
<input name="send" type="submit" class="button" id="send" value="" />
</p>
</form>
<!-- E-mail verification. Do not edit -->
<?php
}
function isEmail($email)
{
return(preg_match("/^[-_.[:alnum:]]+@((([[:alnum:]]|[[:alnum:]][[:alnum:]-]*[[:alnum:]])\.)+(ad|ae|aero|af|ag|ai|al|am|an|ao|aq|ar|arpa|as|at|au|aw|az|ba|bb|bd|be|bf|bg|bh|bi|biz|bj|bm|bn|bo|br|bs|bt|bv|bw|by|bz|ca|cc|cd|cf|cg|ch|ci|ck|cl|cm|cn|co|com|coop|cr|cs|cu|cv|cx|cy|cz|de|dj|dk|dm|do|dz|ec|edu|ee|eg|eh|er|es|et|eu|fi|fj|fk|fm|fo|fr|ga|gb|gd|ge|gf|gh|gi|gl|gm|gn|gov|gp|gq|gr|gs|gt|gu|gw|gy|hk|hm|hn|hr|ht|hu|id|ie|il|in|info|int|io|iq|ir|is|it|jm|jo|jp|que|kg|kh|ki|km|kn|kp|kr|kw|ky|kz|la|lb|lc|li|lk|lr|ls|lt|lu|lv|ly|ma|mc|md|mg|mh|mil|mk|ml|mm|mn|mo|mp|mq|mr|ms|mt|mu|museum|mv|mw|mx|my|mz|na|name|nc|ne|net|nf|ng|ni|nl|no|np|nr|nt|nu|nz|om|org|pa|pe|pf|pg|ph|pk|pl|pm|pn|pr|pro|ps|pt|pw|py|qa|re|ro|ru|rw|sa|sb|sc|sd|se|sg|sh|si|sj|sk|sl|sm|sn|so|sr|st|su|sv|sy|sz|tc|td|tf|tg|th|tj|tk|tm|tn|to|tp|tr|tt|tv|tw|tz|ua|ug|uk|um|us|uy|uz|va|vc|ve|vg|vi|vn|vu|wf|ws|ye|yt|yu|za|zm|zw)$|(([0-9][0-9]?|[0-1][0-9][0-9]|[2][0-4][0-9]|[2][5][0-5])\.){3}([0-9][0-9]?|[0-1][0-9][0-9]|[2][0-4][0-9]|[2][5][0-5]))$/i" ,$email));
}
?>
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