|
Enrollment
| |
|
|
Enrollment
in a study is completely voluntary, if you
are interested in participating please contact
us to schedule an appointment at our facility
most convenient to you.
CLINICAL RESEARCH
INTITUTE, INC. (CCRII)
Phone: (312) 823 - 6800, Fax:
(312) 791 - 3253
Address: 2555 S. Dr. Martin
Luther King Drive, 2nd Floor, Chicago, IL
60616
CLINICAL RESEARCH
INTITUTE, INC. (CCRII) - Flint.
Phone: (810) 908 - 5501,
Fax: (810) 235 - 1005 Address:
1201 Flushing Road, Flint, Michigan, 48504
ADMINISTRATIVE
OFFICE:
CLINICAL RESEARCH INTITUTE, INC. (CCRII)
Phone: (312) 823 - 6800, Fax:
(630) 920 - 1902 Address:
11 Sylvan Glen Ct. Burr Ridge, IL 60527-0703
Averroes, India.
Phone: 011 91 9866425534
Address: Plot # 225 Brindavan
Colony, Tolichowli, Hyderabad, India.
Pincode: 500008
Email: enrollment@ccrii.us |
|
<%
'Declaring Variables
Dim uname,phone,fax,email
Dim subject,otherdetails,action,IsError
' Grabbing variables from the form post
Uname = Request("uname")
Phone = Request("phone")
Fax = Request("fax")
Email = Request("from")
OtherDetails = Request("otherdetails")
Action = Request("action")
'Used to check that the email entered is in a valid format
Function IsValidEmail(Email)
Dim ValidFlag,BadFlag,atCount,atLoop,SpecialFlag,UserName,DomainName,atChr,tAry1
ValidFlag = False
If (Email <> "") And (InStr(1, Email, "@") > 0) And (InStr(1, Email, ".") > 0) Then
atCount = 0
SpecialFlag = False
For atLoop = 1 To Len(Email)
atChr = Mid(Email, atLoop, 1)
If atChr = "@" Then atCount = atCount + 1
If (atChr >= Chr(32)) And (atChr <= Chr(44)) Then SpecialFlag = True
If (atChr = Chr(47)) Or (atChr = Chr(96)) Or (atChr >= Chr(123)) Then SpecialFlag = True
If (atChr >= Chr(58)) And (atChr <= Chr(63)) Then SpecialFlag = True
If (atChr >= Chr(91)) And (atChr <= Chr(94)) Then SpecialFlag = True
Next
If (atCount = 1) And (SpecialFlag = False) Then
BadFlag = False
tAry1 = Split(Email, "@")
UserName = tAry1(0)
DomainName = tAry1(1)
If (UserName = "") Or (DomainName = "") Then BadFlag = True
If Mid(DomainName, 1, 1) = "." then BadFlag = True
If Mid(DomainName, Len(DomainName), 1) = "." then BadFlag = True
ValidFlag = True
End If
End If
If BadFlag = True Then ValidFlag = False
IsValidEmail = ValidFlag
End Function
%>
<% ' ***** Email Content Starts ***** %>
<% If Action = "SendEmail" Then
' Here we quickly check/validate the information entered
' These checks could easily be improved to look for more things
If Uname = "" Then
IsError = "Yes"
Response.Write("You did not enter your ""Name"".
")
End If
If Phone = "" Then
IsError = "Yes"
Response.Write("You did not enter your ""Company"" name.
")
End If
If IsValidEmail(Email) = "False" Then
IsError = "Yes"
Response.Write("You did not enter a valid ""Email"" ID.
")
End If
'If designation = "" Then
'IsError = "Yes"
'Response.Write("You did not enter ""designation"".
")
'End If
End If
' If there were no input errors and the action of the form is "SendEMail" we send the email off
If Action = "SendEmail" And IsError <> "Yes" Then
Dim strBody
' Here we create a nice looking html body for the email
strBody = strBody & "" & "Enrollment Form submitted at : " & "" & Now() & vbCrLf & "
"
'strBody = strBody & "From http://" & Request.ServerVariables("HTTP_HOST") & vbCrLf & "
"
'strBody = strBody & "IP " & Request.ServerVariables("REMOTE_ADDR") & vbCrLf & "
"
strBody = strBody & "" & "Name" & " : " & "" & " " & Replace(Uname,vbCr,"
") & "
"
strBody = strBody & "" & "Phone" & " : " & "" & " " & Replace(Phone,vbCr,"
") & "
"
strBody = strBody & "" & "Fax" & " : " & "" & " " & Replace(Fax,vbCr,"
") & "
"
strBody = strBody & "" & "Email" & " : " & "" & " " & Replace(Email,vbCr,"
") & "
"
strBody = strBody & "" & "Brief Details" & " : " & "" & " " & Replace(OtherDetails,vbCr,"
") & "
"
strBody = strBody & ""
Dim objEmail
Set objEmail = CreateObject("CDO.Message")
objEmail.From = "enrollment@ccrii.us"
objEmail.To = "enrollment@ccrii.us"
objEmail.Subject = "CCRII - Enrollment Enquiry"
'ObjEmail.TextBody = strBody
'objEmail.TextBody = "This is a test message."
objEmail.HTMLBody = strBody
'objEmail.HTMLBody = "How r u ?"
With objEmail.Configuration.Fields
.Item("http://schemas.microsoft.com/cdo/configuration/sendusing") = 2
.Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = "sendmail4.brinkster.com"
.Item("http://schemas.microsoft.com/cdo/configuration/sendusername") = "enrollment@ccrii.us"
.Item("http://schemas.microsoft.com/cdo/configuration/sendpassword") = "amr1125"
.Item("http://schemas.microsoft.com/cdo/configuration/smtpauthenticate") = 1
.Item("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25
.Update
End With
objEmail.Send
Set objEmail = Nothing
' change the success messages below to say or do whatever you like
' you could do a response.redirect or offer a hyperlink somewhere.. etc etc
%>
Your request
has been sent successfully. Thank
You !!
Go
Back
<% Else %>
<% End If %>
<% ' ***** Email Content Ends ***** %>
|
|
|
| |
|
 |
 |
| |
We are currently seeking
individauls to participate in the following trials
Adults with Type II Diabetes
who are not taking any medication
Adults with Type II Diabetes who are taking only
Metformin
Adults with Type II Diabetes who are taking Metformin
and any other oral anti-diabetic treatment
Adults with Type II Diabetes and Chronic Kidney
Disease
Adults with Chronic Knee Pain
If you or anybody you know would be interested
in finding out more concerning these trials, Please
Email us at info@ccrii.us
|
| |
|
