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| <?php
$destinataire = 'registration@XXXXXXX.org';
$copie = 'oui';
$form_action = '';
$message_envoye = "<script>\n document.location='form-acknowledgement.php';</script>";
$message_non_envoye = "Sorry, the message has not been sent, please try again.";
$message_formulaire_invalide = "Check all fields have been fed and the e-mail address is without mistake.";
function Rec($text)
{
$text = trim($text);
if (1 === get_magic_quotes_gpc())
{$stripslashes = create_function('$txt', 'return stripslashes($txt);');}
else{$stripslashes = create_function('$txt', 'return $txt;'); }
$text = $stripslashes($text);
$text = htmlspecialchars($text, ENT_QUOTES);
$text = nl2br($text);
return $text;};
function IsEmail($email)
{$pattern = "^([a-z0-9_]|\\-|\\.)+@(([a-z0-9_]|\\-)+\\.)+[a-z]{2,7}$";
return (eregi($pattern,$email)) ? true : false;};
$err_formulaire = false;
$nom = (isset($_POST['nom'])) ? Rec($_POST['nom']) : '';
$email = (isset($_POST['email'])) ? Rec($_POST['email']) : '';
$objet = (isset($_POST['objet'])) ? Rec($_POST['objet']) : '';
$message = (isset($_POST['message'])) ? Rec($_POST['message']) : '';
if (isset($_POST['envoi'])){
$email = (IsEmail($email)) ? $email : '';
$err_formulaire = (IsEmail($email)) ? false : true;
if (($nom != '') && ($email != '') && ($objet != '') && ($message != ''))
{$headers = 'From: '.$nom.' <'.$email.'>' . "\r\n";
if ($copie == 'oui')
{$cible = $destinataire.','.$email;}
else{$cible = $destinataire;};
$message = html_entity_decode($message);
$message = str_replace(''',"'",$message);
$message = str_replace('’',"'",$message);
$message = str_replace('<br>','',$message);
$message = str_replace('<br />','',$message);
if (mail($cible, $objet, $message, $headers))
{echo '<p>'.$message_envoye.'</p>'."\n";}
else{echo '<p>'.$message_non_envoye.'</p>'."\n";};}
else{echo '<p>'.$message_formulaire_invalide.' <a href="registration.php">Back to blank form.</a></p>'."\n";
$err_formulaire = true;};};
if (($err_formulaire) || (!isset($_POST['envoi']))){
echo ' <form id="order" method="post" action="'.$form_action.'">'."\n";
echo ' <fieldset><legend>Your coordinates</legend>'."\n";
echo ' <p>'."\n";
echo ' <label for="nom">Full name (name, first name, middle name) [required]:</label>'."\n";
echo ' <input type="text" size="80" id="nom" name="nom" value="'.stripslashes($nom).'" tabindex="1">'."\n";
echo ' </p>'."\n";
echo ' <p>'."\n";
echo ' <label for="email">E-mail [required] (it must be a personal e-mail address with your name mentioned in it) :</label>'."\n";
echo ' <input type="text" size="60" id="email" name="email" value="'.stripslashes($email).'" tabindex="2">'."\n";
echo ' </p>'."\n";
echo ' </fieldset>'."\n";
echo ' <fieldset><legend>Your message :</legend>'."\n";
echo ' <p>'."\n";
echo ' <label for="objet">Subject [required] (fill your name in place of NAME and payment date, in place of YYYY-MM-DD, e.g., 2015-11-03):</label>'."\n";
echo ' <input type="text" size="130" id="objet" name="objet" value="XXXXXXX, NAME, fee payment date YYYY-MM-DD, membership'.stripslashes($objet).'" tabindex="3">'."\n";
echo ' </p>'."\n";
echo ' <p>'."\n";
echo ' <label for="message">Message [required] (fill data, then delete the explanation texts within parenthesis):</label>'."\n";
echo ' <textarea id="message" name="message" tabindex="4" cols="100" rows="11">"blabla avec 1056 caractères"'.stripslashes($message).'</textarea>'."\n";
echo ' </p>'."\n";
echo ' </fieldset>'."\n";
echo ' <div style="text-align:center;"><input type="submit" name="envoi" value="Send the form !"></div>'."\n";
echo '</form>'."\n";};
?> |
