<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("workshopregistrationdata_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(11) Dim arFormDBFields0(11) Dim arFormValues0(11) arFormFields0(0) = "FirstName" arFormDBFields0(0) = "FirstName" arFormValues0(0) = Request("FirstName") arFormFields0(1) = "LastName" arFormDBFields0(1) = "LastName" arFormValues0(1) = Request("LastName") arFormFields0(2) = "Address" arFormDBFields0(2) = "Address" arFormValues0(2) = Request("Address") arFormFields0(3) = "City" arFormDBFields0(3) = "City" arFormValues0(3) = Request("City") arFormFields0(4) = "State" arFormDBFields0(4) = "State" arFormValues0(4) = Request("State") arFormFields0(5) = "ZipCode" arFormDBFields0(5) = "ZipCode" arFormValues0(5) = Request("ZipCode") arFormFields0(6) = "PhonePrimary" arFormDBFields0(6) = "PhonePrimary" arFormValues0(6) = Request("PhonePrimary") arFormFields0(7) = "PhoneSecondary" arFormDBFields0(7) = "PhoneSecondary" arFormValues0(7) = Request("PhoneSecondary") arFormFields0(8) = "EmailAddress" arFormDBFields0(8) = "EmailAddress" arFormValues0(8) = Request("EmailAddress") arFormFields0(9) = "WaiverSignature" arFormDBFields0(9) = "WaiverSignature" arFormValues0(9) = Request("WaiverSignature") arFormFields0(10) = "WaiverDate" arFormDBFields0(10) = "WaiverDate" arFormValues0(10) = Request("WaiverDate") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmationFromArrays "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "TrainingGroupRegistration_form.asp",_ "Return to the form.",_ arFormDBFields0,_ arFormValues0 End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> <% Response.Buffer = True %> Results -- New
Training Group Registration
Results Page | | Database Editor


 

If you are 18 years or older, please enter the following data to register for the HeartFit Training Group:

 

First Name

 

Last Name

 

Address

 

City

 

State

 

Zip

 

Phone (Primary)

 

Phone (Secondary)

 

Email

 

 

Waiver of Liability

All participants in the HeartFit Training Program are required to assume all risk of participation in the program by signing this general release statement.  The undersigned participant on behalf of himself/herself and on behalf of participant’s personal representatives, assigns, heirs, executors, hereby fully and forever releases, waives, discharges and covenants not to sue HeartFit or any agency whose property and/or personnel are used from all liability to the participant and his/her personal representatives, assigns, heirs, executors, for all loss(es).  Participant also grants permission for all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.  The attendee warrants that all statements made herein are true and correct. Attendee has read the foregoing and intentionally and voluntarily signs this release and waiver of liability agreement.

I am 18 years or older and I agree to the above Waiver of Liability.          Date

 

 

After registering, please use the Buy Now button to pay using your charge card with PayPal.

 

If you are younger than 18 years old, please use the mail in registration.  Click here for a Mail-in Registration Form