"; } if(!empty($_POST['email'])){ $email = $_POST['email']; }else{ $errs .= "Your Email
"; } if(!empty($_POST['seminar'])){ $seminar = $_POST['seminar']; }else{ $errs .= "Seminar Name
"; } if(!empty($_POST['date'])){ $date = $_POST['date']; }else{ $errs .= "Seminar Date
"; } if(!empty($_POST['attending'])){ $attending = $_POST['attending']; }else{ $errs .= "Number Attending
"; } if(!empty($_POST['title'])){ $title = $_POST['title']; }else{ $errs .= "Your Title
"; } if(!empty($_POST['practice'])){ $practice = $_POST['practice']; }else{ $errs .= "Your Practice
"; } if(!empty($_POST['address'])){ $address = $_POST['address']; }else{ $errs .= "Your Address
"; } $address2 = $_POST['address2']; $city = $_POST['city']; $state = $_POST['state']; $zipcode = $_POST['zipcode']; $phone = $_POST['phone']; $ext = $_POST['ext']; $fax = $_POST['fax']; $guest = $_POST['guest']; $comments = $_POST['comments']; if(empty($errs)){//looks good $header = "Reply-To: info@cghealthcaresolutions.com\r\n" . "From: info@cghealthcaresolutions.com\r\n"; $to .= ", info@cowangunteski.com"; $su = "CG Healthcare Seminar Request"; $bo = "SEMINAR NAME: $seminar\n SEMINAR DATE: $date\n NUMBER ATTENDING: $attending\n FULLNAME: $fullname\n TITLE: $title\n PRACTICE: $practice\n EMAIL: $email\n ADDRESS: $address\n ADDRESS2: $address2\n CITY: $city\n STATE: $state\n ZIPCODE: $zipcode\n PHONE: $phone\n EXT: $ext\n FAX: $fax\n GUEST(s): $guest\n COMMENTS: $comments"; //send mail $sent = mail($to, $su, $bo, $header); if($sent){$successful = "Thank You for registering."; //redirect echo ""; } } } ?> CG Healthcare Solutions, LLC - Seminar Registration

Seminar Registration

We can only accept registrations for seminars sponsored by CG Healthcare Solutions, LLC or Cowan, Gunteski & Co., P.A.  Please register directly with the sponsor for all other seminars.

Please complete the following required fields:
$errs

";} ?> $successful";}?>
*Required Field
Name of Seminar*
Date of Seminar*
Number Attending*
Full Name*
Title*
Practice*
Email*
Address*
Address 2
City*
State *
Zip Code*
Phone*
Ext.
Fax
Guest name(s)
(if applicable)
Comments
Seminar fees, if applicable, will be billed to the address listed above