"; if (! eregi("^[a-z A-Z]*$", $_POST["fname"]) ) { $error .= "*** Please enter only alpha characters in the First Name Field ***
"; } if (!$_POST["lname"]) $error .= "*** Please enter your Last Name ***
"; if (! eregi("^[a-z A-Z]*$", $_POST["lname"]) ) { $error .= "*** Please enter only alpha characters in the Last Name Field ***
"; } if (!$_POST["email"]) $error .= "*** Please enter your Email ***
"; if (($_POST["email"]) && (!eregi("^[_a-z0-9-]+(\.[_a-z0-9-]+)*@[a-z0-9-]+(\.[a-z0-9-]+)*(\.[a-z]{2,4})$", $_POST["email"]))) { $error .= "*** Please enter a valid Email Address ***
"; } if ($_POST["city"]) { if ($_POST["state"] == "Choose") $error .= "*** Please enter your State ***
"; } include("../../3gs/securimage/securimage.php"); $securimage = new Securimage(); if ($securimage->check($_POST['captcha_code']) == false) { $error .= "***The code you entered was incorrect. ***
"; } if (!$error) { // Create Success Message // Mail notification that a resume was submited $formInfo = $formInfo . "First Name:\t" . $_POST['fname'] . "\n\n"; $formInfo = $formInfo . "Last Name:\t" . $_POST['lname'] . "\n\n"; $formInfo = $formInfo . "Email:\t" . $_POST['email'] . "\n\n"; $formInfo = $formInfo . "Street Address:\t" . $_POST['address'] . "\n\n"; $formInfo = $formInfo . "City:\t" . $_POST['city'] . "\n\n"; $formInfo = $formInfo . "State:\t" . $_POST['state'] . "\n\n"; $formInfo = $formInfo . "Zip:\t" . $_POST['zip'] . "\n\n"; $formInfo = $formInfo . "Phone:\t(" . $_POST['area'] . ") " . $_POST['prefix'] . "-" . $_POST['suffix'] . "\n\n"; $formInfo = $formInfo . "Comments:\t" . $_POST['comments'] . "\n\n"; $to = "info@chdstudies.org"; // $to = "kelly@smashingpixels.com"; $subject = "Autism Contact Form"; $headers = "From: " . $_POST['fname'] ." " .$_POST['lname'] . "\r\n"; $header = "Location: contact-us-thanks.php"; mail($to,$subject,$formInfo,$headers); // Create Success Message header($header); } } ?>

Early Determinants of Autism Study

Contact Us

Child Health and Development Studies

Phone: (510) 649-6390 if calling from the Bay Area or
call toll free (877) 482-0264, from outside the Bay Area.

Email:

The Autism Study staff is happy to answer any questions you have about the Autism Study, the CHDS, or to hear about your Autism study participation experience. Please use the form below or feel free to call us.

You can use this form to contact us by email. We will reply to your email by the next business day.

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"); ?>

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