Thank you to anyone who has already donated - your generous donations helped make three months of treatment possible.

My brother Nate continues to fight stage IV Hodgkin's lymphoma. He's just 31, with a wife and baby girl. They have no active income (since he's been unable to return to work), no insurance, and cannot afford the treatment he needs. Nate and his family need your help. Please consider a donation, every dollar helps. Thanks.


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<?php
$your_email=trim($_POST['your_email']);
$your_web_site_name=trim($_POST['your_web_site_name']);
?>

<?php 
//If the form is submitted
if(isset($_POST['name'])) {
 
    //Check to make sure that the name field is not empty
    if(trim($_POST['name']) === '') {
      $hasError = true;
    } else {
      $name = trim($_POST['name']);
    }
    
    //Check to make sure sure that a valid email address is submitted
    if(trim($_POST['email']) === '')  {
      $hasError = true;
    } else if (!preg_match('^[a-zA-Z0-9_.-]+@[a-zA-Z0-9-]+.[a-zA-Z0-9-.]+$^', trim($_POST['email']))) {
      $hasError = true;
      $errorMessage = $_POST['text_4'];
    } else {
      $email = trim($_POST['email']);
    }

    //phone
    if(isset($_POST['phone'])) $phone = trim($_POST['phone']);
    
    //company name
    if(isset($_POST['company_name'])) $company_name = trim($_POST['company_name']);

    //company url
    if(isset($_POST['company_url'])) $company_url = trim($_POST['company_url']);    
      
    //Check to make sure comments were entered  
    if(trim($_POST['message']) === '') {
      $hasError = true;
    } else {
      if(function_exists('stripslashes')) {
        $comments = stripslashes(trim($_POST['message']));
      } else {
        $comments = trim($_POST['message']);
      }
    }

    //If there is no error, send the email
    if(!isset($hasError)) {

      $emailTo = $your_email;
      $subject = 'Contact Form Submission from '.$name;
      
      //message body 
      $body  ="Name: $name \n\n";
      $body .="Email: $email \n\n";
      if(isset($phone)) $body .="Phone:$phone\n\n";
      if(isset($company_name)) $body .="Company Name: $company_name\n\n";
      if(isset($company_url)) $body .="Company Url: $company_url \n\n";
      $body .="Message: $comments";

        $headers  = 'MIME-Version: 1.0' . "\r\n";
        $headers .= 'Content-type: text/html; charset=utf-8' . "\r\n";
      $headers .= 'From: '.$your_web_site_name.' <'.$emailTo.'>' . "\r\n" . 'Reply-To: ' . $email;
      
      mail($emailTo, $subject, $body, $headers); 
      $emailSent = true;
    }
} 
?>

<?php if(isset($emailSent) == true) { ?>
  <div class="ok_box">
    <h3><?php echo $_POST['text_1'];?>, <?php echo $name;?></h3>
    <p><?php echo $_POST['text_2'];?></p>
  </div>
<?php } ?>

<?php if(isset($hasError) ) { ?>
  <div class="error_box">
    <?php echo $_POST['text_3'];?>
    <br />
    <?php echo $errorMessage;?>
  </div>
<?php } ?>