Dance/Fitness Class Registration> <meta http-equiv="content-type" content="text/html; charset=ISO-8859-1"> <link rel="stylesheet" href="ywcastyle.css" type="text/css"> <link rel="stylesheet" type="text/css" href="example2.css" /> <script type="text/javascript" src="../ie5.js"></script> <script type="text/javascript" src="XulMenu.js"></script> <style type="text/css"> html, body { height: 100%; } body { margin: 0; padding: 0; } #bar { background: #ffcc33; border: 0px solid; border-color: #ffcc33 #ffcc33 #ffcc33 #ffcc33; padding: 3px; cursor: default; } p </style> <script language="JavaScript" src="gen_validatorv31.js" type="text/javascript"></script> <script language="JavaScript" src="validate.js" type="text/javascript"></script> </head> <body background="images/bg.gif" text="#000000" link="#0000FF" vlink="#0000FF" alink="#0000FF"> <f style="position: absolute; left: 0px; top: 0px"> <table width="750" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="231" height="100" bgcolor="#FFFFFF"><img src="logo3.jpg"></td> <td valign="bottom"><h1><font face="Geneva" font color=?#003366?> Dance/Fitness Registration</font></h1></td> </tr> <tr> <td colspan="2"><img src="images/bluebar.gif" width="751" height="30" border="0"></td> </tr> <tr> <td bgcolor="#ffcc33" valign="top"> <table cellspacing="0" cellpadding="0" height="100%"><tr><td id="bar"> <table cellspacing="0" cellpadding="0" id="menu1" class="XulMenu"> <tr> <td> <div style="position: fixed; left: 2px; top: 130px"> <form name="jksearch" action="http://www.google.com/search" method="get" onSubmit="jksitesearch(this)"> <input id="hiddenquery" type="hidden" name="q" /> <input name="qfront" type="text" style="width: 200px" value="Search YWCA-Berkeley.com" /> <br> <input type="submit" value="Search" /><br /> <div style="font: bold 11px Verdana;"><input name="se" type="hidden" checked> </div> <script type="text/javascript"> // All-in-one Internal Site Search script- By JavaScriptKit.com (http://www.javascriptkit.com) // For this and over 400+ free scripts, visit JavaScript Kit- http://www.javascriptkit.com/ // This notice must stay intact for use //Enter domain of site to search. var domainroot="www.ywca-berkeley.org" var searchaction=[ //form action for the 3 search engines "http://www.google.com/search"] var queryfieldname=["q","p","q"] //name of hidden query form for the 3 search engines function switchaction(cur, index){ cur.form.action=searchaction[index] document.getElementById("hiddenquery").name=queryfieldname[index] } function jksitesearch(curobj){ for (i=0; 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With your membership, you also receive reduced fees for all classes and workshops. An annual $15 membership fee entitles you to program brochures, newsletters, notices of special events, and an invitation to our annual dinner. To become a member, simply fill out the online form below <b>(if you are paying by credit card)</b>, or call 848-6370 for all other payment methods. <font size=3 color=#FF6600><b> _______________________________________________________</b></font> <br> <p><b><u>Please do not register online if the class session begins today. Register by phone or in person instead.</u></b></p> <form name="myform" action="https://www.ywca-berkeley.org/cgi-bin/mailto" method="post"> <input type="hidden" name="RECIPIENT" value="dancefitness@ywca-berkeley.org"> <input type="hidden" name="THANKURL" value="http://www.ywca-berkeley.org/thanks.html"> <input type=hidden name="subject" value="Dance/Fitness Registration"> <p>Please email to <a href="mailto:info@ywca-berkeley.org">info@ywca-berkeley.org</a> if you have trouble submitting this form.</p> First Name: <input type="text" name="firstname" size="20"> <br> Last Name: <input type="text" name="lastname" size="20"> <br>E-Mail: <input type="text" name="FROMADDRESS" size="20"> <br> Phone (ex:555 999 4444): <input type="text" maxlength=3 name="phone" size="3"> <input type="text" maxlength=3 name="phone" size="3"> <input type="text" maxlength=4 name="phone" size="4"> <br> <br>Address <br><input type="text" name="address" size="40"> <br>City: <br><input type="text" name="city" size="20"> <br>Zip Code: <br><input type="text" maxlength=5 name="zip" size="5"> <br> <br><br>What Class or Classes would you like to sign up for? <br> <table border="0" cellpadding="12"> <tr> <td align="left"> <i><b>Format</b></i> <br>Class name <br>Instructor Name <br>Price: </td> <td align="left"> <i><b> Example:</b></i> <br> Beginning Salsa Series II <br> Instructor: Ava Apple <br> $58 (non-members) </td> </tr> </table> <br> <i>Feel free to copy and paste from our <a class="button" href="dance-1.html" target="_blank">dance</a> or <a class="button" href="dance-2.html" target="_blank">fitness</a> pages</i> <br><textarea cols="40" rows="10" name="Class Selection"></textarea>  <br><br>  <br> Are you currently a YWCA member?<br> <input type="radio" name="member?" value="Yes"> Yes <input type="radio" name="member?" value="No"> No<br> <br> If you are not a member, would you like to sign up for YWCA membership now ($15 annually)?<br> <br> <input type="radio" name="MemberSignUp?" value="Yes"> Yes<br> <input type="radio" name="MemberSignUp?" value="No"> No<br> <br> Are you a student?<br> <br> <input type="radio" name="Student?" value="Yes"> Yes. I graduated in:<input type="text" maxlength=4 name="graduationDate" size="4"> <br> <input type="radio" name="Student?" value="No"> No<br>  <p><b>Credit Card Payment Information</b> <p>Credit Card Number (required): <br><b><i>Only Visa or Mastercard accepted</i></b> <br> <input type="text" maxlength=4 name="CreditCardNumber" size="4"> <input type="text" maxlength=4 name="CreditCardNumber" size="4"> <input type="text" maxlength=4 name="CreditCardNumber" size="4"> <input type="text" maxlength=4 name="CreditCardNumber" size="4"> <p>Expiration Date (required): <br><input type="text" maxlength=4 name="expirationDate" size="4"> (mmyy) <p>First 5 digits of Billing Zip Code for credit card <br><i>(cannot process transaction without this information)</i> <br><input type="text" maxlength=5 name="billing_zip" size="5"> <p><b>Refund Policy for Classes: We refund all fees for classes we must cancel. If you are unable to complete a class for medical reasons, submit a physician's note and we will refund fees for the remainder of the session. Otherwise, there are no refunds, so please make sure you are able to attend the entire session.</b></p> <br> <br> <br>Additional Comments <p><textarea cols="60" rows="10" name="Additional Comments"></textarea> <br> <br> <br> <br> <br>  <p><input type="submit" value="Submit"> <input type="reset" value="Clear Form">  <script language="JavaScript" type="text/javascript"> var frmvalidator = new Validator("myform"); frmvalidator.addValidation("firstname","req","Please enter your First Name"); frmvalidator.addValidation("firstname","maxlen=20", "Max length for FirstName is 20"); frmvalidator.addValidation("firstname","alpha"); frmvalidator.addValidation("lastname","req","Please enter your Last Name"); frmvalidator.addValidation("lastname","maxlen=20"); frmvalidator.addValidation("FROMADDRESS","maxlen=50"); frmvalidator.addValidation("FROMADDRESS","req","Please enter a valid email address"); frmvalidator.addValidation("FROMADDRESS","email","Please enter a valid email address"); frmvalidator.addValidation("phone","req","Please enter a valid phone number"); frmvalidator.addValidation("phone","numeric","Please enter a valid phone number"); frmvalidator.addValidation("phone","minlen=3","Please enter a valid phone number"); frmvalidator.addValidation("phone","maxlen=4","Please enter a valid phone number"); frmvalidator.addValidation("address","req","Please enter a valid Street Address"); frmvalidator.addValidation("city","req","Please enter a city."); frmvalidator.addValidation("zip","req","Please enter a valid zip code"); frmvalidator.addValidation("zip","numeric","Please enter a valid zip code"); frmvalidator.addValidation("zip","minlen=5","Please enter a valid zip code"); frmvalidator.addValidation("zip","maxlen=5","Please enter a valid zip code"); frmvalidator.addValidation("Student?","selone_radio","Are you currently a student? Please select yes or no"); frmvalidator.addValidation("member?","selone_radio","Are you currently a member? Please select yes or no"); frmvalidator.addValidation("CreditCardNumber","req","Please enter a valid Credit Card Number"); frmvalidator.addValidation("CreditCardNumber","numeric"," Please enter a valid Credit Card Number"); frmvalidator.addValidation("CreditCardNumber","minlen=4","Please enter a valid Credit Card Number"); frmvalidator.addValidation("CreditCardNumber","maxlen=4","Please enter a valid Credit Card Number"); frmvalidator.addValidation("expirationDate","req","Please enter a valid expiration date. Format: MMYY"); frmvalidator.addValidation("expirationDate","numeric","Please enter a valid expiration date. Format: MMYY"); frmvalidator.addValidation("expirationDate","minlen=4","Please enter a valid expiration date. Format: MMYY"); frmvalidator.addValidation("expirationDate","maxlen=4","Please enter a valid expiration date. Format: MMYY"); frmvalidator.addValidation("billing_zip","req","Please enter a valid billing zip code"); frmvalidator.addValidation("billing_zip","numeric","Please enter a valid billing zip code"); frmvalidator.addValidation("billing_zip","minlen=5","Please enter a valid billing zip code"); frmvalidator.addValidation("billing_zip","maxlen=5","Please enter a valid billing zip code"); </script> </form> <br><br><br> <p class="credit">YWCA Berkeley © 2010 All Rights Reserved</p> <br> </td> </tr> </table> </center> </td> </tr> </table> </div> <script type="text/javascript"> var menu1 = new XulMenu("menu1"); menu1.type = "vertical"; menu1.position.level1.left = 2; menu1.arrow1 = "images/arrow1.gif"; menu1.arrow2 = "images/arrow2.gif"; menu1.init(); </script> <script type="text/javascript"> var gaJsHost = (("https:" == document.location.protocol) ? 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