<%@ Language=VBScript %> <% dim sFrom, sTo sFrom="support@pharmacistelink.com" sTo = "jennifer.bruckart@ncpanet.org" call SentContactEmail sub SentContactEmail() dim sFirstname, sLastname, sAddress1, sAddress2, sCity, sState, sZip, sEmail, sPhone, sFax, sComments, sMessage2 sEmail =trim(request.form("tbEMAIL")) if (sEmail<>"") then 'process the form and redirect sFirstname =trim(request.form("tbFIRST_NAME")) sLastname =trim(request.form("tbLAST_NAME")) sAddress1 =trim(request.form("tbADDRESS1")) sAddress2 =trim(request.form("tbADDRESS2")) sCity =trim(request.form("tbCITY")) sState =trim(request.form("tbSTATE")) sZip =trim(request.form("tbZIP")) sPhone =trim(request.form("tbPHONE")) sFax =trim(request.form("tbFAX")) sComments =trim(request.form("tbCOMMENTS")) 'send Contact Request Email sMessage="First Name: " & chr(32) & sFirstname & chr(13) sMessage=sMessage & "Last Name: " & chr(32) & sLastname & chr(13) sMessage=sMessage & "Address1: " & chr(32) & sAddress1 & chr(13) sMessage=sMessage & "Address2: " & chr(32) & sAddress2 & chr(13) sMessage=sMessage & "City: " & chr(32) & sCity & chr(13) sMessage=sMessage & "State: " & chr(32) & sState & chr(13) sMessage=sMessage & "Zip: " & chr(32) & sZip & chr(13) sMessage=sMessage & "Email: " & chr(32) & sEmail & chr(13) sMessage=sMessage & "Phone: " & chr(32) & sPhone & chr(13) sMessage=sMessage & "Fax: " & chr(32) & sFax & chr(13) sMessage=sMessage & "Comments: " & chr(32) & sComments & chr(13) SendMail sFrom, sTo, "NCPA Medicare Contact Us", sMessage 'send Thank you Email sMessage = "Thank you for your NCPA Medicare contact submission." & chr(10) & chr(13) sMessage = sMessage & "We will try to respond to your request as soon as we can. If you have any questions, please call our office at 703.683.8200." SendMail sFrom, sEmail, "NCPA Medicare Contact Us", sMessage Response.Redirect("contactus_thank.asp") end if end sub %> CONTACT US

CONTACT US

National Community Pharmacists Association
100 Daingerfield Road, Alexandria, VA 22314
Voice: 703-683-8200, 800-544-7447 - Fax: 703-683-3619
Webmaster: webmaster@pharmacistelink.com

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