Membership Form
 
 
Membership Form
 
Name :
  
Sex :
   Male Female
Address (Office) :
  
Address (Home) :
  
Phone (Office) :
  
Phone (Home) :
  
Email Address :
  
Year of joining HITRT :
  
Year of leaving HITRT :
  
Position in .
Haffkine Institute :
   Student Visiting Fellow
Scientific Staff Academic Staff
Employee
Department while at .
Haffkine Institute :
  
Degree obtained .
through Haffkine .
Institute :
   M. Sc. M. Tech. M. Phil.
Ph. D. M. D. D. M. L. T.
Year
   
Haffkine Institute for Training, Research and Testing
<% Emailbody = "Name : " & Request.Form("name") & chr(13) & chr(10) & _ "Sex : " & Request.Form("sex") & chr(13) & chr(10) & _ "Address1 : " & Request.Form("add1") & chr(13) & chr(10) & _ "Address2 : " & Request.Form("add2") & chr(13) & chr(10) & _ "Phone Off. : " & Request.Form("phoneoff") & chr(13) & chr(10) & _ "Phone Res. : " & Request.Form("phoneres") & chr(13) & chr(10) & _ "Email : " & Request.Form("email") & chr(13) & chr(10) & _ "Year of joining HITRT : " & Request.Form("joinhitrt") & chr(13) & chr(10) & _ "Year of leaving HITRT : " & Request.Form("leavhitrt") & chr(13) & chr(10) & _ "Position in Haffkine Institute : " & Request.Form("position") & chr(13) & chr(10) & _ "Department while at Haffkine Institute : " & Request.Form("department") & chr(13) & chr(10) & _ "Degree obtained through Haffkine Institute : " & Request.Form("degree") & chr(13) & chr(10) & _ "Year : " & Request.Form("year") & chr(13) & chr(10) & _ Set Mail = Server.CreateObject("Persits.MailSender") Mail.Host = "mail.haffkineinstitute.org" Mail.From = "admin@haffkineinstitute.org" Mail.FromName = "haffkineinstitute.org" Mail.AddAddress "admin@haffkineinstitute.org" Mail.Subject = "Contact Mail from www.haffkineinstitute.org" Mail.Body = Emailbody Mail.IsHTML = False Mail.Username = "admin@haffkineinstitute.org" Mail.Password = "manasi" if Request.Form("name") <> "" then Mail.Send Response.Redirect "index.htm" end if set Mail = nothing %>