PHP Form Sending E-mail without inputs in Safari

I’ve looked through posts, reread the coding over and over, and pretty much pulled my hair out. I’m at a loss.

I submitted the contact form on my site in safari and it sends the e-mail, but the postings are not there. I submitted the same contact form on my site in firefox and it sends the e-mail with all the postings perfectly. It’s driving me bananas. I’m about ready to go crazy and am pleading for any input as to why it would work perfectly in firefox and not in safari. It’s a pretty simple input form.

Just wanted to add in that I have searched the Forum, and have found a couple of similar problems. But I have not been able to apply any of them to fix my issue. Which is why I’m resorting to posting the code now. Before I lose it ha.

Let me know if anyone sees a problem below. Here is the PHP codes.

<?php
// e-mail taken out
$to = "null@gmail.com";
$subject = "Contact Us";
$email = $_REQUEST['email'] ;
$name = $_POST ['name'] ;
$email = $_POST ['email'] ;
$state = $_POST ['state'] ;
$telephone = $_POST ['telephone'] ;
$comment = $_POST ['comment'] ;
$message = "Hello!

Your contact form has been submitted by:

Name: $name
Email: $email
State: $state
Telephone: $telephone

Comments:
$comment

End of Message
";
$headers = "From: $name";
$sent = mail($to, $subject, $message, $headers) ;
if($sent)
{print "Your mail was sent successfully"; }
else
{print "We encountered an error sending your mail"; }
echo $message
?>

Here is the portion of the HTML that posts to the PHP

<FORM action="Contact.php" method="post">
<TABLE BORDER="0" CELLSPACING="0" CELLPADDING="4" WIDTH="90%">
<TR>
<TD width="30%"><DIV align="right">
<B>Name:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="name" size="40">
</TD>
</TR>
<TR>
<TD><DIV align="right"><B>Email:</B></DIV>
</TD>
<TD>
<INPUT type="text" name="email" size="40">
</TD>
</TR>
<TR>
<TD><DIV align="right"><B>State:</B></DIV>
</TD>
<TD>
<INPUT type="text" name="state" size="40">
</TD>
</TR>
<TR>
<TD><DIV align="right"><B>Telephone:</B></DIV>
</TD>
<TD>
<INPUT type="text" name="telephone" size="40">
</TD>
</TR>
<TR>
<TD><DIV align="center">
<B>How may we help you?:</B>
</DIV>
</TD>
<TD><TEXTAREA name="comment" cols="40" wrap="virtual" rows="10">
</TEXTAREA>
</TD></TR>
<TR>
<TD>&nbsp;</TD>
<TD>
<INPUT type="submit" name="submit" value="Submit">
<INPUT type="reset" name="reset" value="Reset">
</TD></TR>
</TABLE>
</FORM>

Thank you in advances for helping save my sanity

The email is sent on the back end. So it doesn’t matter what browser is being used as long as the data is getting passed.

You can check this by typing this at the top of the php script: print_r($_POST);

On another point, you have no validation on your form. It is a sitting duck for hackers that might like to hijack it and use for nefarious purposes.

Check out this site:

It has a nice form script.

E

Ya, nothing comes up in Safari with the print, but does in firefox. I dunno why it works in one but not the other.

Thanks for the notice about the validation. As I am pretty new at PHP coding and, although i’ve done a couple HTML websites, pretty novice at HTML, I would not have noticed that. Thanks for the tip about that site as well. At this point replacing the code is the best option to prevent me from losing my mind, so i’ll check out that form

Try changing INPUT to input, (Use lower case for form, textarea and input or any other form object) just a complete stab in the dark.

Refer to the link below for sending emails from web form using PHP script - http://top-answers.net/webhost/web-hosting.html

Hi everyone. I’m having a similar problem and can’t seem to find the problem. My form works fine in chrome and firefox but not safari. Below is my code. Please let me know if you can help.

HTML Code
<form id=“form_280313” class=“appnitro” method=“post” action=“email.php” enctype=“text/html”>
<!–<div class=“form_description”>
<h2>Untitled Form</h2>
<p>This is your form description. Click here to edit.</p>
</div> –>
<ul >

				&lt;li id="li_1" &gt;
	&lt;label class="description" for="booked_by"&gt;Booked By: &lt;/label&gt;
	&lt;div&gt;
		&lt;input id="booked_by" name="booked_by" class="element text medium" type="text" maxlength="255" value=""/&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_16" &gt;
	&lt;label class="description" for="element_16_1"&gt;Proposed Rental Date &lt;/label&gt;
	&lt;span&gt;
		&lt;input id="element_16_1" name="element_16_1" class="element text" size="2" maxlength="2" value="Month" type="text"&gt; /
		&lt;label for="element_16_1"&gt;MM&lt;/label&gt;
	&lt;/span&gt;
	&lt;span&gt;
		&lt;input id="element_16_2" name="element_16_2" class="element text" size="2" maxlength="2" value="Day" type="text"&gt; /
		&lt;label for="element_16_2"&gt;DD&lt;/label&gt;
	&lt;/span&gt;
	&lt;span&gt;
 		&lt;input id="element_16_3" name="element_16_3" class="element text" size="4" maxlength="4" value="Year" type="text"&gt;
		&lt;label for="element_16_3"&gt;YYYY&lt;/label&gt;
	&lt;/span&gt;

	&lt;span id="calendar_16"&gt;
		&lt;img id="cal_img_16" class="datepicker" src="form/calendar.gif" alt="Pick a date."&gt;	
	&lt;/span&gt;
	&lt;script type="text/javascript"&gt;
		Calendar.setup({
		inputField	 : "element_16_3",
		baseField    : "element_16",
		displayArea  : "calendar_16",
		button		 : "cal_img_16",
		ifFormat	 : "%B %e, %Y",
		onSelect	 : selectDate
		});
	&lt;/script&gt;
	
	&lt;/li&gt;		&lt;li id="li_22" &gt;
	&lt;label class="description" for="hours"&gt;Rental Hours &lt;/label&gt;
	&lt;span&gt;
		&lt;input id="element_22_1" name="hours" class="element checkbox" type="checkbox" value="Half Day - 8am - 12pm" /&gt;

<label class=“choice” for=“element_22_1”>Half Day - 8am - 12pm</label>
<input id=“element_22_2” name=“hours” class=“element checkbox” type=“checkbox” value=“Half Day - 1pm - 4pm” />
<label class=“choice” for=“element_22_2”>Half Day - 1pm - 4pm</label>
<input id=“element_22_3” name=“hours” class=“element checkbox” type=“checkbox” value=“Full Day - 8am - 4pm” />
<label class=“choice” for=“element_22_3”>Full Day - 8am - 4pm</label>
<input id=“element_22_4” name=“hours” class=“element checkbox” type=“checkbox” value=“Evening after 4pm” />
<label class=“choice” for=“element_22_4”>Evening after 4pm</label>
<input id=“element_22_5” name=“hours” class=“element checkbox” type=“checkbox” value=“Weekend” />
<label class=“choice” for=“element_22_5”>Weekend</label>

	&lt;/span&gt;
	&lt;/li&gt;		&lt;li id="li_2" &gt;
	&lt;label class="description" for="attendees"&gt;Number of Attendees &lt;/label&gt;
	&lt;div&gt;
		&lt;input id="element_2" name="attendees" class="element text medium" type="text" maxlength="255" value=""/&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_17" &gt;
	&lt;label class="description" for="theme"&gt;Theme of workshop &lt;/label&gt;
	&lt;div&gt;
	&lt;select class="element select medium" id="element_17" name="theme"&gt;
		&lt;option value=""&gt;&lt;/option&gt;

<option value=“1” selected=“selected” >(Select one)</option>
<option value=“Lecture” >Lecture</option>
<option value=“Lab” >Lab</option>
<option value=“Both” >Both</option>

	&lt;/select&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_3" &gt;
	&lt;label class="description" for="surgeon"&gt;Contact Name &lt;/label&gt;
	&lt;div&gt;
		&lt;input id="element_3" name="surgeon" class="element text medium" type="text" maxlength="255" value=""/&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_4" &gt;
	&lt;label class="description" for="surgeon_contact"&gt;Contact Info &lt;/label&gt;
	&lt;div&gt;
		&lt;input id="element_4" name="surgeon_contact" class="element text medium" type="text" maxlength="255" value=""/&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_5" &gt;
	&lt;label class="description" for="lab_procedures"&gt;Please list proposed lab procedures &lt;/label&gt;
	&lt;div&gt;
		&lt;textarea id="element_5" name="lab_procedures" class="element textarea medium"&gt;&lt;/textarea&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_6" &gt;
	&lt;label class="description" for="specimens"&gt;Specimens (Please list if needed) &lt;/label&gt;
	&lt;div&gt;
		&lt;textarea id="element_6" name="specimens" class="element textarea medium"&gt;&lt;/textarea&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_7" &gt;
	&lt;label class="description" for="instruments"&gt;Instrumentation &lt;/label&gt;
	&lt;div&gt;
		&lt;textarea id="element_7" name="instruments" class="element textarea medium"&gt;&lt;/textarea&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_18" &gt;
	&lt;label class="description" for="carm"&gt;C-Arm &lt;/label&gt;
	&lt;div&gt;
	&lt;select class="element select medium" id="element_18" name="carm"&gt;
		&lt;option value=""&gt;&lt;/option&gt;

<option value=“1” selected=“selected” >(Select one)</option>
<option value=“Yes” >Yes</option>
<option value=“No” >No</option>

	&lt;/select&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_19" &gt;
	&lt;label class="description" for="conference_room"&gt;Conference Room &lt;/label&gt;
	&lt;div&gt;
	&lt;select class="element select medium" id="element_19" name="conference_room"&gt;
		&lt;option value=""&gt;&lt;/option&gt;

<option value=“1” selected=“selected” >(Select one)</option>
<option value=“Yes” >Yes</option>
<option value=“No” >No</option>

	&lt;/select&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li class="section_break"&gt;
&lt;label class="description" for="conference_room"&gt;A/V Needs &lt;/label&gt;
	&lt;/li&gt;		&lt;div&gt;

	&lt;textarea name="avneeds" id="avneeds" cols="45" rows="5"&gt;&lt;/textarea&gt;
	&lt;/div&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_9" &gt;
	&lt;label class="description" for="food"&gt;Food & Beverage (if applicable) &lt;/label&gt;
	&lt;div&gt;
		&lt;textarea id="element_9" name="food" class="element textarea medium"&gt;&lt;/textarea&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_14" &gt;
	&lt;label class="description" for="billing"&gt;Billing Address &lt;/label&gt;
	
	&lt;div&gt;
		&lt;input id="element_14_1" name="billing" class="element text large" value="" type="text"&gt;
		&lt;label for="element_14_1"&gt;Street Address&lt;/label&gt;
	&lt;/div&gt;

	&lt;div&gt;
		&lt;input id="element_14_2" name="billing1" class="element text large" value="" type="text"&gt;
		&lt;label for="element_14_2"&gt;Address Line 2&lt;/label&gt;
	&lt;/div&gt;

	&lt;div class="left"&gt;
		&lt;input id="element_14_3" name="billing2" class="element text medium" value="" type="text"&gt;
		&lt;label for="element_14_3"&gt;City&lt;/label&gt;
	&lt;/div&gt;

	&lt;div class="right"&gt;
		&lt;input id="element_14_4" name="billing3" class="element text medium" value="" type="text"&gt;
		&lt;label for="element_14_4"&gt;State / Province / Region&lt;/label&gt;
	&lt;/div&gt;

	&lt;div class="left"&gt;
		&lt;input id="element_14_5" name="billing4" class="element text medium" maxlength="15" value="" type="text"&gt;
		&lt;label for="element_14_5"&gt;Postal / Zip Code&lt;/label&gt;
	&lt;/div&gt;

	&lt;div class="right"&gt;
		&lt;select class="element select medium" id="element_14_6" name="billing5"&gt;
		&lt;option value="" selected="selected"&gt;&lt;/option&gt;

<option value=“Afghanistan” >Afghanistan</option>
<option value=“Albania” >Albania</option>
<option value=“Algeria” >Algeria</option>
<option value=“Andorra” >Andorra</option>
<option value=“Antigua and Barbuda” >Antigua and Barbuda</option>
<option value=“Argentina” >Argentina</option>
<option value=“Armenia” >Armenia</option>
<option value=“Australia” >Australia</option>
<option value=“Austria” >Austria</option>
<option value=“Azerbaijan” >Azerbaijan</option>
<option value=“Bahamas” >Bahamas</option>
<option value=“Bahrain” >Bahrain</option>
<option value=“Bangladesh” >Bangladesh</option>
<option value=“Barbados” >Barbados</option>
<option value=“Belarus” >Belarus</option>
<option value=“Belgium” >Belgium</option>
<option value=“Belize” >Belize</option>
<option value=“Benin” >Benin</option>
<option value=“Bhutan” >Bhutan</option>
<option value=“Bolivia” >Bolivia</option>
<option value=“Bosnia and Herzegovina” >Bosnia and Herzegovina</option>
<option value=“Botswana” >Botswana</option>
<option value=“Brazil” >Brazil</option>
<option value=“Brunei” >Brunei</option>
<option value=“Bulgaria” >Bulgaria</option>
<option value=“Burkina Faso” >Burkina Faso</option>
<option value=“Burundi” >Burundi</option>
<option value=“Cambodia” >Cambodia</option>
<option value=“Cameroon” >Cameroon</option>
<option value=“Canada” >Canada</option>
<option value=“Cape Verde” >Cape Verde</option>
<option value=“Central African Republic” >Central African Republic</option>
<option value=“Chad” >Chad</option>
<option value=“Chile” >Chile</option>
<option value=“China” >China</option>
<option value=“Colombia” >Colombia</option>
<option value=“Comoros” >Comoros</option>
<option value=“Congo” >Congo</option>
<option value=“Costa Rica” >Costa Rica</option>
<option value=“Côte d’Ivoire” >Côte d’Ivoire</option>
<option value=“Croatia” >Croatia</option>
<option value=“Cuba” >Cuba</option>
<option value=“Cyprus” >Cyprus</option>
<option value=“Czech Republic” >Czech Republic</option>
<option value=“Denmark” >Denmark</option>
<option value=“Djibouti” >Djibouti</option>
<option value=“Dominica” >Dominica</option>
<option value=“Dominican Republic” >Dominican Republic</option>
<option value=“East Timor” >East Timor</option>
<option value=“Ecuador” >Ecuador</option>
<option value=“Egypt” >Egypt</option>
<option value=“El Salvador” >El Salvador</option>
<option value=“Equatorial Guinea” >Equatorial Guinea</option>
<option value=“Eritrea” >Eritrea</option>
<option value=“Estonia” >Estonia</option>
<option value=“Ethiopia” >Ethiopia</option>
<option value=“Fiji” >Fiji</option>
<option value=“Finland” >Finland</option>
<option value=“France” >France</option>
<option value=“Gabon” >Gabon</option>
<option value=“Gambia” >Gambia</option>
<option value=“Georgia” >Georgia</option>
<option value=“Germany” >Germany</option>
<option value=“Ghana” >Ghana</option>
<option value=“Greece” >Greece</option>
<option value=“Grenada” >Grenada</option>
<option value=“Guatemala” >Guatemala</option>
<option value=“Guinea” >Guinea</option>
<option value=“Guinea-Bissau” >Guinea-Bissau</option>
<option value=“Guyana” >Guyana</option>
<option value=“Haiti” >Haiti</option>
<option value=“Honduras” >Honduras</option>
<option value=“Hong Kong” >Hong Kong</option>
<option value=“Hungary” >Hungary</option>
<option value=“Iceland” >Iceland</option>
<option value=“India” >India</option>
<option value=“Indonesia” >Indonesia</option>
<option value=“Iran” >Iran</option>
<option value=“Iraq” >Iraq</option>
<option value=“Ireland” >Ireland</option>
<option value=“Israel” >Israel</option>
<option value=“Italy” >Italy</option>
<option value=“Jamaica” >Jamaica</option>
<option value=“Japan” >Japan</option>
<option value=“Jordan” >Jordan</option>
<option value=“Kazakhstan” >Kazakhstan</option>
<option value=“Kenya” >Kenya</option>
<option value=“Kiribati” >Kiribati</option>
<option value=“North Korea” >North Korea</option>
<option value=“South Korea” >South Korea</option>
<option value=“Kuwait” >Kuwait</option>
<option value=“Kyrgyzstan” >Kyrgyzstan</option>
<option value=“Laos” >Laos</option>
<option value=“Latvia” >Latvia</option>
<option value=“Lebanon” >Lebanon</option>
<option value=“Lesotho” >Lesotho</option>
<option value=“Liberia” >Liberia</option>
<option value=“Libya” >Libya</option>
<option value=“Liechtenstein” >Liechtenstein</option>
<option value=“Lithuania” >Lithuania</option>
<option value=“Luxembourg” >Luxembourg</option>
<option value=“Macedonia” >Macedonia</option>
<option value=“Madagascar” >Madagascar</option>
<option value=“Malawi” >Malawi</option>
<option value=“Malaysia” >Malaysia</option>
<option value=“Maldives” >Maldives</option>
<option value=“Mali” >Mali</option>
<option value=“Malta” >Malta</option>
<option value=“Marshall Islands” >Marshall Islands</option>
<option value=“Mauritania” >Mauritania</option>
<option value=“Mauritius” >Mauritius</option>
<option value=“Mexico” >Mexico</option>
<option value=“Micronesia” >Micronesia</option>
<option value=“Moldova” >Moldova</option>
<option value=“Monaco” >Monaco</option>
<option value=“Mongolia” >Mongolia</option>
<option value=“Montenegro” >Montenegro</option>
<option value=“Morocco” >Morocco</option>
<option value=“Mozambique” >Mozambique</option>
<option value=“Myanmar” >Myanmar</option>
<option value=“Namibia” >Namibia</option>
<option value=“Nauru” >Nauru</option>
<option value=“Nepal” >Nepal</option>
<option value=“Netherlands” >Netherlands</option>
<option value=“New Zealand” >New Zealand</option>
<option value=“Nicaragua” >Nicaragua</option>
<option value=“Niger” >Niger</option>
<option value=“Nigeria” >Nigeria</option>
<option value=“Norway” >Norway</option>
<option value=“Oman” >Oman</option>
<option value=“Pakistan” >Pakistan</option>
<option value=“Palau” >Palau</option>
<option value=“Panama” >Panama</option>
<option value=“Papua New Guinea” >Papua New Guinea</option>
<option value=“Paraguay” >Paraguay</option>
<option value=“Peru” >Peru</option>
<option value=“Philippines” >Philippines</option>
<option value=“Poland” >Poland</option>
<option value=“Portugal” >Portugal</option>
<option value=“Puerto Rico” >Puerto Rico</option>
<option value=“Qatar” >Qatar</option>
<option value=“Romania” >Romania</option>
<option value=“Russia” >Russia</option>
<option value=“Rwanda” >Rwanda</option>
<option value=“Saint Kitts and Nevis” >Saint Kitts and Nevis</option>
<option value=“Saint Lucia” >Saint Lucia</option>
<option value=“Saint Vincent and the Grenadines” >Saint Vincent and the Grenadines</option>
<option value=“Samoa” >Samoa</option>
<option value=“San Marino” >San Marino</option>
<option value=“Sao Tome and Principe” >Sao Tome and Principe</option>
<option value=“Saudi Arabia” >Saudi Arabia</option>
<option value=“Senegal” >Senegal</option>
<option value=“Serbia and Montenegro” >Serbia and Montenegro</option>
<option value=“Seychelles” >Seychelles</option>
<option value=“Sierra Leone” >Sierra Leone</option>
<option value=“Singapore” >Singapore</option>
<option value=“Slovakia” >Slovakia</option>
<option value=“Slovenia” >Slovenia</option>
<option value=“Solomon Islands” >Solomon Islands</option>
<option value=“Somalia” >Somalia</option>
<option value=“South Africa” >South Africa</option>
<option value=“Spain” >Spain</option>
<option value=“Sri Lanka” >Sri Lanka</option>
<option value=“Sudan” >Sudan</option>
<option value=“Suriname” >Suriname</option>
<option value=“Swaziland” >Swaziland</option>
<option value=“Sweden” >Sweden</option>
<option value=“Switzerland” >Switzerland</option>
<option value=“Syria” >Syria</option>
<option value=“Taiwan” >Taiwan</option>
<option value=“Tajikistan” >Tajikistan</option>
<option value=“Tanzania” >Tanzania</option>
<option value=“Thailand” >Thailand</option>
<option value=“Togo” >Togo</option>
<option value=“Tonga” >Tonga</option>
<option value=“Trinidad and Tobago” >Trinidad and Tobago</option>
<option value=“Tunisia” >Tunisia</option>
<option value=“Turkey” >Turkey</option>
<option value=“Turkmenistan” >Turkmenistan</option>
<option value=“Tuvalu” >Tuvalu</option>
<option value=“Uganda” >Uganda</option>
<option value=“Ukraine” >Ukraine</option>
<option value=“United Arab Emirates” >United Arab Emirates</option>
<option value=“United Kingdom” >United Kingdom</option>
<option value=“United States” >United States</option>
<option value=“Uruguay” >Uruguay</option>
<option value=“Uzbekistan” >Uzbekistan</option>
<option value=“Vanuatu” >Vanuatu</option>
<option value=“Vatican City” >Vatican City</option>
<option value=“Venezuela” >Venezuela</option>
<option value=“Vietnam” >Vietnam</option>
<option value=“Yemen” >Yemen</option>
<option value=“Zambia” >Zambia</option>
<option value=“Zimbabwe” >Zimbabwe</option>

		&lt;/select&gt;
	&lt;label for="billing5"&gt;Country&lt;/label&gt;
&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_11" &gt;
	&lt;label class="description" for="email"&gt;Email Address &lt;/label&gt;
	&lt;div&gt;
		&lt;input id="element_11" name="email" class="element text medium" type="text" maxlength="255" value=""/&gt;
	&lt;/div&gt;
	&lt;/li&gt;		&lt;li id="li_12" &gt;
	&lt;label class="description" for="phone"&gt;Phone Number &lt;/label&gt;
	&lt;span&gt;
		&lt;input id="element_12_1" name="phone" class="element text" size="3" maxlength="3" value="" type="text"&gt; -
		&lt;label for="element_12_1"&gt;(###)&lt;/label&gt;
	&lt;/span&gt;
	&lt;span&gt;
		&lt;input id="element_12_2" name="phone1" class="element text" size="3" maxlength="3" value="" type="text"&gt; -
		&lt;label for="element_12_2"&gt;###&lt;/label&gt;
	&lt;/span&gt;
	&lt;span&gt;
 		&lt;input id="element_12_3" name="phone2" class="element text" size="4" maxlength="4" value="" type="text"&gt;
		&lt;label for="element_12_3"&gt;####&lt;/label&gt;
	&lt;/span&gt;
	
	&lt;/li&gt;		&lt;li id="li_13" &gt;
	&lt;label class="description" for="fax"&gt;Fax Number &lt;/label&gt;
	&lt;span&gt;
		&lt;input id="element_13_1" name="fax" class="element text" size="3" maxlength="3" value="" type="text"&gt; -
		&lt;label for="element_13_1"&gt;(###)&lt;/label&gt;
	&lt;/span&gt;
	&lt;span&gt;
		&lt;input id="element_13_2" name="fax1" class="element text" size="3" maxlength="3" value="" type="text"&gt; -
		&lt;label for="element_13_2"&gt;###&lt;/label&gt;
	&lt;/span&gt;
	&lt;span&gt;
 		&lt;input id="element_13_3" name="fax2" class="element text" size="4" maxlength="4" value="" type="text"&gt;
		&lt;label for="element_13_3"&gt;####&lt;/label&gt;
	&lt;/span&gt;
	
	&lt;/li&gt;		&lt;li id="li_10" &gt;
	&lt;label class="description" for="confirm"&gt;Best way to confirm bookings &lt;/label&gt;
	&lt;div&gt;
		&lt;input id="element_10" name="confirm" class="element text medium" type="text" maxlength="255" value=""/&gt;
	&lt;/div&gt;
	&lt;/li&gt;
		
				&lt;li class="buttons"&gt;
		    &lt;input type="hidden" name="form_id" value="280313" /&gt;
		
			&lt;input id="saveForm" class="button_text" type="submit" name="submit" value="Submit" /&gt;
	&lt;/li&gt;
		&lt;/ul&gt;
	&lt;/form&gt;	

PHP CODE
<?
$sendTo = “me@yahoo.com”;
$subject = “We would like to book an event at Fusion Solutions”;
$thankyou = “thanks.html”;

$headers = "From: " . $_POST[“name”];
$headers .= “<” . $_POST[“email”] . ">\r
";
$headers .= "Reply-To: " . $_POST[“email”] . "\r
";
$headers .= "Return-Path: " . $_POST[“email”];
$message = "Booked By: " .$_POST[“booked_by”] . "\r
";
$message .= "Month: " .$_POST[“element_16_1”] . "\r
";
$message .= "Day: " .$_POST[“element_16_2”] . "\r
";
$message .= "Year: " .$_POST[“element_16_3”] . "\r
";
$message .= "Rental Hours: " .$_POST[“hours”] . "\r
";
$message .= "Number of Attendees: " .$_POST[“attendees”] . "\r
";
$message .= "Theme of workshop: " .$_POST[“theme”] . "\r
";
$message .= "Contact name: " .$_POST[“surgeon”] . "\r
";
$message .= "Contact Info: " .$_POST[“surgeon_contact”] . "\r
";
$message .= "Lab Procedures: " .$_POST[“lab_procedures”] . "\r
";
$message .= "Specimens: " .$_POST[“specimens”] . "\r
";
$message .= "Instrumentation: " .$_POST[“instruments”] . "\r
";
$message .= "C-Arm: " .$_POST[“carm”] . "\r
";
$message .= "Conference room: " .$_POST[“conference_room”] . "\r
";
$message .= "A/V Needs: " .$_POST[“avneeds”] . "\r
";
$message .= "Food & Beverage: " .$_POST[“food”] . "\r
";
$message .= "Address: " .$_POST[“billing”] . "\r
";
$message .= "Address2: " .$_POST[“billing1”] . "\r
";
$message .= "City: " .$_POST[“billing2”] . "\r
";
$message .= "State: " .$_POST[“billing3”] . "\r
";
$message .= "Zip: " .$_POST[“billing4”] . "\r
";
$message .= "Country: " .$_POST[“billing5”] . "\r
";
$message .= "Email: " .$_POST[“email”] . "\r
";
$message .= "Phone: " .$_POST[“phone”] . "\r
";
$message .= "Phone: " .$_POST[“phone1”] . "\r
";
$message .= "Phone: " .$_POST[“phone2”] . "\r
";
$message .= "Fax: " .$_POST[“fax”] . "\r
";
$message .= "Fax: " .$_POST[“fax1”] . "\r
";
$message .= "Fax: " .$_POST[“fax2”] . "\r
";
$message .= "Best way to confirm: " .$_POST[“confirm”];

mail($sendTo, $subject, $message, $headers) or die (“Failure”);

header(“Location: $thankyou”);

?>