$value ) { eval( ' global $'.$value.'; ' ); }; } else { $value = $varValue; eval( ' global $'.$value.'; ' ); }; /* recipients */ $to = "Becky Mortimer "; /* subject */ $subject = "Latino Opinions Needed [Form]"; /* message */ $message = '=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Latino Opinions Needed '.( date("m-d-Y H:i:s(T)",time()) ).' =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= First Name: '.strip_tags($FNAME).' Last Name: '.strip_tags($LNAME).' Email: '.strip_tags($EMAIL).' Phone: '.strip_tags($PHONE).' '; if( $AGE ) { $message .= 'Age: '.strip_tags($AGE).' '; }; $message .= 'Address: '.strip_tags($ADDRESS1).' '; if( $ADDRESS2 ) { $message .= 'Address: '.strip_tags($ADDRESS2).' '; }; $message .= 'City: '.strip_tags($CITY).' State: '.strip_tags($STATE).' Zip: '.strip_tags($ZIP).' '; if( $SCHOOL ) { $message .= 'School: '.strip_tags($SCHOOL).' '; }; $message .= ' '; if( $CONTACTBY ) { $message .= 'Contact me by: '.strip_tags($CONTACTBY).' '; }; if( $MESSAGE ) { $message .= '25 word explanation: '.strip_tags($MESSAGE).' '; }; $message .= '=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= '; /* To send HTML mail, you can set the Content-type header. */ // $headers = "MIME-Version: 1.0\r\n"; // $headers .= "Content-type: text/html; charset=iso-8859-1\r\n"; /* additional headers */ $headers .= "From: ".$FNAME." ".$LNAME." <".$EMAIL.">\r\n"; $headers .= "Cc: \r\n"; $headers .= "Bcc: \r\n"; /* mail form off */ mail($to, $subject, $message, $headers); return; } // GET POST DATA INTO GLOBAL VARIABLES post2global( Array( 'FormAction', '!FNAME', '!LNAME', '!@EMAIL', '!#PHONE', 'AGE', '!ADDRESS1', 'ADDRESS2', '!CITY', '!STATE', '!#ZIP', 'SCHOOL', 'MESSAGE' ) ); $formDictionary = Array( 'FNAME'=>'First Name', 'LNAME'=>'Last Name', 'EMAIL'=>'Email', 'PHONE'=>'Telephone', 'ADDRESS1'=>'Address', 'CITY'=>'City', 'STATE'=>'State', 'ZIP'=>'Zip' ); if( $FormAction ) { if( validateForm() ) { $formErrorFlag = false; mailForm(); header( "Location: thankyou.html" ); } else { $formErrorFlag = true; }; }; ?> Stereotipo - Latino Opinions Needed
Stereotipo
Who We Are What We Do Why Us Home Login Contact
Latino Opinions Needed
Are you interested in airing your opinion?
Are you Hispanic and between the age of 13 and 20?
Do you have an interest in Apparel, Footwear, Cosmetics, Hair Products, Music and Videos?

If so, we would love to hear from you and have you join our panel. Offer your opinions and receive product and cash while gaining insights into consumer product companies.

Provide the information requested below and we will be in touch with you shortly.

The fields in bold are required.

Error: The fields in bold are required.
Please fillin the following fields:
.
First Name:
Last Name:
Email:
Telephone:
Age:
Address:
 
City:
State:
Zip:
School:
Would you prefer to be contacted by:
Email
Telephone
Please give us a 25 word explanation of why you would like to be part of the Stereotipo consumer base:
Submit
© 2002 Stereotipo, LLC. All rights reserved. Terms of use