2007 Claims/Underwriting Seminar Registration

<% ' FP_ASP ASP Automatically generated by a FrontPage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("registration_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(11) Dim arFormDBFields0(11) Dim arFormValues0(11) arFormFields0(0) = "SeminarLocation" arFormDBFields0(0) = "SeminarDate" arFormValues0(0) = Request("SeminarLocation") arFormFields0(1) = "LawFirm" arFormDBFields0(1) = "LawFirm" arFormValues0(1) = Request("LawFirm") arFormFields0(2) = "AgencyNo" arFormDBFields0(2) = "AgencyNo" arFormValues0(2) = Request("AgencyNo") arFormFields0(3) = "Nickname" arFormDBFields0(3) = "Nickname" arFormValues0(3) = Request("Nickname") arFormFields0(4) = "Fax" arFormDBFields0(4) = "Fax" arFormValues0(4) = Request("Fax") arFormFields0(5) = "OutsideEmp" arFormDBFields0(5) = "OutsideEmp" arFormValues0(5) = Request("OutsideEmp") arFormFields0(6) = "Occupation" arFormDBFields0(6) = "Occupation" arFormValues0(6) = Request("Occupation") arFormFields0(7) = "FirstName" arFormDBFields0(7) = "FirstName" arFormValues0(7) = Request("FirstName") arFormFields0(8) = "AgencyName" arFormDBFields0(8) = "AgencyName" arFormValues0(8) = Request("AgencyName") arFormFields0(9) = "BarNo" arFormDBFields0(9) = "BarNo" arFormValues0(9) = Request("BarNo") arFormFields0(10) = "LastName" arFormDBFields0(10) = "LastName" arFormValues0(10) = Request("LastName") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type" End If If Request.ServerVariables("REMOTE_HOST") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name" End If FP_SaveFieldToDB fp_rs, Now, "Timestamp" If Request.ServerVariables("REMOTE_USER") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name" End If fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close Session("FP_SavedFields")=arFormFields0 Session("FP_SavedValues")=arFormValues0 Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") Response.Redirect "http://www.southcarolina.ctic.com/confirmation.html" End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> 2007 Claims/Underwriting Seminar Registration

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ICL's

Underwriting

Claims/Underwriting Seminar Registration Form

Please fill this form out once for each person attending the seminar.

Agency Number:

Agency Name:

Law Firm Name:

Fax Number:

Please choose your desired seminar date / location

November 1, 2007     - Hilton Head Island, SC (Hilton Oceanfront Resort)
November 6, 2007     - Greenville, SC (Embassy Suites)
November 8, 2007     - Myrtle Beach, SC (Sheraton Myrtle Beach Convention Center Hotel)
November 9, 2007     - Charleston, SC (North Charleston Convention Center)
November 15, 2007    - Columbia, SC (Embassy Suites)

Please provide us with your information

First Name:

Last Name:

Nickname: (for name badges)

Check one: Attorney Paralegal Other

Bar Number (or "N/A"):

Please check this box if attendee is not an employee of the Agency or Firm listed above.

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