html form

<?php
if(isset($_POST['email'])) {

    // SEND TO
    $email_to = "webmaster@marineconomicforum.org";
    $email_subject = "MEF Application";




    $name = $_POST['name'];
    $primary_organization = $_POST['primary_organization'];
    $eprimary_position = $_POST['primary_position'];
    $street = $_POST['street'];
    $city = $_POST['city'];
	$state = $_POST['state'];
	$zip = $_POST['zip'];
	$address = $_POST['address'];
	$day_phone = $_POST['day_phone'];
	$mobile_phone = $_POST['mobile_phone'];
	$qualifiy1 = $_POST['qualify1'];
	$qualifiy2 = $_POST['qualify2'];
	$qualifiy3 = $_POST['qualify3'];
	$group1 = $_POST['group1'];
	$position1 = $_POST['position1'];
	$group2 = $_POST['group2'];
    $position2 = $_POST['position2'];
    $group3 = $_POST['group3'];
    $position3 = $_POST['position3'];
	$group4 = $_POST['group4'];
    $position4 = $_POST['position4'];
	$group5 = $_POST['group5'];
    $position5 = $_POST['position5'];
	$position = $_POST['position'];
	$comittee1 = $_POST['comittee1'];
	$comittee_position1 = $_POST['comittee_position1'];
	$comittee2 = $_POST['comittee2'];
	$comittee_position2 = $_POST['comittee_position2'];
	$comittee3 = $_POST['comittee3'];
	$comittee_position3 = $_POST['comittee_position3'];
	$comittee4 = $_POST['comittee4'];
	$comittee_position4 = $_POST['comittee_position4'];
	$accomplishments = $_POST['accomplishments'];
	$interests = $_POST['interests'];
	$comments = $_POST['comments'];


    $email_message = "Form details below.\n\n";

    function clean_string($string) {
      $bad = array("content-type","bcc:","to:","cc:","href");
      return str_replace($bad,"",$string);
    }

    $email_message .= "Name [Last, First MI] ".clean_string($name)."\n";
    $email_message .= "Primary Organization ".clean_string($primary_organization)."\n";
    $email_message .= "Primary Position ".clean_string($primary_position)."\n";
    $email_message .= "Street Address < ".clean_string($street)."\n";
    $email_message .= "City ".clean_string($city)."\n";
    $email_message .= "State ".clean_string($state)."\n";
    $email_message .= "Zip Code ".clean_string($zip)."\n";
    $email_message .= "Email Address ".clean_string($address)."\n";
	$email_message .= "Daytime Phone ".clean_string($day_phone)."\n";
    $email_message .= "Mobile Phone ".clean_string($mobile_phone)."\n";
	$email_message .= "For profit based? ".clean_string($qualify1)."\n";
    $email_message .= "Marin Work Place? ".clean_string($qualify2)."\n";
	$email_message .= "Marin Resident?".clean_string($qualify3)."\n";
	$email_message .= "Organization or Group ".clean_string($group1)."\n";
	$email_message .= "Position(s)/Tenure".clean_string($position1)."\n";
	$email_message .= "Organization or Group ".clean_string($group2)."\n";
	$email_message .= "Position(s)/Tenure".clean_string($position2)."\n";
	$email_message .= "Organization or Group ".clean_string($group3)."\n";
	$email_message .= "Position(s)/Tenure".clean_string($position3)."\n";
	$email_message .= "Organization or Group ".clean_string($group4)."\n";
	$email_message .= "Position(s)/Tenure".clean_string($position4)."\n";
	$email_message .= "Organization or Group ".clean_string($group5)."\n";
	$email_message .= "Position(s)/Tenure".clean_string($position5)."\n";
	$email_message .= "Status during 2010 ".clean_string($position)."\n";
	$email_message .= "Comittees Served On ".clean_string($comittee1)."\n";
	$email_message .= "Position on each Comittee ".clean_string($comittee_position1)."\n";
	$email_message .= "Comittees Served On".clean_string($comittee2)."\n";
	$email_message .= "Position on each Comittee ".clean_string($comittee_position2)."\n";
	$email_message .= "Comittees Served On".clean_string($comittee3)."\n";
	$email_message .= "Position on each Comittee ".clean_string($comittee_position3)."\n";
	$email_message .= "Comittees Served On".clean_string($comittee4)."\n";
	$email_message .= "Position on each Comittee ".clean_string($comittee_position4)."\n";
	$email_message .= "Comittees Served On".clean_string($comittee5)."\n";
	$email_message .= "Position on each Comittee ".clean_string($comittee_position5)."\n";
	$email_message .= "Accomplishments".clean_string($accomplishments)."\n";
	$email_message .= "Interests/Goals 2011 ".clean_string($comittee_position1)."\n";
	$email_message .= "Additional Comments ".clean_string($comments)."\n";




// create email headers
$headers = 'From: '.$email_from."\r\n".
'Reply-To: '.$email_from."\r\n" .
'X-Mailer: PHP/' . phpversion();
@mail($email_to, $email_subject, $email_message, $headers);
?>

<!-- http://marineconomicforum.org/send_form_application.php -->

Thank you for contacting us. We will be in touch with you very soon.

<?php
}
?>