Untitled

<?php

if (isset($_REQUEST['submit']))
{
    $error = validate();
    if($error)
    {
        form_page($error);
    }
    else
    {
        output_page( );
    }

}
else
{
    form_page('');
}

?>

<html>
<?php

function validate()
{
    $reg_exp1 = "/^[a-zA-Z\-\']+$/";

    $reg_exp2 = "^[a-zA-Z0-9._-]+@[a-zA-Z0-9._-]+\.([a-zA-Z]{2,4})$";

    $id_number = trim($_REQUEST['idnumber']);
    $first_name = trim($_REQUEST['firstname']);
    $last_name = trim($_REQUEST['lastname']);
    $address = trim($_REQUEST['address']);
    $email = trim($_REQUEST['email']);
    $phone = trim($_REQUEST['phone']);
    $why = ($_REQUEST['why']) ? $_REQUEST['why'] : '';
    $often = ($_REQUEST['often']) ? $_REQUEST['often'] : '';
    $health = ($_REQUEST['health']) ? $_REQUEST['health'] : '';
    $comments = ($_REQUEST['comments']) ? $_REQUEST['comments'] : '';

    $error ='';

    if (!is_numeric($id_number))
    {
        $error .= "<span class=\"error\"> Id is invalid. (format, Numbers only)</span><br>";

    }

    if(! preg_match($reg_exp1, $first_name))
    {
        $error .= "<span class=\"error\">First name is invalid (letters,hyphens, ',only)</span><br>";
    }

    if(! preg_match($reg_exp1, $last_name))
    {
        $error .= "<span class=\"error\">Last name is invalid (letters,hyphens, ',only)</span><br>";
    }

    if(! eregi($reg_exp2, $email))
    {
        $error .= "<span class=\"error\"> Email is invalid. (Format as xxxx@yyyy only)</span><br>";
    }

    if (! eregi("^[[:digit:]]{3}-[[:digit:]]{7}$",$phone))
    {
        $error .= "<span class=\"error\"> Phone number invalid. (Format as 999-9999999)</span><br>";
    }

    if( empty($often))
    {
        $error .="<span class=\"error\"> Select how often you take exercise</span><br>";
    }

    if(! is_array($why))
    {
        $error .= "<span class=\"error\"> You must select your reason for joining the gym.</span><br>";
     }

    ?>

<?php


    return $error;
}
?>

<?php

function output_page()
{
    $self = $_REQUEST['PHP_SELF'];
    $id_number = trim($_REQUEST['idnumber']);
    $first_name = trim($_REQUEST['firstname']);
    $last_name = trim($_REQUEST['lastname']);
    $address = trim($_REQUEST['address']);
    $email = trim($_REQUEST['email']);
    $phone = trim($_REQUEST['phone']);
    $why = ($_REQUEST['why']) ? $_REQUEST['why'] : '';
    $often = ($_REQUEST['often']) ? $_REQUEST['often'] : '';
    $health = ($_REQUEST['health']) ? $_REQUEST['health'] : '';
    $comments = ($_REQUEST['comments']) ? $_REQUEST['comments'] : '';
    ?>
    <html>
    <head><title> Form Results</title></head>
    <body>
    <h1>Form Results</h1>
    <br>
    <p> Please review your answers: </p>
    <br>

    <form action = mailto:youremail@email.com method = "post">

    <textarea rows="20" cols="60"wrap="physical" name ="comments">

    <?php
    echo " \n
ID: $id_number \n
First name: $first_name \n
Last name: $last_name \n
Address: $address     \n
Email: $email          \n
Phone: $phone        \n
Health: $health           \n
Frequency of visits to gym: $often     \n
You wish to join for the following reasons: $why \n
Comments: $comments \n
"

           ?>

    </textarea>
    <br>
    <br>
    <input type="submit"value ="Send Thru Email" name="submit">
    <br>
    <br>
    </form>
    <html>
    <a href="<?php $self ?>"> Back to form </a>
    </html>


<?php
}
?>


<?php

function form_page($error)
{
if($error)
{
    echo "<FONT COLOR='red'><p>$error</></font>\n";

    $id_number = trim($_REQUEST['idnumber']) ? $_REQUEST['idnumber'] : '';
    $first_name = trim($_REQUEST['firstname']) ? $_REQUEST['firstname'] : '';
    $last_name = trim($_REQUEST['lastname']) ? $_REQUEST['lastname'] : '';
    $address = trim($_REQUEST['address']) ? $_REQUEST['address'] : '';
    $email = trim($_REQUEST['email']) ? $_REQUEST['email'] : '';
    $phone = trim($_REQUEST['phone']) ? $_REQUEST['phone'] : '';
    $why = ($_REQUEST['why']) ? $_REQUEST['why'] : '';
    $often = ($_REQUEST['often']) ? $_REQUEST['often'] : '';
    $health = ($_REQUEST['health']) ? $_REQUEST['health'] : '';
    $comments = ($_REQUEST['comments']) ? $_REQUEST['comments'] : '';
}
?>
<html>

<style>

h2 {color: red;
    background: #CCCC66;}

#sectionone {background: #FF33CC;}

#sectiontwo {background: #FFCC66; }

#sectionthree {background: #99FF66; }

#textfield {margin-left: 20px;}
</style>

<body>

<h1> Gym Questionnaire </h1>

<p> Please fill out the form below </p>

    <div id= "sectionone">
    <h2>Personal information </h2>


    <form action="<?php echo $self?>" method="get">
    ID Number: <input type="text" size="12" maxlength="30" name="idnumber" value = "<?php echo $id_number?>"/> <br>

    Firstname: <input type="text" size="12" maxlength="30" name="firstname" value = "<?php echo $first_name?>"/> <br>

    Lastname: <input type="text" size="12" maxlength="30" name="lastname" value = "<?php echo $last_name?>"/> <br>

    Address: <input type="text" size="12" maxlength="30" name="address" value = "<?php echo $address?>"/> <br>

    Email: <input type="text" size="12" maxlength="30" name="email" value = "<?php echo $email?>"/> <br>

    Phone: <input type="text" size="12" maxlength="30" name="phone" value = "<?php echo $phone?>"/> <br>
    <br>
    </div>


    <div id= "sectiontwo">
    <h2>Health </h2>

    What is your general health like?:
                                       <select name="health"
                                       <option selected="selected">Above average. </option>
                                       <option>Average.  </option>
                                       <option>Below Average. </option>
                                       </select>
    <br>
    <br>

    How often do you go to the gym each week?:
     <br>
     <input type="radio" name="often"value="less"<?php check2($often,"less") ?>> Less than once
     <br>
    <input type="radio" name="often"value="once"<?php check2($often,"once") ?>> once:
     <br>
    <input type="radio" name="often"value="two"<?php check2($often,"two") ?>> 2-3 times
    <br>
    <input type="radio" name="often"value="fourmore"<?php check2($often,"fourormore") ?>> 4- times

    <br>
    <br>


    Why do you go to the gym? (Tick all that apply)
    <br>
    Health improvement<Input type="checkbox" name="why[]"value ="Health improvement"<?php check($why,"Health improvement") ?>>
    <br>
    Rehabilitation<Input type="checkbox" name="why[]" value = "Rehabilitation"<?php check($why,"Rehabilitation") ?> />
    <br>
    Strength Training<Input type="checkbox" name="why[]" value = "Strength Training"<?php check($why,"Strength Training") ?> />
    <br>
    Weight loss<Input type="checkbox" name="why[]" value = "Weight loss"<?php check($why,"Weight loss")  ?> />
    <br>
    Lifestyle<Input type="checkbox" name="why[]" value = "Lifestyle"<?php check($why,"Lifestyle") ?> />
    <br>
    <br>

    </div>

<div id= "sectionthree">
    <h2>Comments </h2>
    <br>
    <div id= "textfield">
    <textarea rows="10" cols="20"wrap="physical" name ="comments">
    Enter any comments here!
    </textarea>
    </div>
</div>
    <br>
    <br>
    <input type="submit"value ="Submit" name="submit">
    <input type="reset" value="Start over" name="Clear">


    </form>
<?php

}
/*check that $checkboxes is an array and that val(s) exsist and place a tic*/
function check($why,$val)
{
    if (is_array($why) and in_array($val, $why))
    {
    echo 'checked = "checked"';
    }
}

function check2($often, $val2)
{
   if ($often === $val2)
   {
      echo 'checked = "checked"';
   }
}//end of fuction2

function check3($comments, $val3)
{
    if($comments == $val3)
    {
        echo 'checked = "checked"';
    }
}


?>


</html>