<?php
	require_once('recaptchalib.php');
																		
	// Get a key from https://www.google.com/recaptcha/admin/create
	$publickey = "6LdXML8SAAAAAL6Xv5VO4y_0OiMd5-kjG0feX691";
	$privatekey = "6LdXML8SAAAAABx6Z0MtsGlfPkk2lSY4ppbirudC";
	
	# the response from reCAPTCHA
	$resp = null;
	# the error code from reCAPTCHA, if any
	$error = null;
	
	# was there a reCAPTCHA response
	
	if ( $_POST['register'] ) {
		
		if ($_POST["recaptcha_response_field"]) {
			$resp = recaptcha_check_answer ($privatekey,
										$_SERVER["REMOTE_ADDR"],
										$_POST["recaptcha_challenge_field"],
										$_POST["recaptcha_response_field"]);
		}
		
		if ( $_POST['date'] && $_POST['company'] && $_POST['phone'] && $resp->is_valid) {
			
			$department = 'diane@awjohnson.com';
			
			require_once('Rmail/Rmail.php');
			
			$mail = new Rmail();
		
			/**
			* Set the from address of the email
			*/
			$mail->setFrom( $_POST['company'] . ' <'. $_POST['email'] .'>');
			
			/**
			* Set the subject of the email
			*/
			$mail->setSubject('Class Registration');
			
			/**
			* Set high priority for the email. This can also be:
			* high/normal/low/1/3/5
			*/
			$mail->setPriority('normal');
					
			/**
			* Set the text of the Email
			*/
			$mail->setText('Date of class: &nbsp;&nbsp;' . $_POST['date'] . '<br><br>Company Name:&nbsp;&nbsp; ' . $_POST['company'] . '<br><br>Address:<br><br>' . $_POST['street'] . '<br>' . $_POST['city'] . ' <br><br>Phone Number:&nbsp;&nbsp;' . $_POST['phone'] . ' <br><br>Email:&nbsp;&nbsp;' . $_POST['email'] . '<br><br>Contact:&nbsp;&nbsp; ' . $_POST['contact'] . '<br><br>CA Contractors License Number:&nbsp;&nbsp; ' . $_POST['contractors'] . '<br><br>Students Attending:<br><br>1.&nbsp; ' . $_POST['name1'] . '<br>2.&nbsp;&nbsp;' . $_POST['name2'] . '<br>3.&nbsp;&nbsp;' . $_POST['name3'] . '<br>4.&nbsp;&nbsp;' . $_POST['name4'] . '<br>5.&nbsp;&nbsp;' . $_POST['name5'] . '<br>6.&nbsp;&nbsp;' . $_POST['name6'] . '<br>7.&nbsp;&nbsp;' . $_POST['name7'] . '<br>8.&nbsp;&nbsp;' . $_POST['name8'] . '<br>9.&nbsp;&nbsp;' . $_POST['name9'] . '<br>10.&nbsp;&nbsp;' . $_POST['name10'] . '<br>IP.&nbsp;&nbsp;' . $_SERVER['REMOTE_ADDR']);
			
			/**
			* Set the HTML of the email. Any embedded images will be automatically found as long as you have added them
			* using addEmbeddedImage() as below.
			*/
			$mail->setHTML('Date of class: &nbsp;&nbsp;' . $_POST['date'] . '<br><br>Company Name:&nbsp;&nbsp; ' . $_POST['company'] . '<br><br>Address:<br><br>' . $_POST['street'] . '<br>' . $_POST['city'] . ' <br><br>Phone Number:&nbsp;&nbsp;' . $_POST['phone'] . ' <br><br>Email:&nbsp;&nbsp;' . $_POST['email'] . '<br><br>Contact:&nbsp;&nbsp; ' . $_POST['contact'] . '<br><br>CA Contractors License Number:&nbsp;&nbsp; ' . $_POST['contractors'] . '<br><br>Students Attending:<br><br>1.&nbsp; ' . $_POST['name1'] . '<br>2.&nbsp;&nbsp;' . $_POST['name2'] . '<br>3.&nbsp;&nbsp;' . $_POST['name3'] . '<br>4.&nbsp;&nbsp;' . $_POST['name4'] . '<br>5.&nbsp;&nbsp;' . $_POST['name5'] . '<br>6.&nbsp;&nbsp;' . $_POST['name6'] . '<br>7.&nbsp;&nbsp;' . $_POST['name7'] . '<br>8.&nbsp;&nbsp;' . $_POST['name8'] . '<br>9.&nbsp;&nbsp;' . $_POST['name9'] . '<br>10.&nbsp;&nbsp;' . $_POST['name10'] . '<br>IP.&nbsp;&nbsp;' . $_SERVER['REMOTE_ADDR']);
			
			/**
			* Set the delivery receipt of the email. This should be an email address that the receipt should be sent to.
			* You are NOT guaranteed to receive this receipt - it is dependent on the receiver.
			*/
			//$mail->setReceipt('');
			
			/**
			* Add an embedded image. The path is the file path to the image.
			*/
			//$mail->addEmbeddedImage(new fileEmbeddedImage(''));
			
			/**
			* Add an attachment to the email.
			*/
			//$mail->addAttachment(new fileAttachment(''));
		
			/**
			* Send the email. Pass the method an array of recipients.
			*/
			$address = $department;
			$result  = $mail->send(array($address));
			
			$success_register = 1;
			
		}
		
	}
?>
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-gb" lang="en-gb" dir="ltr" >
<head>
  <meta http-equiv="content-type" content="text/html; charset=UTF-8" />
  <meta name="robots" content="index, follow" />
  <meta name="keywords" content="joomla, Joomla" />
  <meta name="title" content="test" />
  <meta name="author" content="Administrator" />
  <meta name="description" content="Joomla! - the dynamic portal engine and content management system" />
  <meta name="generator" content="Joomla! 1.5 - Open Source Content Management" />

  <title>Class Registration</title>
  <link href="/templates/theme_391/favicon.ico" rel="shortcut icon" type="image/x-icon" />
  <script type="text/javascript" src="/js/mootools.js"></script>
  <script type="text/javascript" src="/js/caption.js"></script>

<link rel="stylesheet" href="/css/template.css" type="text/css" />
<link rel="stylesheet" href="/css/constant.css" type="text/css" />
<!--equal-->

<!--[if IE 6]>
   <script type="text/javascript" src="/templates/theme_391/scripts/ie_png.js"></script>
   <script type="text/javascript">
       ie_png.fix('.png');
	</script>
<![endif]-->
<meta name="google-site-verification" content="Z9dGX_FLFF-OBP_B_G_M4rPp7M4vYZME_0BvvKi6Bjk" />
</head>
<body id="body">
<div class="main">
    <!--header-->
    <div class="header clear">
        <div class="fright">
            <div class="row-search clear" style="height:35px">
                
            </div>
            <div class="row-top-menu clear">

                <div class="module">
        <ul class="menu-nav"><li class="item28"><a href="http://www.awjohnson.com/"><span>Home</span></a></li><li class="item55"><a href="/industries"><span>Industries</span></a></li><li class="item54"><a href="/achievements"><span>Achievements</span></a></li><li class="item57"><a href="/our-clients"><span>Our Clients</span></a></li><li class="item53"><a href="/contact-us"><span>Contact Us</span></a></li></ul>    </div>

            </div>
        </div>
                <div class="fleft">

            <h1 id="logo"><a href="/home" title="AWJohnson"><img title="AWJohnson" src="/images/logo.jpg"  alt="logo"  /></a></h1>
        </div>
            </div>
        <img src="/images/koi/banner-services-medicalgastraining.jpg" title="AW Johnson & Associatess - Services - Training Class Requirements" />
    <!--content-->
    <div id="content" class="clear">
        <div class="content-top">
            <div class="clear">
                <!--right-->

                                <!--left-->
                                <div id="left">
                    <div class="left-indent">
                        <div class="clear">
                            
        <div class="wrapper-box clear module_menu">
            <div class="wrapper-corner-top clear png"><span class="png"><span class="png"></span></span></div>
            <div class="center-wrapper-left png clear">
                <div class="center-wrapper-right png clear">
                    <div class="center-wrapper-left-top png">

                        <div class="center-wrapper-right-top png">
                            <div class="center-wrapper-indent">
                                 <div class="center-wrapper png">
                                    <div class="center-wrapper-top clear png">
                                                                                <div class="box-title png">
                                            <div class="box-title-line">
                                            	<h3>Courses</h3>
                                            </div>

                                        </div>
                                                                               <div class="main-box">
                                            <div class="clear"><ul class="menu"><li class="item121"><a href="/class-schedule"><span>Class Schedule</span></a></li><li class="item123"><a href="/class-requirements"><span>Class Requirements</span></a></li><li id="current" class="active item120"><a href="/class-registration"><span>Class Registration</span></a></li><li class="item124"><a href="/class-location"><span>Class Location</span></a></li></ul></div>
                                        </div>
                                    </div>
                                 </div>

                            </div>
                        </div>
                    </div>
                </div>
            </div>
             <div class="wrapper-corner-bottom clear png"><span class="png"><span class="png"></span></span></div>
        </div>
                        </div>
                    </div>
                </div>
                                <div id="container" style="height:1500px">
                    <div class="wrapper-corner-top clear png"><span class="png"><span class="png"></span></span></div>
                    <div class="center-wrapper-left png clear">
                        <div class="center-wrapper-right png">
                            <div class="center-wrapper-left-top png">
                                <div class="center-wrapper-right-top png">
                                    <div class="center-wrapper-indent">
                                        <div class="center-wrapper png">

                                            <div class="center-wrapper-top clear png">
                                                <div class="clear">
                                                                                                        <div class="content-indent-title png">
                                                            <div class="content-wrapper-title">
                                                            <table class="contentpaneopen">
                                                            <tr>
                                                            <td class="contentheading" width="100%">Class Registration</td>
                                                            
                                                            </tr>
                                                            </table>
                                                            
                                                            </div>
</div>
<div class="clear">
	<div class="article-info">
                                                        </div>
</div>
    

     <div class="article-indent">
    <div class="clear">

    <table class="contentpaneopen">
                
                <tr>
            <td valign="top" class="article_indent"> 
            			<table width="600" cellspacing="10">
                        		<tr>
                                		<td colspan="2">
                                        		<table width="100%" cellspacing="5">
                                                		<tr>
                                                        		<td colspan="2"><h1><span style="color: rgb(180, 180, 180);">Course A Tuition:</span></h1></td>
                                                        </tr>
                                                        <tr>
                                                        		<td width="10%">&nbsp;</td>
                                                        </tr>
                                                        <tr>
                                                        		<td><span style="color: rgb(180, 180, 180);">$1,200.00</span></td>
                                                                <td width="90%">ASSE 6010 Medical Gas Systems Installer.</td>
                                                        </tr>
                                                        
                                                        
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><div style="background: #484848 url(aa010307.gif) no-repeat scroll center center; height: 1px;"><hr style="display: none;" /></div></td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><h1><span style="color: rgb(180, 180, 180);">Course B Tuition:</span></h1></td>
                                                        </tr>
                                                        <tr>
                                                        		<td>&nbsp;</td>
                                                        </tr>
                                     					<tr>
                                                        		<td><span style="color: rgb(180, 180, 180);">$850.00</span></td>
                                                                <td>ASSE 6020 - Medical Gas Systems Inspectors</td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><div style="background: #484848 url(aa010307.gif) no-repeat scroll center center; height: 1px;"><hr style="display: none;" /></div></td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><h1><span style="color: rgb(180, 180, 180);">Course C Tuition:</span></h1></td>
                                                        </tr>
                                                        <tr>
                                                        		<td>&nbsp;</td>
                                                        </tr>
                                     					<tr>
                                                        		<td><span style="color: rgb(180, 180, 180);">$300.00</span></td>
                                                                <td>For each student, this includes all handouts and instructions for brazing of the coupons.  This includes the Brazer Performance Test Record and Maintenance Log</td>
                                                        </tr>
                                                        <tr>
                                                        		<td><span style="color: rgb(180, 180, 180);">$300.00</span></td>
                                                                <td>For Brazing Procedure Qualification and Brazing Procedure Specification documents Each company will be required to purchase these documents only once, even if more students are sent for training and qualification at another time.</td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><div style="background: #484848 url(aa010307.gif) no-repeat scroll center center; height: 1px;"><hr style="display: none;" /></div></td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><h1><span style="color: rgb(180, 180, 180);">Course D &amp; E Tuition:</span></h1></td>
                                                        </tr>
                                                        <tr>
                                                        		<td>&nbsp;</td>
                                                        </tr>
                                     					<tr>
                                                        		<td><span style="color: rgb(180, 180, 180);">$125.00</span></td>
                                                                <td>For each coupon, two coupons minimum.  This includes the Brazer or Solderer Performance Test Record and Maintenance Log. </td>
                                                        </tr>
                                                        <tr>
                                                        		<td><span style="color: rgb(180, 180, 180);">$300.00</span></td>
                                                                <td>For Brazing Procedure Qualification and Brazing Procedure Specification documents Each company will be required to purchase these documents only once, even if more students are sent for training and qualification at another time.</td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><div style="background: #484848 url(aa010307.gif) no-repeat scroll center center; height: 1px;"><hr style="display: none;" /></div></td>
                                                        </tr>
                                                        <tr>
                                                        		<td height="10"></td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2">Payments by Company Check, VISA, and Master Card are accepted.</td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2"><strong><span style="color: rgb(180, 180, 180);">Cancellations will not be accepted within 5 days of the class start date to avoid full tuition.</span></strong></td>
                                                        </tr>
                                                        <tr>
                                                        		<td>&nbsp;</td>
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2">&nbsp;</td>
                                                        </tr>
                                                </table>
                                        </td>
                                </tr>
                                <tr>
                                		<td colspan="2"><div style="background: #484848 url(aa010307.gif) no-repeat scroll center center; height: 1px;"><hr style="display: none;" /></div></td>
                                </tr>
                        	<?php if (!$success_register) { ?>
                           
                            	<tr>
                                		<td colspan="2" valign="top"><p>
                                        <script type="text/javascript">
										 var RecaptchaOptions = {
											theme : 'blackglass'
										 };
										 </script>
                                         <form method="post">
                            			 <input type="hidden" name="register" value="1" />
                                        		<table width="100%" height="100%" cellpadding="0" cellspacing="6">

                                                        <tr>
                                                                <td align="center">For Class Date: *</td>
                                                                <td align="center">Company Name: *</td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center"><input name="date" type="text" value="<?php echo $_POST['date']; ?>" /></td>
                                                                <td align="center"><input name="company" type="text" value="<?php echo $_POST['company']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td><div style="padding-left:50px"><span style="color: rgb(180, 180, 180);"><strong>ADDRESS:</strong></span></div></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center"><span style="color: rgb(180, 180, 180);">Number and Street:</span></td>
                                                                <td align="center"><span style="color: rgb(180, 180, 180);">City, State, Zip:</span></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center"><input name="street" type="text" value="<?php echo $_POST['street']; ?>" /></td>
                                                                <td align="center"><input name="city" type="text" value="<?php echo $_POST['city']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">Phone Number: *</td>
                                                                <td align="center">Email Address: *</td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center"><input name="phone" type="text" value="<?php echo $_POST['phone']; ?>" /></td>
                                                                <td align="center"><input name="email" type="text" value="<?php echo $_POST['email']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">Contact:</td>
                                                                <td align="center">CA Contractors License Number:</td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center"><input name="contact" type="text" value="<?php echo $_POST['contact']; ?>" /></td>
                                                                <td align="center"><input name="contractors" type="text" value="<?php echo $_POST['contractors']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td colspan="2" align="center"><h1><span style="color: rgb(180, 180, 180);">Students Full Name Attending Program:</span></h1></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">&nbsp;</td>
                                                                <td align="center">&nbsp;</td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">1.&nbsp;&nbsp;<input name="name1" type="text" value="<?php echo $_POST['name1']; ?>" /></td>
                                                                <td align="center">2.&nbsp;&nbsp;<input name="name2" type="text" value="<?php echo $_POST['name2']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">3.&nbsp;&nbsp;<input name="name3" type="text" value="<?php echo $_POST['name3']; ?>" /></td>
                                                                <td align="center">4.&nbsp;&nbsp;<input name="name4" type="text" value="<?php echo $_POST['name4']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">5.&nbsp;&nbsp;<input name="name5" type="text" value="<?php echo $_POST['name5']; ?>" /></td>
                                                                <td align="center">6.&nbsp;&nbsp;<input name="name6" type="text" value="<?php echo $_POST['name6']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">7.&nbsp;&nbsp;<input name="name7" type="text" value="<?php echo $_POST['name7']; ?>" /></td>
                                                                <td align="center">8.&nbsp;&nbsp;<input name="name8" type="text" value="<?php echo $_POST['name8']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td align="center">9.&nbsp;&nbsp;<input name="name9" type="text" value="<?php echo $_POST['name9']; ?>" /></td>
                                                                <td align="center">10.<input name="name10" type="text" value="<?php echo $_POST['name10']; ?>" /></td>
                                                        </tr>
                                                        <tr>
                                                                <td colspan="2" align="center"><br>
<span style="font-size:10px; color:#FFFFFF">* = required field. Form will not be sent without all required fields filled out properly.</span></td> 
                                                        </tr>
                                                        <tr>
                                                        		<td colspan="2" align="center"><br>
                                                                	<?php
																		echo recaptcha_get_html($publickey, $error);
																		?>
																		<br/>
																		<input type="submit" value="submit" />
                                                                </td>
                                                        </tr>
                                                       
                                                        <tr>
                                                          <td colspan="2" align="center">&nbsp;</td>
                                                        </tr>
                                                </table>
                                          </form>
													<?php } else { ?>
                                                    <div align="center"><h1 style="color:#060">Thank you for registering. We will be contacting you asap to confirm registration.</h1><p></div>
                                                    <?php } ?>
                                        </td>
                                </tr>
                        </table>
				
								
 					</td>

      			  </tr>
                  <tr>
                  		<td><p>&nbsp;</p>
                  		  <p>&nbsp;</p>
                  		  <p style="color:#141414">.</p></td>
                  </tr>
          </table>
 </div>
    <p>&nbsp;</p>
     </div>
   <div class="article-separator-indent"><span class="article_separator">&nbsp;</span></div>  

                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>

                            </div>
                        </div>
                    </div>
                    <div class="wrapper-corner-bottom clear png"><span class="png"><span class="png"></span></span></div>
                </div>

            </div>
        </div>
    </div>
    <!--footer-->
    <div class="footer clear">Copyright &copy; 2017 AW Johnson & Associates All rights reserved.   </div>
</div>
<script type="text/javascript">
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www.");
document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E"));
</script>

<script type="text/javascript">
try {
var pageTracker = _gat._getTracker("UA-15244090-1");
pageTracker._trackPageview();
} catch(err) {}</script>
</body>
</html>
