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<!--- When the user submits the Form, she sees the information that she sent --->
<cfif isDefined("FORM")>
<!--- Display "success" message to user --->
<h2>Thank you. Your information has been sent to the ASC Association.</h2>
<p>If you have questions or concerns, please contact the ASC Association at <a href="mailto:ASC@ascassociation.org">ASC@ascassociation.org</a>.</p>
<p>Here is the information you sent:</p>
<cfquery name="getRegistrationData" dbtype="query">
SELECT Name,Degree,Title,FacilityCompany,Address1,Address2,City,State,Zip,Phone,Fax,Email,WebSite,MainConference1stAttendeeAmountBefore8Sep625,MainConference2ndAttendeeAmountBefore8Sep575,MainConference3rdAttendeeAmountBefore8Sep525,MainConference4thAttendeeAmountBefore8Sep500,MainConference1stAttendeeAmountAfter8Sep725,MainConference2ndAttendeeAmountAfter8Sep675,MainConference3rdAttendeeAmountAfter8Sep625,MainConference4thAttendeeAmountAfter8Sep600,MainandPreConference1stAttendeeAmountBefore8Sep825,MainandPreConference2ndAttendeeAmountBefore8Sep775,MainandPreConference3rdAttendeeAmountBefore8Sep725,MainandPreConference4thAttendeeAmountBefore8Sep700,MainandPreConference1stAttendeeAmountAfter8Sep975,MainandPreConference2ndAttendeeAmountAfter8Sep875,MainandPreConference3rdAttendeeAmountAfter8Sep825,MainandPreConference4thAttendeeAmountAfter8Sep800,BeckersASCReviewSpecialDiscount,ASCReviewSubscriberDiscountFifty,TotalEnclosed,CheckEnclosed,CheckNumber,AuthorizeCharge,CreditCard,CreditCardNumber,ExpirationDate,PrintedCardHolderName,CreditCardZIPCode,CVV,DateCreated
FROM RegistrationEntries
WHERE RegistrationID=#FORM.RegistrationID#
</cfquery>
<cfoutput query="getRegistrationData">
<p><strong>RegistrationID:</strong> #FORM.RegistrationID#</p>
<p><strong>Name:</strong> #FORM.Name#</p>
<p><strong>Degree:</strong> #FORM.Degree#</p>
<p><strong>Title:</strong> #FORM.Title#</p>
<CFIF FacilityCompany IS NOT ""><p><strong>Facility / Company:</strong> #FORM.FacilityCompany#</p></CFIF>
<p><strong>Address Line 1:</strong> #FORM.Address1#</p>
<CFIF Address2 IS NOT ""><p><strong>Address Line 2:</strong> #FORM.Address2#</p></CFIF>
<p><strong>City:</strong> #FORM.City#</p>
<p><strong>State:</strong> #FORM.State#</p>
<p><strong>Zip:</strong> #FORM.Zip#</p>
<p><strong>Phone:</strong> #FORM.Phone#</p>
<CFIF Fax IS NOT ""><p><strong>Fax:</strong> #FORM.Fax#</p></CFIF>
<p><strong>Email:</strong> #FORM.Email#</p>
<CFIF WebSite IS NOT ""><p><strong>Web Site:</strong> #FORM.WebSite#</p></CFIF>
<CFIF MainConference1stAttendeeAmountBefore8Sep625 IS NOT ""><p><strong>Main Conference 1st Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainConference1stAttendeeAmountBefore8Sep625#</p></CFIF>
<CFIF MainConference2ndAttendeeAmountBefore8Sep575 IS NOT ""><p><strong>Main Conference 2nd Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainConference2ndAttendeeAmountBefore8Sep575#</p></CFIF>
<CFIF MainConference3rdAttendeeAmountBefore8Sep525 IS NOT ""><p><strong>Main Conference 3rd Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainConference3rdAttendeeAmountBefore8Sep525#</p></CFIF>
<CFIF MainConference4thAttendeeAmountBefore8Sep500 IS NOT ""><p><strong>Main Conference 4th Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainConference4thAttendeeAmountBefore8Sep500#</p></CFIF>
<CFIF MainConference1stAttendeeAmountAfter8Sep725 IS NOT ""><p><strong>Main Conference 1st Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainConference1stAttendeeAmountAfter8Sep725#</p></CFIF>
<CFIF MainConference2ndAttendeeAmountAfter8Sep675 IS NOT ""><p><strong>Main Conference 2nd Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainConference2ndAttendeeAmountAfter8Sep675#</p></CFIF>
<CFIF MainConference3rdAttendeeAmountAfter8Sep625 IS NOT ""><p><strong>Main Conference 3rd Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainConference3rdAttendeeAmountAfter8Sep625#</p></CFIF>
<CFIF MainConference4thAttendeeAmountAfter8Sep600 IS NOT ""><p><strong>Main Conference 4th Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainConference4thAttendeeAmountAfter8Sep600#</p></CFIF>
<CFIF MainandPreConference1stAttendeeAmountBefore8Sep825 IS NOT ""><p><strong>Mainand PreConference 1st Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainandPreConference1stAttendeeAmountBefore8Sep825#</p></CFIF>
<CFIF MainandPreConference2ndAttendeeAmountBefore8Sep775 IS NOT ""><p><strong>Mainand PreConference 2nd Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainandPreConference2ndAttendeeAmountBefore8Sep775#</p></CFIF>
<CFIF MainandPreConference3rdAttendeeAmountBefore8Sep725 IS NOT ""><p><strong>Mainand PreConference 3rd Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainandPreConference3rdAttendeeAmountBefore8Sep725#</p></CFIF>
<CFIF MainandPreConference4thAttendeeAmountBefore8Sep700 IS NOT ""><p><strong>Mainand PreConference 4th Attendee Amount Remitted Before 8 Sep 2008:</strong> #FORM.MainandPreConference4thAttendeeAmountBefore8Sep700#</p></CFIF>
<CFIF MainandPreConference1stAttendeeAmountAfter8Sep975 IS NOT ""><p><strong>Mainand PreConference 1st Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainandPreConference1stAttendeeAmountAfter8Sep975#</p></CFIF>
<CFIF MainandPreConference2ndAttendeeAmountAfter8Sep875 IS NOT ""><p><strong>Mainand PreConference 2nd Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainandPreConference2ndAttendeeAmountAfter8Sep875#</p></CFIF>
<CFIF MainandPreConference3rdAttendeeAmountAfter8Sep825 IS NOT ""><p><strong>Mainand PreConference 3rd Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainandPreConference3rdAttendeeAmountAfter8Sep825#</p></CFIF>
<CFIF MainandPreConference4thAttendeeAmountAfter8Sep800 IS NOT ""><p><strong>Mainand PreConference 4th Attendee Amount Remitted After 8 Sep 2008:</strong> #FORM.MainandPreConference4thAttendeeAmountAfter8Sep800#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>Beckers ASC Review Special Discount:</strong> #FORM.BeckersASCReviewSpecialDiscount#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>ASC Review Subscriber Discount ($50):</strong> #FORM.ASCReviewSubscriberDiscountFifty#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>Total Enclosed:</strong> #FORM.TotalEnclosed#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>Check Enclosed:</strong> #FORM.CheckEnclosed#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>Check Number:</strong> #FORM.CheckNumber#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>Authorize Charge:</strong> #FORM.AuthorizeCharge#</p></CFIF>
<CFIF FacilityCompany IS NOT ""><p><strong>Credit Card:</strong> #FORM.CreditCard#</p></CFIF>
<CFIF CreditCardNumber IS NOT ""><p><strong>Credit Card Number:</strong> (Obscured for security)</p></CFIF>
<CFIF ExpirationDate IS NOT ""><p><strong>Expiration Date:</strong> (Obscured for security)</p></CFIF>
<CFIF PrintedCardHolderName IS NOT ""><p><strong>Printed Card Holder Name:</strong> #FORM.PrintedCardHolderName#</p></CFIF>
<CFIF CreditCardZIPCode IS NOT ""><p><strong>Credit Card ZIP Code:</strong> #FORM.CreditCardZIPCode#</p></CFIF>
<CFIF CVV IS NOT ""><p><strong>CVV:</strong> #FORM.CVV#</p></CFIF>
<p><strong>Date Submitted:</strong> #FORM.DateCreated#</p>
</cfoutput>
<!--- Otherwise, display the form to user... --->
<cfelse>
<!--- A form to populate conference registration information in table RegistrationEntries --->
<cfform action="/conference_data_insert.cfm" enctype="multipart/form-data">
<h1>REGISTRATION INFORMATION</h1>
<table class="uvatable">
<tr><td><strong>Name:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="Name" /></td></tr>
<tr><td><strong>Degree: As you wish it to appear on your badge:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="Degree" /></td></tr>
<tr><td><strong>Title:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="Title" /></td></tr>
<tr><td><strong>Facility / Company:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="FacilityCompany" /></td></tr>
<tr><td><strong>Address Line 1:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="Address1" /></td></tr>
<tr><td><strong>Address Line 2:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="Address2" /></td></tr>
<tr><td><strong>City:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="City" /></td></tr>
<tr><td><strong>State:</strong></td> <td><cfinput TYPE="text" SIZE="5" NAME="State" /></td></tr>
<tr><td><strong>ZIP:</strong></td> <td><cfinput TYPE="text" SIZE="5" NAME="Zip" /></td></tr>
<tr><td><strong>Phone:</strong></td> <td><cfinput TYPE="text" SIZE="20" NAME="Phone" /></td></tr>
<tr><td><strong>Fax:</strong></td> <td><cfinput TYPE="text" SIZE="20" NAME="Fax" /></td></tr>
<tr><td><strong>Email:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="Email" /></td></tr>
<tr><td><strong>Web Site:</strong></td> <td><cfinput TYPE="text" SIZE="30" NAME="WebSite" /></td></tr>
</table>
<h1>REGISTRATION FEES</h1>
<h2>ANNUAL CONFERENCE & EXHIBITS</h2>
<p>Receive multiple registrant discount(s). The more people you send the greater discount you receive. The prices listed
below are per person. Your registration includes all conference sessions, materials, and the meal functions.</p>
<h2>MAIN CONFERENCE ONLY</h2>
<table class="uvatable">
<tr>
<td></td>
<td><strong>FEES<br />(Before 9/10/08)</strong></td>
<td><strong>ENTER AMOUNT</strong></td>
<td><strong>FEES<br />(After 9/10/08)</strong></td>
<td><strong>ENTER AMOUNT</strong></td>
</tr>
<tr>
<td>1st Attendee</td>
<td>$625</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference1stAttendeeAmountBefore8Sep625" /></td>
<td>$725</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference1stAttendeeAmountAfter8Sep725" /></td>
</tr>
<tr>
<td>2nd Attendee</td>
<td>$575</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference2ndAttendeeAmountBefore8Sep575" /></td>
<td>$675</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference2ndAttendeeAmountAfter8Sep675" /></td>
</tr>
<tr>
<td>3rd Attendee</td>
<td>$525</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference3rdAttendeeAmountBefore8Sep525" /></td>
<td>$625</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference3rdAttendeeAmountAfter8Sep625" /></td>
</tr>
<tr>
<td>4th Attendee or more</td>
<td>$500</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference4thAttendeeAmountBefore8Sep500" /></td>
<td>$600</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainConference4thAttendeeAmountAfter8Sep600" /></td>
</tr>
</table>
<p><em>Ask about larger group discounts.</em></p>
<h2>MAIN CONFERENCE + PRE-CONFERENCE</h2>
<table class="uvatable">
<tr>
<td></td>
<td><strong>FEES<br />(Before 9/10/08)</strong></td>
<td><strong>ENTER AMOUNT</strong></td>
<td><strong>FEES<br />(After 9/10/08)</strong></td>
<td><strong>ENTER AMOUNT</strong></td>
</tr>
<tr>
<td>1st Attendee</td>
<td>$825</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference1stAttendeeAmountBefore8Sep825" /></td>
<td>$975</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference1stAttendeeAmountAfter8Sep975" /></td>
</tr>
<tr>
<td>2nd Attendee</td>
<td>$775</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference2ndAttendeeAmountBefore8Sep775" /></td>
<td>$875</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference2ndAttendeeAmountAfter8Sep875" /></td>
</tr>
<tr>
<td>3rd Attendee</td>
<td>$725</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference3rdAttendeeAmountBefore8Sep725" /></td>
<td>$825</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference3rdAttendeeAmountAfter8Sep825" /></td>
</tr>
<tr>
<td>4th Attendee or more</td>
<td>$700</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference4thAttendeeAmountBefore8Sep700" /></td>
<td>$800</td>
<td><cfinput TYPE="text" SIZE="30" NAME="MainandPreConference4thAttendeeAmountAfter8Sep800" /></td>
</tr>
</table>
<h2>OPTIONAL</h2>
<table class="uvatable">
<tr>
<td>Becker's ASC Review Special Discount Offer</td>
<td>$100 (per year) </td>
<td><cfinput TYPE="text" SIZE="30" NAME="BeckersASCReviewSpecialDiscount" /></td>
</tr>
<tr>
<td>50 Discount per attendee if paid ASC Association Member
or Becker's ASC Review Subscriber </td>
<td>(- 50) </td>
<td><cfinput TYPE="text" SIZE="30" NAME="ASCReviewSubscriberDiscountFifty" /></td>
</tr>
<tr>
<td></td>
<td><strong>TOTAL ENCLOSED</strong></td>
<td><cfinput TYPE="text" SIZE="30" NAME="TotalEnclosed" /></td>
</tr>
</table>
<h1>PAYMENT INFORMATION</h1>
<p>To remit payment, you may print this form and mail it to ASC Association with a check (see information below). Or, submit your credit card information, below. Credit card information is submitted through a secure connection, certified by SecureTrust.</p>
<p class="float-left"><cfinput type="Checkbox" name="CheckEnclosed" /> Enclosed is a check, payable to ASC Association Fall Conference</p>
<p class="float-right">Check # <cfinput TYPE="text" SIZE="30" NAME="CheckNumber" /></p>
<div class="clear-both"></div>
<p class="float-left"><cfinput type="Checkbox" name="AuthorizeCharge" /> I authorize ASC Association to charge my:</p>
<p class="float-right">
<select name="CreditCard">
<option value="SelectCard">Select a Credit Card</option>
<option value="Visa">Visa</option>
<option value="MasterCard">MasterCard</option>
<option value="AmericanExpress">American Express</option></select></p>
<div class="clear-both"></div>
<table class="uvatable">
<tr>
<td>Credit Card Number:</td>
<td><cfinput TYPE="text" SIZE="30" NAME="CreditCardNumber" /></td>
<td>Expiration Date:</td>
<td><cfinput TYPE="text" SIZE="30" NAME="ExpirationDate" /></td>
</tr>
<tr>
<td>Printed Cardholder Name:</td>
<td><cfinput TYPE="text" SIZE="30" NAME="PrintedCardHolderName" /></td>
<td>Zip Code:</td>
<td><cfinput TYPE="text" SIZE="30" NAME="CreditCardZIPCode" /></td>
</tr>
<tr>
<td>Signature (if printing and mailing):</td>
<td></td>
<td>CVV#/3-digit #:</td>
<td><cfinput TYPE="text" SIZE="30" NAME="CVV" /></td>
</tr>
</table>
<h1>TO REGISTER</h1>
<h2>COMPLETE REGISTRATION FORM AND MAIL OR FAX AS FOLLOWS:</h2>
<p><strong>Mail:</strong> Make checks payable to ASC Association Fall Conference and mail to:
ASC Association, 1012 Cameron St., Alexandria, VA 22314</p>
<p><strong>Fax:</strong> Fax registration form with credit card information to (703) 836-2090</p>
<p><strong>Call:</strong> Call (703) 836-5904 to register by phone</p>
<p><strong>Web site:</strong> <a href="http://www.BeckersASC.com">www.BeckersASC.com</a></p>
<p><strong>Cancellation policy:</strong> Written cancellation requests must be received by September 18, 2008. Refunds are subject to a 100 processing fee.
Refunds will not be made after this date.</p>
<p>Fax registration form with credit card information to (703) 836-2090.</p>
<cfinput type="submit" name="submit" value="Send to ASC Association" />
</cfform>
<!--- close CFIF --->
</cfif>
<p>If you have trouble sending the form, please print and fax to 703-549-0976.</p>
<p>This information will only be used in conjunction with ASC Association business. We will not share your information with any other organizations.</p>
<cfinclude template="/SiteFooter.cfm">
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