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submit_form.php
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submit_form.php
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<?php
//Include commonly used variables
include('vars.php');
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<!--
/************************************************************************
*
* phpAbstracts
* http://www.phpabstracts.com
*
* Copyright (c) 2008 Omar Qazi
*
* phpAbstracts is free software: you can redistribute it and/or modify
* it under the terms of the GNU General Public License as published by
* the Free Software Foundation, either version 3 of the License, or
* (at your option) any later version.
*
* phpAbstracts is distributed in the hope that it will be useful,
* but WITHOUT ANY WARRANTY; without even the implied warranty of
* MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
* GNU General Public License for more details.
*
* You should have received a copy of the GNU General Public License
* along with phpAbstracts. If not, see <http://www.gnu.org/licenses/>.
*
************************************************************************/
-->
<head>
<title><?php echo $site_title; ?></title>
<link href="css/abstracts.css" rel="stylesheet" type="text/css" />
<script language="javascript" type="text/javascript" src="js/submit_form.js"></script>
<script type="text/javascript">
//for submit_form.js
var countsuffix = "_words";
var remainingwords = "words_remaining";
total_limit = <?php echo $total_words_limit; ?>;
</script>
</head>
<body>
<div id="header" class="top_container">
<img src="<?php echo $site_logo ?>">
</div>
<div class="centering_container" id="main_container" >
<h1>Call for abstracts</h1>
<p>52nd Annual Meeting of the Northwest Society of Plastic Surgeons</p>
<p style="font-weight:bold;">Please note that it will not be possible to edit an abstract after it has been
submitted.</p>
<br />
<form id="abstract_submit_form" enctype="multipart/form-data" name="abstract_submit_form" method="post" action="submit_process.php"
class="aform" onsubmit="return validate(this)">
<h3>Author</h3>
<div id="name" class="conf_form_name">
<label for="name">Name</label>
<input name="name" type="text" id="name" size="60" />
<br />
<label for="clinic">Practice</label>
<input name="clinic" type="text" id="clinic" size="60" />
<br />
<label for="address">Address</label>
<input name="address" type="text" id="address" size="60"/>
<br />
<label for="city">City/ST/ZIP</label>
<input name="city" type="text" id="city" size="34"/>
<input name="state" type="text" id="state" size="2" />
<input name="zip" type="text" id="zip" size="9" />
<br />
<label for="email">E-mail</label>
<input type="text" name="email" id="email" size="60" />
<br />
<label for="phone">Phone</label>
<input type="text" name="phone" id="phone" size="60" />
</div>
<br />
<br />
<h3>Abstract</h3>
<p>Tips on presentation:</p>
<ol>
<li>Use good and standardized before and after photos.</li>
<li>Don’t read from your slides.</li>
<li>A good picture is worth a thousand words.</li>
<li>Keep graphs simple; remember we're surgeons.</li>
<li>Ensure your talk with remain on time.</li>
<ol>
<p>Enter information about your desired presentation at the conference.</p>
<p>Enter the title of your abstract.</p>
<label for="title">Title</label>
<input type="text" name="title" id="title" size="60" maxlength="250" />
<br />
<label for="duration">Length of Presentation</label>
<select id="duration" name="duration">
<option value="5">5 minutes</option>
<option value="10">10 minutes</option>
<option value="15">15 minutes</option>
<option value="20">20 minutes</option>
</select>
<p>Brief summary of presentation:</p>
<!--label for="summary">
<span class="suggested_words">Suggested<br /><?php echo $summary_words_limit; ?> words</span>
<span id="summary_your_words" class="your_words">
Your count<br /><span id="summary_words">0</span> words
</span>
</label-->
<textarea name="summary" wrap="hard" cols="60" rows="10"
onkeyup="check_length(this, gap, need, change, <?php echo $summary_words_limit; ?>);"
onkeydown="check_length(this, gap, need, change, <?php echo $summary_words_limit; ?>);"
onmouseout="check_length(this, gap, need, change, <?php echo $summary_words_limit; ?>);"></textarea>
<br /><br />
<p>What is the practice based issue you want to address?</p>
<!--label for="gap">
<span class="suggested_words">Suggested<br /><?php echo $gap_words_limit; ?> words</span>
<span id="gap_your_words" class="your_words">
Your count<br /><span id="gap_words">0</span> words
</span>
</label-->
<textarea name="gap" wrap="hard" cols="60" rows="10"
onkeyup="check_length(this, summary, need, change, <?php echo $gap_words_limit; ?>);"
onkeydown="check_length(this, summary, need, change, <?php echo $gap_words_limit; ?>);"
onmouseout="check_length(this, summary, need, change, <?php echo $gap_words_limit; ?>);"></textarea>
<br /><br />
<p>Why does that issue exist? (need)</p>
<!--label for="need">
<span class="suggested_words">Suggested:<br /><?php echo $need_words_limit; ?> words</span>
<span id="need_your_words" class="your_words">
Your count:<br /><span id="need_words">0</span> words
</span>
</label-->
<textarea name="need" wrap="hard" cols="60" rows="12"
onkeyup="check_length(this, summary, gap, change, <?php echo $need_words_limit; ?>);"
onkeydown="check_length(this, summary, gap, change, <?php echo $need_words_limit; ?>);"
onmouseout="check_length(this, summary, gap, change, <?php echo $need_words_limit; ?>);"></textarea>
<br /><br />
<p>What do we want to change? (How are we going to approach the management of patients differently?)</p>
<!--label for="change">
<span class="suggested_words">Suggested<br /><?php echo $change_words_limit; ?> words</span>
<span id="change_your_words" class="your_words">
Your count<br /><span id="change_words">0</span> words
</span>
</label-->
<textarea name="change" wrap="hard" cols="60" rows="15"
onkeyup="check_length(this, summary, gap, need, <?php echo $change_words_limit; ?>);"
onkeydown="check_length(this, summary, gap, need, <?php echo $change_words_limit; ?>);"
onmouseout="check_length(this, summary, gap, need, <?php echo $change_words_limit; ?>);"></textarea>
<br /><br />
<p>Note: the complete abstract should not exceed <?php echo $total_words_limit; ?> words</p>
<span style="color:gray">Suggested Total: <?php echo $total_words_limit; ?> words</span>
<span style="padding:0px 20px 0px 20px;"> | </span>
<!--span id="total_words_remaining" style="color:#009900;">
Your Total: <span id="words_remaining">0</span> words
</span>
<input type="hidden" id="word_count" name="word_count" value="0" /-->
<br /><br />
<h3>Presentation Upload</h3>
<p>All Presentations:
<ol>
<li>Must be in Microsoft PowerPoint or Apple Keynote.</li>
<li>Must include a financial disclosure slide.</li>
<li>Must be ready to load onto the master computer the day prior to your scheduled presentation. These will be deleted from the master computer after your presentation.</li>
</ol>
</p>
<label for="presentation">Presentation:</label>
<input type="file" name="presentation" id="presentation"><br />
<h3>Disclosure Form</h3>
<p>All presenters are required to complete a disclosure form. Please upload your signed disclosure form below.</p>
<label for="disclosure">Filename:</label>
<input type="file" name="disclosure" id="disclosure"><br />
<p>
<input type="checkbox" name="agree" value="agree">
I accept the terms and conditions for abstract submission.
</p>
<p>Please note that once you click on the button below, your abstract will be submitted and no further
changes can be made. We appreciate your interest in this conference.</p>
<br />
<input id="submitform" name="submit" type="submit" value="Submit this Abstract"
style="width:250px;height:25px;color:black;" />
</form>
<br /><br />
</div>
</body>
</html>