"; } if (!empty($error)) { $errorcode = file_get_contents($error_url); $replace = "##error##"; $errorcode = str_replace($replace, $error, $errorcode); echo $errorcode; exit; } $internalfields = array ("submit", "reset", "send", "captcha_code"); $message .= $eol; $message .= "IP Address : "; $message .= $_SERVER['REMOTE_ADDR']; $message .= $eol; foreach ($_POST as $key => $value) { if (!in_array(strtolower($key), $internalfields)) { if (!is_array($value)) { $message .= ucwords(str_replace("_", " ", $key)) . " : " . $value . $eol; } else { $message .= ucwords(str_replace("_", " ", $key)) . " : " . implode(",", $value) . $eol; } } } $body = 'This is a multi-part message in MIME format.'.$eol.$eol; $body .= '--'.$boundary.$eol; $body .= 'Content-Type: text/plain; charset=ISO-8859-1'.$eol; $body .= 'Content-Transfer-Encoding: 8bit'.$eol; $body .= $eol.stripslashes($message).$eol; if (!empty($_FILES)) { foreach ($_FILES as $key => $value) { if ($_FILES[$key]['error'] == 0 && $_FILES[$key]['size'] <= $max_filesize) { $body .= '--'.$boundary.$eol; $body .= 'Content-Type: '.$_FILES[$key]['type'].'; name='.$_FILES[$key]['name'].$eol; $body .= 'Content-Transfer-Encoding: base64'.$eol; $body .= 'Content-Disposition: attachment; filename='.$_FILES[$key]['name'].$eol; $body .= $eol.chunk_split(base64_encode(file_get_contents($_FILES[$key]['tmp_name']))).$eol; } } } $body .= '--'.$boundary.'--'.$eol; mail($mailto, $subject, $body, $header); header('Location: '.$success_url); exit; } ?> Untitled Page
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Walsall Deaf Children's Society - Support Group For Families In The Walsall Area - Join Us
Join Us

Please register to join Walsall Deaf Children's Society.

Please fill in as much information as possible.




























































By completing this form you agree to become a member of our group.
Membership is completely free.
We use your data to send you information about our service and activities appropriate to your personal needs. This data will not be shared with any other party without your explicit permission.
You will receive a welcome email within 48 hours confirming your registration to our group. Contained in this email will be your username and password giving you access to members only areas of our site.
Name
Address
Postcode
email
Telephone/Minicom No.
Mobile No.
Are You?
Please Indicate Your Ethnic Origin?
Preferred Language
Child (No. 1) Name
Child (No. 1) Date Of Birth
Is Your Child?
Preferred Communication Method
Equipment Used
Child (No. 2) Name
Child (No. 2) Date Of Birth
Is Your Child?
Preferred Communication Method
Equipment Used
Child (No.3) Name
Child (No. 3) Date Of Birth
Is Your Child?
Preferred Communication Method
Equipment Used
What Are You Hoping To Get Out Of Joining Our Local Group?
What Kind Of Activities Could We Put On That Would Be Attractive To Your Family?
Would You Be Interested In Getting Involved With The Running Of Our Group?
In What Capacity Are You Interested In Our Group?
Enter The Characters Shown
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Walsall DCS is a registered association of
National Deaf Children's Society (Registered Charity 1016532)