") else %>
Clinical Trials Investigator Requests
If you are a physician interested in participating in future Regeneron clinical trials, please enter your information below.
<% end if %>
<%
if request.ServerVariables("REQUEST_METHOD") = "POST" then
dim mailObj, toAddress, fromAddress, subject, message, objErr
toAddress="Joanne.Papadopoulos@regeneron.com"
fromAddress="no-reply@regeneron.com"
set mailObj = Server.CreateObject("CDO.Message")
mailObj.To = toAddress
mailObj.From = fromAddress
mailObj.Subject = "clinical trial physician request"
mailObj.TextBody = "This message was generated from the form located at http://www.regeneron.com/physician_form.asp. Please do not reply to this email."
mailObj.TextBody = mailObj.TextBody & VbCrLf & VbCrLf & "First Name: "+Request.Form("first_name")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Last Name: "+Request.Form("last_name")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Specialty: "+Request.Form("specialty")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Years Experience: "+Request.Form("years_experience")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Practice Name: "+Request.Form("practice_name")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Address One: "+Request.Form("address_one")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Address Two: "+Request.Form("address_two")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "City: "+Request.Form("city")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "State: "+Request.Form("state")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Postal Code: "+Request.Form("postal_code")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Country: "+Request.Form("country")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "email: "+Request.Form("email")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Phone Number: "+Request.Form("phone_number")
mailObj.TextBody = mailObj.TextBody & VbCrLf & "Additional Information: "+Request.Form("additional_information")
'chnange default smtp configuration
mailObj.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/sendusing") = 2
mailObj.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = "192.246.118.40"
mailObj.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25
mailObj.Configuration.Fields.Update
mailObj.Send
set mailObj = nothing
Response.Write("Thank you for your submission.
") else %>
<% end if %>
") else %>
<% end if %>