\n";
$showSignupForm = true; // don't change this value
}
else {
// check recaptcha
$postdata = array();
$postdata['secret'] = '6Lfd5RcTAAAAANqxhQj_0hqmPJusJAh90pkloOKA';
$postdata['response'] = @$_REQUEST['g-recaptcha-response'];
$postdata['remoteip'] = $_SERVER['REMOTE_ADDR'];
$url = "https://www.google.com/recaptcha/api/siteverify?". http_build_query($postdata, '', '&');
list($json, $httpStatusCode, $headers, $request) = getPage($url, 5, '', true);
$recaptchaResponse = json_decode($json, true);
if (!@$recaptchaResponse['success']) {
if (is_array(@$recaptchaResponse['error-codes'])) {
if (in_array('missing-input-secret', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "There's a problem with recaptcha, please let us know! (no secret)
\n"; }
if (in_array('invalid-input-secret', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "There's a problem with recaptcha, please let us know! (invald secret)
\n"; }
if (in_array('missing-input-response', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "Please fill out the recaptcha box!
\n";
$showSignupForm = true; // do we need this line?
}
if (in_array('invalid-input-response', @$recaptchaResponse['error-codes'])) { $errorsAndAlerts .= "Please fill out the recaptcha box again, your answer was incorrect!
\n"; $showSignupForm = true; // do we need this line?
}
if (!$errorsAndAlerts) { $errorsAndAlerts .= "Invalid captcha response, please try again or contact us directly and let us know."; }
@trigger_error("Failed recaptcha on signup form", E_USER_NOTICE);
}}
}
return $errorsAndAlerts;
}
?>
\n"; }
if (!@$_REQUEST['last_name']) { $errorsAndAlerts .= "You must enter a last name
\n"; }
if (!@$_REQUEST['email']) { $errorsAndAlerts .= "You must enter your email!
\n"; }
else if(!isValidEmail(@$_REQUEST['email'])) { $errorsAndAlerts .= "Please enter a valid email (example: user@example.com)
\n"; }
else if (@$_REQUEST['email'] != @$_REQUEST['email2']) { $errorsAndAlerts .= "Your emails must match
\n"; }
$first = $_REQUEST['first_name'];
$last = $_REQUEST['last_name'];
$practice = $_REQUEST['practice_name'];
if(preg_match("/[?!\"\[\]\*0-9&#<>\(\).]/", $first )){
$errorsAndAlerts .= "
Firsr names can not contain anything except alphabetical characters
\n";
}
if(preg_match("/[?!\"\[\]\*0-9&#<>\(\).]/", $last )){
$errorsAndAlerts .= "Last names an not contain anything except alphabetical characters
\n";
}
if(preg_match("/[?!\"\[\]\*0-9&#<>\(\).]/", $practice )){
$errorsAndAlerts .= "Practice names can not contain anything except alphabetical characters
\n";
}
// add user
if (!$errorsAndAlerts) {
@$_REQUEST['practice_name'] = preg_replace("/ /", '-', @$_REQUEST['practice_name']);
@$_REQUEST['first_name'] = preg_replace("/ /", '-', @$_REQUEST['first_name']);
@$_REQUEST['last_name'] = preg_replace("/ /", '-', @$_REQUEST['last_name']);
// send email to Admin
$emailHeaders = emailTemplate_loadFromDB(array(
'template_id' => 'DIRECTORY-LISTING-REQUEST',
'placeholders' => array(
'contact.firstName' => $_REQUEST['first_name'],
'contact.lastName' => $_REQUEST['last_name'],
'contact.email' => $_REQUEST['email'],
'practice' => $_REQUEST['practice_name'],
'contact.username' => $_REQUEST['username'],
)));
$mailErrors = sendMessage($emailHeaders);
if ($mailErrors) { alert("Mail Error: $mailErrors"); }
// show thanks
$errorsAndAlerts = "
THANKS FOR WANTING TO LIST YOUR SERVICES
IN THE DBT SERVICE PROVIDER DIRECTORY
Your directory listing request has been sent successfully.
You'll get an email from us after we've reviewed your request.
Best,
The DPT Service Provider Directory Team
";
$_REQUEST = array(); // clear form values
$showSignupForm = false;
}
?>
LISTING REQUEST - DBT Provider Directory
">
$upload): ?>
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USE THIS FORM TO TO REQUEST A LISTING
IN THE DBT SERVICE PROVIDER DIRECTORY
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