<% if Request.Form("Name") <> "" then Set Mail = Server.CreateObject("Persits.MailSender") Mail.Host = "mail.RMHOnline.org" ' Specify a valid SMTP server Mail.From = "mail@RMHOnline.org" ' Specify sender's address Mail.FromName = "RMHOnline.org" ' Specify sender's name Mail.AddAddress "jhansbro@rhcc.com" if Request.Form("MailingList") <> "" then Mail.AddCC "jhansbro@rhcc.com" end if Mail.AddReplyTo "jhansbro@rhcc.com" Mail.Subject = "RMHOnline.com Physician Recruitment Information Request" BodyText = "RMHOnline.com Physician Recruitment Information Request" & vbcrlf BodyText = BodyText & "---------------------------------------------------" & vbcrlf & vbcrlf BodyText = BodyText & "Name: " & Request.Form("Name") & vbcrlf BodyText = BodyText & "Email: " & Request.Form("Email") & vbcrlf BodyText = BodyText & "Phone: " & Request.Form("Phone") & vbcrlf BodyText = BodyText & "Address: " & Request.Form("Address") & vbcrlf BodyText = BodyText & "City, State/Zip: " & Request.Form("City") & ", " & Request.Form("State") & " " & Request.Form("Zip") & vbcrlf BodyText = BodyText & "Area of Interest: " & Request.Form("Interest") & vbcrlf BodyText = BodyText & "Employment: " & Request.Form("Employment") & vbcrlf BodyText = BodyText & "Additional Information: " & Request.Form("AdditionalInfo") & vbcrlf if Request.Form("MailingList") <> "" then BodyText = BodyText & "This person would like to be contacted." & vbcrlf end if BodyText = BodyText & "---------------------------------------------------" & vbcrlf & vbcrlf Mail.Body = BodyText On Error Resume Next Mail.Send If Err <> 0 Then Response.Write "Error encountered: " & Err.Description Else Response.Write "






" Response.Write "Your request has been sent to our in-house physician recruiter.

Thank You!" End If set Mail = nothing Else %>

Physician Recruitment Information Request

Please complete the form below to contact an in-house physician recruiter.
Name*
Email*
Phone*
Address*
City, State/Zip* ,
Area of Interest*
Are you
interested in: 

Additional Information
I would like a physician recruiter to contact me.
* These fields are required
<% end if %>