<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Session.LCID = 1033 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("authorization_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(17) Dim arFormDBFields0(17) Dim arFormValues0(17) arFormFields0(0) = "dav" arFormDBFields0(0) = "dav" arFormValues0(0) = Request("dav") arFormFields0(1) = "honor_guard" arFormDBFields0(1) = "honor_guard" arFormValues0(1) = Request("honor_guard") arFormFields0(2) = "honor_guard_location" arFormDBFields0(2) = "honor_guard_location" arFormValues0(2) = Request("honor_guard_location") arFormFields0(3) = "dates_of_service" arFormDBFields0(3) = "dates_of_service" arFormValues0(3) = Request("dates_of_service") arFormFields0(4) = "american_legion_post" arFormDBFields0(4) = "american_legion_post" arFormValues0(4) = Request("american_legion_post") arFormFields0(5) = "branch_of_service" arFormDBFields0(5) = "branch_of_service" arFormValues0(5) = Request("branch_of_service") arFormFields0(6) = "email" arFormDBFields0(6) = "email" arFormValues0(6) = Request("email") arFormFields0(7) = "referral" arFormDBFields0(7) = "referral" arFormValues0(7) = Request("referral") arFormFields0(8) = "telephone" arFormDBFields0(8) = "telephone" arFormValues0(8) = Request("telephone") arFormFields0(9) = "war_conflict" arFormDBFields0(9) = "war_conflict" arFormValues0(9) = Request("war_conflict") arFormFields0(10) = "dav_chapter" arFormDBFields0(10) = "dav_chapter" arFormValues0(10) = Request("dav_chapter") arFormFields0(11) = "american_legion" arFormDBFields0(11) = "american_legion" arFormValues0(11) = Request("american_legion") arFormFields0(12) = "name" arFormDBFields0(12) = "name" arFormValues0(12) = Request("name") arFormFields0(13) = "state_of_residence" arFormDBFields0(13) = "state_of_residence" arFormValues0(13) = Request("state_of_residence") arFormFields0(14) = "questions_comments" arFormDBFields0(14) = "questions_comments" arFormValues0(14) = Request("questions_comments") arFormFields0(15) = "vfw_post" arFormDBFields0(15) = "vfw_post" arFormValues0(15) = Request("vfw_post") arFormFields0(16) = "vfw" arFormDBFields0(16) = "vfw" arFormValues0(16) = Request("vfw") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 If Request.ServerVariables("REMOTE_HOST") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name1" End If If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type1" End If FP_SaveFieldToDB fp_rs, Now, "Timestamp1" If Request.ServerVariables("REMOTE_USER") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name1" End If fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close Session("FP_SavedFields")=arFormFields0 Session("FP_SavedValues")=arFormValues0 Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") Response.Redirect "confirmation.asp" End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> Veteran Authorization Form
   

Veteran Authorization Form

In order for the TriState Insider to include your information in the "Tribute to Active Troops and Veterans" we must have your permission.  Please complete the following form and submit it.  If you prefer to print the form and mail it to us, we have included a link to a printable form at the bottom of this page.  Please help us spread the word so more service men and women can be honored.

Should you have questions, please don't hesitate to ask.  We appreciate your service for our country and the opportunity to say "Thank You!"
 

Your Name:

 (Last name, First name)

State of Residence:

Telephone: (optional)

e-Mail Address:

Branch of Service

Dates of Service:

Name of War/Conflict:

If you served in more than one war/conflict, please complete a separate form for each one. 

What Veteran Organizations are you a member of?

American Legion:

 Post:

Disabled American Veterans (DAV)

 Chapter: 

Veterans of Foreign Affairs (VFW)

 Post:

Honor Guard:

 Location:
 

Please use the field below to ask questions, make comments or offer suggestions:

 

How did you hear about the TriState Insider?

 

Submission of this form grants my permission to the TriState Insider to publish on their website the service information I have provided.  I understand this information will only be used to recognize and pay tribute to the Veterans and Active Duty Personnel of the tri-state area for their role in America's freedom and will not be used in any other way.
 

If you have questions please contact us by email or telephone: (706) 838-5920

For a printable version of this form, Click Here.

home | georgia | north carolina | tennessee | advertising | auction | for rent | for sale |

place ad | atkins diet recipes | tribute to veterans | contact us

©2007 - 2009 TriState Insider. All rights reserved.
Site Developed and Maintained by Biz Solutions Unlimited

TriState Insider is Veteran Owned and Operated