q1="Please fill in your\nName"
q2="Please fill in your\nHome Address"
q3="Please fill in your\nCity"
q4="Please fill in your\nState"
q5="Please fill in your\nZip Code"
q6="Please fill in your\nHome Phone"
q7="Please fill in a valid\ne-mail address"


function checkdata(){
valid8=1;stamp=""
a1=document.abc
a1.action ="http://www.bethelct.org/health/healthvf.php"
if( valid8==1){;fn=a1.name.value;if (fn==""){;alert(q1);valid8=0;};};
if( valid8==1){;fn=a1.Haddress.value;if (fn==""){;alert(q2);valid8=0;};};
if( valid8==1){;fn=a1.Hcity.value;if (fn==""){;alert(q3);valid8=0;};};
if( valid8==1){;fn=a1.Hstate.value;if (fn==""){;alert(q4);valid8=0;};};
if( valid8==1){;fn=a1.Hzip.value;if (fn==""){;alert(q5);valid8=0;};};
if( valid8==1){;digits = "0123+()- 456789";pn=a1.Hphone.value;pnl=pn.length;
if(pnl<7){;valid8=0;};
for(pt=0;pt<pnl+1;pt++){
FP = pn.charAt(pt);
if (digits.indexOf(FP) == -1){;valid8=0;break;};
}
if( valid8==0){;alert(q6);};
}

//if( valid8==1){;fn=a1.email.value;
//if(fn!=""){
//tt=fn.indexOf("@");uu=fn.indexOf(".");emailPat=/^.+@.+\..{2,4}$/; asd5=fn.match(emailPat);
//if (fn=="" || tt<1 || uu<1 || asd5==null){;alert(q4);valid8=0;};};
//}
if( valid8==1){
a1.oem.value=a1.Hemail.value
if((a1.Hemail.value=="") && (a1.Wemail.value=="")){
a1.oem.value="None@x.yz"
}

if((a1.Hemail.value=="") && (a1.Wemail.value!="")){
a1.oem.value=a1.Wemail.value
}
if(a1.Hemail.value==""){
a1.Hemail.value="None@x.yz"
}
if(a1.Wemail.value==""){
a1.Wemail.value="None@x.yz"
}
}

stamp="Home Information\n"+a1.name.value+"\nAddress: "+a1.Haddress.value+"\n"+a1.Hcity.value+", "+a1.Hstate.value+" "+a1.Hzip.value+"\nPhone: "+a1.Hphone.value+"     Fax: "+a1.Hfax.value+"\nHome email "+a1.Hemail.value+"\n\n"
stamp=stamp+"Work Information\n"+a1.Wname.value+"\nAddress: "+a1.Waddress.value+"\n"+a1.Wcity.value+", "+a1.Wstate.value+" "+a1.Wzip.value+"\nPhone: "+a1.Wphone.value+"     Fax: "+a1.Wfax.value+"\nWork email "+a1.Wemail.value+"\n\n"
tm="No"
if(a1.textmessage[0].checked==1){;tm="Yes";};
stamp=stamp+"Occupation Skills:\n"+a1.occupation.value+"\n\nCell Phone: "+a1.Cphone.value+"    Text Messaging available: "+tm+"\n\n"
compe1=""
if(valid8==1){
compe1="Areas of Interest:\n"
if(a1.ab.checked==1){;compe1=compe1+a1.ab.value+"\n";};
if(a1.a2.checked==1){;compe1=compe1+a1.a2.value+"\n";};
if(a1.a3.checked==1){;compe1=compe1+a1.a3.value+"\n";};
if(a1.a4.checked==1){;compe1=compe1+a1.a4.value+"\n";};
if(a1.a5.checked==1){;compe1=compe1+a1.a5.value+"\n";};
if(a1.a6.checked==1){;compe1=compe1+a1.a6.value+"\n";};
if(a1.a7.checked==1){;compe1=compe1+a1.a7.value+"\n";};
if(a1.a8.checked==1){;compe1=compe1+a1.a8.value+"\n";};
if(a1.a9.checked==1){;compe1=compe1+a1.a9.value+"\n";};
if(a1.a10.checked==1){;compe1=compe1+a1.a10.value+"\n";};
if(a1.a11.checked==1){;compe1=compe1+a1.a11.value+"\n";};
if(a1.a12.checked==1){;compe1=compe1+a1.a12.value+"\n";};
if(a1.a13.checked==1){;compe1=compe1+a1.a13.value+"\n";};
if(a1.a14.checked==1){;compe1=compe1+a1.a14.value+"\n";};
if(a1.a15.checked==1){;compe1=compe1+a1.a15.value+"\n";};
if(a1.a16.checked==1){;compe1=compe1+a1.a16.value+"\n";};
if(a1.a17.checked==1){;compe1=compe1+a1.a17.value+"\n";};
stamp=stamp+compe1+"Other Areas of Interest: "+a1.other_interest.value+"\n\n"
}
if( valid8==1){
a1.stamp1.value=stamp
a1.submit()

}

}