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POsending form select option values to database not working
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  1. POsending form select option values to database not working
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    copied!<p>Im working on a form that posts a select option value to my database. I have done all the code with dreamweaver server behaviors but still does not work. Here is the HTML and PHP code.</p> <p>Any help appreciated</p> <pre><code>&lt;form method="POST" action="&lt;?php echo $editFormAction; ?&gt;" name="applynow"&gt; &lt;table width="550" border="0"&gt; &lt;tr&gt;&lt;h4&gt;Name *&lt;/h4&gt; &lt;td width="264"&gt;&lt;input name="fname" type="text" size="30" maxlength="35" placeholder="First Name"/&gt;&lt;/td&gt; &lt;td width="276"&gt;&lt;input name="lname" type="text" size="30" maxlength="35" placeholder="Last Name"/&gt;&lt;/td&gt; &lt;/tr&gt; &lt;/table&gt; &lt;p&gt; &lt;label&gt; &lt;input type="radio" name="gender" value="male" id="male" /&gt; Male&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="gender" value="female" id="female" /&gt; Female&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;/table&gt; &lt;table width="550" border="0"&gt; &lt;tr&gt; &lt;h4&gt;Address *&lt;/h4&gt;&lt;p&gt;&lt;input style="width:485px" name="address_1" type="text" size="30" maxlength="30" placeholder="Street Address"/&gt; &lt;/tr&gt; &lt;tr&gt; &lt;input style="width:485px" name="address_2" type="text" size="30" maxlength="30" placeholder="Address Line 2"/&gt; &lt;/tr&gt; &lt;/table&gt; &lt;table width="550" border="0"&gt; &lt;tr&gt; &lt;td&gt;&lt;input name="city" type="text" size="30" maxlength="30" placeholder="City"/&gt;&lt;/td&gt; &lt;td&gt;&lt;input name="state" type="text" size="30" maxlength="30" placeholder="State / Province / Region"/&gt;&lt;/td&gt; &lt;/tr&gt; &lt;tr&gt; &lt;td&gt;&lt;input name="zipcode" type="text" size="30" maxlength="30" placeholder="Zip / Postal Code"/&gt;&lt;/td&gt; &lt;td&gt; &lt;select style="width:223px" name='Country' tabindex='12' id="Country" &gt; &lt;option value="Not Selected"&gt;Select you country&lt;/option&gt; &lt;option value='Afghanistan' &gt;Afghanistan&lt;/option&gt; &lt;option value='Albania'&gt;Albania&lt;/option&gt; &lt;option value='Algeria' &gt;Algeria&lt;/option&gt; &lt;option value='American Samoa' &gt;American Samoa&lt;/option&gt; &lt;option value='Andorra' &gt;Andorra&lt;/option&gt; &lt;option value='Angola' &gt;Angola&lt;/option&gt; &lt;option value='Antigua and Barbuda' &gt;Antigua and Barbuda&lt;/option&gt; &lt;option value='Argentina' &gt;Argentina&lt;/option&gt; &lt;option value='Armenia' &gt;Armenia&lt;/option&gt; &lt;option value='Australia' &gt;Australia&lt;/option&gt; &lt;option value='Austria' &gt;Austria&lt;/option&gt; &lt;option value='Azerbaijan' &gt;Azerbaijan&lt;/option&gt; &lt;option value='Bahamas' &gt;Bahamas&lt;/option&gt; &lt;option value='Bahrain' &gt;Bahrain&lt;/option&gt; &lt;option value='Bangladesh' &gt;Bangladesh&lt;/option&gt; &lt;option value='Barbados' &gt;Barbados&lt;/option&gt; &lt;option value='Belarus' &gt;Belarus&lt;/option&gt; &lt;option value='Belgium' &gt;Belgium&lt;/option&gt; &lt;option value='Belize' &gt;Belize&lt;/option&gt; &lt;option value='Benin' &gt;Benin&lt;/option&gt; &lt;option value='Bermuda' &gt;Bermuda&lt;/option&gt; &lt;option value='Bhutan' &gt;Bhutan&lt;/option&gt; &lt;option value='Bolivia' &gt;Bolivia&lt;/option&gt; &lt;option value='Bosnia and Herzegovina' &gt;Bosnia and Herzegovina&lt;/option&gt; &lt;option value='Botswana' &gt;Botswana&lt;/option&gt; &lt;option value='Brazil' &gt;Brazil&lt;/option&gt; &lt;option value='Brunei' &gt;Brunei&lt;/option&gt; &lt;option value='Bulgaria' &gt;Bulgaria&lt;/option&gt; &lt;option value='Burkina Faso' &gt;Burkina Faso&lt;/option&gt; &lt;option value='Burundi' &gt;Burundi&lt;/option&gt; &lt;option value='Cambodia' &gt;Cambodia&lt;/option&gt; &lt;option value='Cameroon' &gt;Cameroon&lt;/option&gt; &lt;option value='Canada' &gt;Canada&lt;/option&gt; &lt;option value='Cape Verde' &gt;Cape Verde&lt;/option&gt; &lt;option value='Central African Republic' &gt;Central African Republic&lt;/option&gt; &lt;option value='Chad' &gt;Chad&lt;/option&gt; &lt;option value='Chile' &gt;Chile&lt;/option&gt; &lt;option value='China' &gt;China&lt;/option&gt; &lt;option value='Colombia' &gt;Colombia&lt;/option&gt; &lt;option value='Comoros' &gt;Comoros&lt;/option&gt; &lt;option value='Congo, Democratic Republic of the' &gt;Congo, Democratic Republic of the&lt;/option&gt; &lt;option value='Congo, Republic of the' &gt;Congo, Republic of the&lt;/option&gt; &lt;option value='Costa Rica' &gt;Costa Rica&lt;/option&gt; &lt;option value='C&amp;ocirc;te d&amp;#039;Ivoire' &gt;C&amp;ocirc;te d'Ivoire&lt;/option&gt; &lt;option value='Croatia' &gt;Croatia&lt;/option&gt; &lt;option value='Cuba' &gt;Cuba&lt;/option&gt; &lt;option value='Cyprus' &gt;Cyprus&lt;/option&gt; &lt;option value='Czech Republic' &gt;Czech Republic&lt;/option&gt; &lt;option value='Denmark' &gt;Denmark&lt;/option&gt; &lt;option value='Djibouti' &gt;Djibouti&lt;/option&gt; &lt;option value='Dominica' &gt;Dominica&lt;/option&gt; &lt;option value='Dominican Republic' &gt;Dominican Republic&lt;/option&gt; &lt;option value='East Timor' &gt;East Timor&lt;/option&gt; &lt;option value='Ecuador' &gt;Ecuador&lt;/option&gt; &lt;option value='Egypt' &gt;Egypt&lt;/option&gt; &lt;option value='El Salvador' &gt;El Salvador&lt;/option&gt; &lt;option value='Equatorial Guinea' &gt;Equatorial Guinea&lt;/option&gt; &lt;option value='Eritrea' &gt;Eritrea&lt;/option&gt; &lt;option value='Estonia' &gt;Estonia&lt;/option&gt; &lt;option value='Ethiopia' &gt;Ethiopia&lt;/option&gt; &lt;option value='Fiji' &gt;Fiji&lt;/option&gt; &lt;option value='Finland' &gt;Finland&lt;/option&gt; &lt;option value='France' &gt;France&lt;/option&gt; &lt;option value='Gabon' &gt;Gabon&lt;/option&gt; &lt;option value='Gambia' &gt;Gambia&lt;/option&gt; &lt;option value='Georgia' &gt;Georgia&lt;/option&gt; &lt;option value='Germany' &gt;Germany&lt;/option&gt; &lt;option value='Ghana' &gt;Ghana&lt;/option&gt; &lt;option value='Greece' &gt;Greece&lt;/option&gt; &lt;option value='Greenland' &gt;Greenland&lt;/option&gt; &lt;option value='Grenada' &gt;Grenada&lt;/option&gt; &lt;option value='Guam' &gt;Guam&lt;/option&gt; &lt;option value='Guatemala' &gt;Guatemala&lt;/option&gt; &lt;option value='Guinea' &gt;Guinea&lt;/option&gt; &lt;option value='Guinea-Bissau' &gt;Guinea-Bissau&lt;/option&gt; &lt;option value='Guyana' &gt;Guyana&lt;/option&gt; &lt;option value='Haiti' &gt;Haiti&lt;/option&gt; &lt;option value='Honduras' &gt;Honduras&lt;/option&gt; &lt;option value='Hong Kong' &gt;Hong Kong&lt;/option&gt; &lt;option value='Hungary' &gt;Hungary&lt;/option&gt; &lt;option value='Iceland' &gt;Iceland&lt;/option&gt; &lt;option value='India' &gt;India&lt;/option&gt; &lt;option value='Indonesia' &gt;Indonesia&lt;/option&gt; &lt;option value='Iran' &gt;Iran&lt;/option&gt; &lt;option value='Iraq' &gt;Iraq&lt;/option&gt; &lt;option value='Ireland' &gt;Ireland&lt;/option&gt; &lt;option value='Israel' &gt;Israel&lt;/option&gt; &lt;option value='Italy' &gt;Italy&lt;/option&gt; &lt;option value='Jamaica' &gt;Jamaica&lt;/option&gt; &lt;option value='Japan' &gt;Japan&lt;/option&gt; &lt;option value='Jordan' &gt;Jordan&lt;/option&gt; &lt;option value='Kazakhstan' &gt;Kazakhstan&lt;/option&gt; &lt;option value='Kenya' &gt;Kenya&lt;/option&gt; &lt;option value='Kiribati' &gt;Kiribati&lt;/option&gt; &lt;option value='North Korea' &gt;North Korea&lt;/option&gt; &lt;option value='South Korea' &gt;South Korea&lt;/option&gt; &lt;option value='Kuwait' &gt;Kuwait&lt;/option&gt; &lt;option value='Kyrgyzstan' &gt;Kyrgyzstan&lt;/option&gt; &lt;option value='Laos' &gt;Laos&lt;/option&gt; &lt;option value='Latvia' &gt;Latvia&lt;/option&gt; &lt;option value='Lebanon' &gt;Lebanon&lt;/option&gt; &lt;option value='Lesotho' &gt;Lesotho&lt;/option&gt; &lt;option value='Liberia' &gt;Liberia&lt;/option&gt; &lt;option value='Libya' &gt;Libya&lt;/option&gt; &lt;option value='Liechtenstein' &gt;Liechtenstein&lt;/option&gt; &lt;option value='Lithuania' &gt;Lithuania&lt;/option&gt; &lt;option value='Luxembourg' &gt;Luxembourg&lt;/option&gt; &lt;option value='Macedonia' &gt;Macedonia&lt;/option&gt; &lt;option value='Madagascar' &gt;Madagascar&lt;/option&gt; &lt;option value='Malawi' &gt;Malawi&lt;/option&gt; &lt;option value='Malaysia' &gt;Malaysia&lt;/option&gt; &lt;option value='Maldives' &gt;Maldives&lt;/option&gt; &lt;option value='Mali' &gt;Mali&lt;/option&gt; &lt;option value='Malta' &gt;Malta&lt;/option&gt; &lt;option value='Marshall Islands' &gt;Marshall Islands&lt;/option&gt; &lt;option value='Mauritania' &gt;Mauritania&lt;/option&gt; &lt;option value='Mauritius' &gt;Mauritius&lt;/option&gt; &lt;option value='Mexico' &gt;Mexico&lt;/option&gt; &lt;option value='Micronesia' &gt;Micronesia&lt;/option&gt; &lt;option value='Moldova' &gt;Moldova&lt;/option&gt; &lt;option value='Monaco' &gt;Monaco&lt;/option&gt; &lt;option value='Mongolia' &gt;Mongolia&lt;/option&gt; &lt;option value='Montenegro' &gt;Montenegro&lt;/option&gt; &lt;option value='Morocco' &gt;Morocco&lt;/option&gt; &lt;option value='Mozambique' &gt;Mozambique&lt;/option&gt; &lt;option value='Myanmar' &gt;Myanmar&lt;/option&gt; &lt;option value='Namibia' &gt;Namibia&lt;/option&gt; &lt;option value='Nauru' &gt;Nauru&lt;/option&gt; &lt;option value='Nepal' &gt;Nepal&lt;/option&gt; &lt;option value='Netherlands' &gt;Netherlands&lt;/option&gt; &lt;option value='New Zealand' &gt;New Zealand&lt;/option&gt; &lt;option value='Nicaragua' &gt;Nicaragua&lt;/option&gt; &lt;option value='Niger' &gt;Niger&lt;/option&gt; &lt;option value='Nigeria' &gt;Nigeria&lt;/option&gt; &lt;option value='Norway' &gt;Norway&lt;/option&gt; &lt;option value='Northern Mariana Islands' &gt;Northern Mariana Islands&lt;/option&gt; &lt;option value='Oman' &gt;Oman&lt;/option&gt; &lt;option value='Pakistan' &gt;Pakistan&lt;/option&gt; &lt;option value='Palau' &gt;Palau&lt;/option&gt; &lt;option value='Palestine' &gt;Palestine&lt;/option&gt; &lt;option value='Panama' &gt;Panama&lt;/option&gt; &lt;option value='Papua New Guinea' &gt;Papua New Guinea&lt;/option&gt; &lt;option value='Paraguay' &gt;Paraguay&lt;/option&gt; &lt;option value='Peru' &gt;Peru&lt;/option&gt; &lt;option value='Philippines' &gt;Philippines&lt;/option&gt; &lt;option value='Poland' &gt;Poland&lt;/option&gt; &lt;option value='Portugal' &gt;Portugal&lt;/option&gt; &lt;option value='Puerto Rico' &gt;Puerto Rico&lt;/option&gt; &lt;option value='Qatar' &gt;Qatar&lt;/option&gt; &lt;option value='Romania' &gt;Romania&lt;/option&gt; &lt;option value='Russia' &gt;Russia&lt;/option&gt; &lt;option value='Rwanda' &gt;Rwanda&lt;/option&gt; &lt;option value='Saint Kitts and Nevis' &gt;Saint Kitts and Nevis&lt;/option&gt; &lt;option value='Saint Lucia' &gt;Saint Lucia&lt;/option&gt; &lt;option value='Saint Vincent and the Grenadines' &gt;Saint Vincent and the Grenadines&lt;/option&gt; &lt;option value='Samoa' &gt;Samoa&lt;/option&gt; &lt;option value='San Marino' &gt;San Marino&lt;/option&gt; &lt;option value='Sao Tome and Principe' &gt;Sao Tome and Principe&lt;/option&gt; &lt;option value='Saudi Arabia' &gt;Saudi Arabia&lt;/option&gt; &lt;option value='Senegal' &gt;Senegal&lt;/option&gt; &lt;option value='Serbia and Montenegro' &gt;Serbia and Montenegro&lt;/option&gt; &lt;option value='Seychelles' &gt;Seychelles&lt;/option&gt; &lt;option value='Sierra Leone' &gt;Sierra Leone&lt;/option&gt; &lt;option value='Singapore' &gt;Singapore&lt;/option&gt; &lt;option value='Slovakia' &gt;Slovakia&lt;/option&gt; &lt;option value='Slovenia' &gt;Slovenia&lt;/option&gt; &lt;option value='Solomon Islands' &gt;Solomon Islands&lt;/option&gt; &lt;option value='Somalia' &gt;Somalia&lt;/option&gt; &lt;option value='South Africa' &gt;South Africa&lt;/option&gt; &lt;option value='Spain' &gt;Spain&lt;/option&gt; &lt;option value='Sri Lanka' &gt;Sri Lanka&lt;/option&gt; &lt;option value='Sudan' &gt;Sudan&lt;/option&gt; &lt;option value='Sudan, South' &gt;Sudan, South&lt;/option&gt; &lt;option value='Suriname' &gt;Suriname&lt;/option&gt; &lt;option value='Swaziland' &gt;Swaziland&lt;/option&gt; &lt;option value='Sweden' &gt;Sweden&lt;/option&gt; &lt;option value='Switzerland' &gt;Switzerland&lt;/option&gt; &lt;option value='Syria' &gt;Syria&lt;/option&gt; &lt;option value='Taiwan' &gt;Taiwan&lt;/option&gt; &lt;option value='Tajikistan' &gt;Tajikistan&lt;/option&gt; &lt;option value='Tanzania' &gt;Tanzania&lt;/option&gt; &lt;option value='Thailand' &gt;Thailand&lt;/option&gt; &lt;option value='Togo' &gt;Togo&lt;/option&gt; &lt;option value='Tonga' &gt;Tonga&lt;/option&gt; &lt;option value='Trinidad and Tobago' &gt;Trinidad and Tobago&lt;/option&gt; &lt;option value='Tunisia' &gt;Tunisia&lt;/option&gt; &lt;option value='Turkey' &gt;Turkey&lt;/option&gt; &lt;option value='Turkmenistan' &gt;Turkmenistan&lt;/option&gt; &lt;option value='Tuvalu' &gt;Tuvalu&lt;/option&gt; &lt;option value='Uganda' &gt;Uganda&lt;/option&gt; &lt;option value='Ukraine' &gt;Ukraine&lt;/option&gt; &lt;option value='United Arab Emirates' &gt;United Arab Emirates&lt;/option&gt; &lt;option value='United Kingdom' &gt;United Kingdom&lt;/option&gt; &lt;option value='United States' &gt;United States&lt;/option&gt; &lt;option value='Uruguay' &gt;Uruguay&lt;/option&gt; &lt;option value='Uzbekistan' &gt;Uzbekistan&lt;/option&gt; &lt;option value='Vanuatu' &gt;Vanuatu&lt;/option&gt; &lt;option value='Vatican City' &gt;Vatican City&lt;/option&gt; &lt;option value='Venezuela' &gt;Venezuela&lt;/option&gt; &lt;option value='Vietnam' &gt;Vietnam&lt;/option&gt; &lt;option value='Virgin Islands, British' &gt;Virgin Islands, British&lt;/option&gt; &lt;option value='Virgin Islands, U.S.' &gt;Virgin Islands, U.S.&lt;/option&gt; &lt;option value='Yemen' &gt;Yemen&lt;/option&gt; &lt;option value='Zambia' &gt;Zambia&lt;/option&gt; &lt;option value='Zimbabwe' &gt;Zimbabwe&lt;/option&gt; &lt;/select&gt; &lt;/td&gt; &lt;/tr&gt; &lt;tr&gt; &lt;td&gt; &lt;h4&gt;Phone *&lt;/h4&gt;&lt;p&gt; &lt;input name="day_phone" type="text" size="30" maxlength="30" /&gt; &lt;/td&gt; &lt;td&gt; &lt;h4&gt;Email&lt;/h4&gt;&lt;p&gt; &lt;input name="email" type="text" size="30" maxlength="30" /&gt; &lt;/td&gt; &lt;/tr&gt; &lt;tr&gt; &lt;td colspan="2"&gt; &lt;h4&gt;Study number or name you are interested in&lt;/h4&gt; &lt;p&gt; &lt;input name="study" style="width:400px" type="text" size="30" maxlength="30" /&gt; &lt;/td&gt; &lt;/tr&gt; &lt;tr&gt; &lt;td colspan="2"&gt; &lt;h4&gt;Language *&lt;/h4&gt;&lt;p&gt; &lt;select name="language" style="width:220px"&gt; &lt;option value="English"&gt;English&lt;/option&gt; &lt;option value="Español" &gt;Español&lt;/option&gt; &lt;option value="Other"&gt;Other&lt;/option&gt; &lt;/select&gt; &lt;tr&gt; &lt;td colspan="2"&gt; &lt;h4&gt;Are you interested in a specific study?&lt;p&gt; &lt;select name="specific-study" style="width:220px"&gt; &lt;option value="Gout"&gt;Gout RDEA594-301&lt;/option&gt; &lt;option value="Diabetes"&gt;Diabetes TYPE II OMNEON-018&lt;/option&gt; &lt;option value="COPD"&gt;COPD PT-003007&lt;/option&gt; &lt;/select&gt; &lt;tr&gt; &lt;td colspan="2"&gt; &lt;h4&gt;How did you hear about us?&lt;/h4&gt;&lt;p&gt; &lt;select name='referral' style="width:220px"&gt; &lt;option value='internet' &gt;Internet&lt;/option&gt; &lt;option value='newspaper'&gt;Newspaper&lt;/option&gt; &lt;option value='magazine'&gt;Magazine&lt;/option&gt; &lt;option value='radio'&gt;Radio&lt;/option&gt; &lt;option value='tv'&gt;Television&lt;/option&gt; &lt;option value='doctor'&gt;Doctor&lt;/option&gt; &lt;option value='friend'&gt;Friend&lt;/option&gt; &lt;option value='family-member'&gt;Family Member&lt;/option&gt; &lt;option value='s-s'&gt;Spouse/Significant Other&lt;/option&gt; &lt;option value='other'&gt;Other&lt;/option&gt; &lt;/select&gt; &lt;/td&gt; &lt;/tr&gt; &lt;tr&gt; &lt;td colspan="2"&gt; &lt;h4&gt;Date of Birth *&lt;/h4&gt;&lt;p&gt; &lt;input type="text" name="birthdate" placeholder="MM/DD/YYYY"/&gt; &lt;/td&gt; &lt;/tr&gt; &lt;/table&gt; &lt;div class="tail2"&gt;&lt;h4&gt;SECTION 2: PARTICIPANT INFORMATION&lt;/h4&gt;&lt;/div&gt; &lt;h4&gt;When are you available for overnight stays? *&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="checkbox" name="overnight-stay" value="anytime" id="anytime" /&gt; Anytime&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="overnight-stay" value="weekends" id="weekends" /&gt; Weekends&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="overnight-stay" value="weekdays" id="weekdays" /&gt; Weekdays&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="overnight-stay" value="outpatient" id="outpatient" /&gt; Outpatient Only&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="overnight-stay" value="shortStaysOnly" id="shortStaysOnly" /&gt; Short Stays Only&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="overnight-stay" value="longStaysOnly" id="longStaysOnly" /&gt; Long Stays Only&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Smoking Status *&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="radio" name="smoking" value="none" id="none" /&gt; None (no nicotine w/in the last 90 days)&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="smoking" value="1-10/day" id="1-10/day" /&gt; 1 to 10 Cigarettes/Day&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="smoking" value="11-20/day" id="11-20/day" /&gt; 11 to 20 Cigarettes/Day&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="smoking" value="21+/day" id="21+/day" /&gt; 21 or more Cigarettes/Day&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="smoking" value="occasional-social" id="occasional-social" /&gt; Occasional Smoker/Social Smoker&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="smoking" value="other" id="other" /&gt; Other&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Taking any Prescriptions or Medicines *&lt;/h4&gt;&lt;p&gt; &lt;textarea style="width:535px; height:100px" name="scripts" cols="150" rows="10"&gt;&lt;/textarea&gt; &lt;p style="font-size:10px; margin-top:-30px"&gt;Please list any prescription or over-the-counter medication you have taken within the last 30 days (Including birth control, vitamins, herbal supplements). If you have not taken any prescription or over-the-counter drugs in the past 30 days, type None.&lt;/p&gt; &lt;h4&gt;Allergies? *&lt;/h4&gt;&lt;p&gt; &lt;textarea style="width:535px; height:100px" name="allergies" cols="150" rows="20"&gt;&lt;/textarea&gt; &lt;p style="font-size:10px; margin-top:-30px"&gt;If you are allergic to medications, please list what they are, and the reaction you have to the medication (e.g. Penicillin: rash, Codeine: swelling). You do no not have any alleriges, type None.&lt;/p&gt; &lt;h4&gt;Medical Conditions? *&lt;/h4&gt;&lt;p&gt; &lt;textarea style="width:535px; height:100px" name="medcond" cols="150" rows="20"&gt;&lt;/textarea&gt; &lt;p style="font-size:10px; margin-top:-30px"&gt;Please list any chronic medical conditions or diagnosis (e.g. asthma, diabetes, high blood pressure, depression, etc.) If you do not have any chronic medical conditions, type None.&lt;/p&gt; &lt;h4&gt;Dietary Needs? *&lt;/h4&gt;&lt;p&gt; &lt;textarea style="width:535px; height:100px" name="dietneeds" cols="150" rows="20"&gt;&lt;/textarea&gt; &lt;p style="font-size:10px; margin-top:-30px"&gt;Please list any special dietary needs (e.g. vegetarian, lactose intolerant, diabetic). If you do not have any special dietary needs, type None.&lt;/p&gt; &lt;h4&gt;If Vegetarian/Vegen/Lactose, would you be willing to eat meat/dairy if the study required it?*&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="radio" name="ifvegan" value="yes" id="yes" /&gt; Yes&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="ifvegan" value="no" id="no" /&gt; No&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="ifvegan" value="na" id="na" /&gt; Not Applicable&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Do you have (please check all that apply)? *&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="checkbox" name="conditions" value="h-a" id="CheckboxGroup1_0" /&gt; Hepatitis A&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="conditions" value="h-b" id="CheckboxGroup1_1" /&gt; Hepatitis B&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="conditions" value="h-c" id="CheckboxGroup1_2" /&gt; Hepatitis C&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="conditions" value="hiv" id="CheckboxGroup1_3" /&gt; HIV&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="checkbox" name="conditions" value="none" id="CheckboxGroup1_4" /&gt; None of the above&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Have you used any illicit drugs in the past year? *&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="radio" name="drugs" value="yes" id="drugs_0" /&gt; Yes&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="drugs" value="no" id="drugs_1" /&gt; No&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Height *&lt;/h4&gt;&lt;p&gt; &lt;input name="height" type="text" size="30" maxlength="30" /&gt; &lt;h4&gt;Weight *&lt;/h4&gt;&lt;p&gt; &lt;input name="weight" type="text" size="30" maxlength="30" /&gt; &lt;h4&gt;What would you classify your race as? *&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="radio" name="race" value="African American/Black" id="race_0" /&gt; African American/Black&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="American Eskimo" id="race_1" /&gt; American Eskimo&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Asian" id="race_2" /&gt; Asian&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Caucasian" id="race_3" /&gt; Caucasian&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Hispanic" id="race_4" /&gt; Hispanic&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Latino" id="race_5" /&gt; Latino&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Middle Eastern" id="race_6" /&gt; Middle Eastern&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Native American" id="race_7" /&gt; Native American&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Pacific Islander" id="race_8" /&gt; Pacific Islander&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="race" value="Other" id="race_9" /&gt; Other&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Can we retain this information in our confidential database? *&lt;/h4&gt; &lt;p&gt; &lt;label&gt; &lt;input type="radio" name="retain-info" value="yes" id="retain-info_0" /&gt; Yes&lt;/label&gt; &lt;br /&gt; &lt;label&gt; &lt;input type="radio" name="retain-info" value="no" id="retain-info_1" /&gt; No&lt;/label&gt; &lt;br /&gt; &lt;/p&gt; &lt;h4&gt;Comments&lt;/h4&gt;&lt;p&gt; &lt;textarea name="comments" cols="1" rows="4" style="width:530px"&gt;&lt;/textarea&gt; &lt;input name="submit" type="submit" value="Submit" /&gt; &lt;input type="hidden" name="MM_insert" value="applynow" /&gt; &lt;/form&gt; &lt;?php require_once('../Connections/conn_db.php'); ?&gt; &lt;?php if (!function_exists("GetSQLValueString")) { function GetSQLValueString($theValue, $theType, $theDefinedValue = "", $theNotDefinedValue = "") { if (PHP_VERSION &lt; 6) { $theValue = get_magic_quotes_gpc() ? stripslashes($theValue) : $theValue; } $theValue = function_exists("mysql_real_escape_string") ? mysql_real_escape_string($theValue) : mysql_escape_string($theValue); switch ($theType) { case "text": $theValue = ($theValue != "") ? "'" . $theValue . "'" : "NULL"; break; case "long": case "int": $theValue = ($theValue != "") ? intval($theValue) : "NULL"; break; case "double": $theValue = ($theValue != "") ? doubleval($theValue) : "NULL"; break; case "date": $theValue = ($theValue != "") ? "'" . $theValue . "'" : "NULL"; break; case "defined": $theValue = ($theValue != "") ? $theDefinedValue : $theNotDefinedValue; break; } return $theValue; } } $editFormAction = $_SERVER['PHP_SELF']; if (isset($_SERVER['QUERY_STRING'])) { $editFormAction .= "?" . htmlentities($_SERVER['QUERY_STRING']); } if ((isset($_POST["MM_insert"])) &amp;&amp; ($_POST["MM_insert"] == "applynow")) { $insertSQL = sprintf("INSERT INTO study_applications (fname, lname, gender, address_1, address_2, city, `state`, zipcode, country, day_phone, email, study, `language`, specific-study, referral, birthdate, overnight-stay, smoking, scripts, allergies, medcond, dietneeds, ifvegan, conditions, drugs, height, weight, race, retain-info, comments) VALUES (%s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s, %s)", GetSQLValueString($_POST['fname'], "text"), GetSQLValueString($_POST['lname'], "text"), GetSQLValueString($_POST['gender'], "text"), GetSQLValueString($_POST['address_1'], "text"), GetSQLValueString($_POST['address_2'], "text"), GetSQLValueString($_POST['city'], "text"), GetSQLValueString($_POST['state'], "text"), GetSQLValueString($_POST['zipcode'], "text"), GetSQLValueString($_POST['Country'], "text"), GetSQLValueString($_POST['day_phone'], "text"), GetSQLValueString($_POST['email'], "text"), GetSQLValueString($_POST['study'], "text"), GetSQLValueString($_POST['language'], "text"), GetSQLValueString($_POST['specific-study'], "text"), GetSQLValueString($_POST['referral'], "text"), GetSQLValueString($_POST['birthdate'], "text"), GetSQLValueString(isset($_POST['overnight-stay']) ? "true" : "", "defined","'Y'","'N'"), GetSQLValueString($_POST['smoking'], "text"), GetSQLValueString($_POST['scripts'], "text"), GetSQLValueString($_POST['allergies'], "text"), GetSQLValueString($_POST['medcond'], "text"), GetSQLValueString($_POST['dietneeds'], "text"), GetSQLValueString($_POST['ifvegan'], "text"), GetSQLValueString(isset($_POST['conditions']) ? "true" : "", "defined","'Y'","'N'"), GetSQLValueString($_POST['drugs'], "text"), GetSQLValueString($_POST['height'], "text"), GetSQLValueString($_POST['weight'], "text"), GetSQLValueString($_POST['race'], "text"), GetSQLValueString(isset($_POST['retain-info']) ? "true" : "", "defined","'Y'","'N'"), GetSQLValueString($_POST['comments'], "text")); mysql_select_db($database_conn_db, $conn_db); $Result1 = mysql_query($insertSQL, $conn_db) or die(mysql_error()); } mysql_select_db($database_conn_db, $conn_db); $query_Recordset1 = "SELECT * FROM study_applications"; $Recordset1 = mysql_query($query_Recordset1, $conn_db) or die(mysql_error()); $row_Recordset1 = mysql_fetch_assoc($Recordset1); $totalRows_Recordset1 = mysql_num_rows($Recordset1); ?&gt; </code></pre> <p>Sorry guys, this is what the error says</p> <p>You have an error in your SQL syntax; check the manual that corresponds to your MySQL server version for the right syntax to use near 'specific-study, referral, birthdate, overnight-stay, smoking, scripts, allergies' at line 1</p>
 

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