Your IP : 216.73.217.79
<?php
$pagetitle = "CPD Validated Courses";
include_once("inc_db.php");
require_once $_SERVER['DOCUMENT_ROOT'] . '/phpmailer/PHPMailer.php';
require_once $_SERVER['DOCUMENT_ROOT'] . '/phpmailer/SMTP.php';
require_once $_SERVER['DOCUMENT_ROOT'] . '/phpmailer/Exception.php';
include_once($_SERVER['DOCUMENT_ROOT'] . "/php/includes/maill.php");
use PHPMailer\PHPMailer\PHPMailer;
//function XMail($to, $subject, $msg, $from, $CC, $type) {
//
// $mail = new PHPMailer;
// $mail->Mailer = "mail";
//
// /*
// $mail->Mailer="smtp";
// $mail->Host="relay.aitonline.co.za";
// $mail->Port=587;
// $mail->Username="mail@cesa.co.za";
// $mail->Password="c3SAmail!@!";
// $mail->SMTPDebug=false;
// $mail->SMTPAuth=true;
// */
// if ($type == "html")
// $mail->IsHTML(true);
//
// $mail->From = $from;
// $mail->FromName = $from;
//
// $arrto = explode(",", $to);
// for ($i = 0; $i < count($arrto); $i++) {
// $mail->AddAddress($arrto[$i]);
// }
// $mail->Subject = $subject;
// $mail->Body = $msg;
//
// if (!$mail->Send())
// echo $mail->ErrorInfo;
//}
?>
<?php include('../inc_header.php4'); ?>
<?php include('menu.php'); ?>
<?php
$sMsg = "";
$bShowForm = true;
if (isset($_POST["go"]) && ($_POST["go"] == 1)) {
if ($_POST['ti'] != md5($_POST['security_code'])) {
// The CAPTCHA code was incorrect
$sMsg .= "<li>You have provided an invalid verification code</li>";
}
if (empty($_POST['Course_Description'])) {
$sMsg .= "<li>You have not provided a description / overview of the course</li>";
}
if (empty($_POST['Accept_Policy'])) {
$sMsg .= "<li>You have not accepted the CESA policy</li>";
}
if (empty($_POST['Confirm_Prices'])) {
$sMsg .= "<li>You have not confirmed that you are aware of our prices</li>";
}
if (!empty($_REQUEST["StartDate"])) {
if (strtotime($_REQUEST["StartDate"]) < time()) {
$sMsg .= "<li>You have not provided a valid start date, or the start date is in the past. Please enter one date only, preferably in the format YYYY-MM-DD. If a start date is not applicable, please leave that field blank.</li>";
}
}
if (empty($sMsg)) {
$bShowForm = false;
$sql = "SELECT * FROM SchoolProviders WHERE ProviderName='" . addslashes(stripslashes($_REQUEST["Training_Provider"])) . "'";
// echo $sql."<br>";
$rec = mysql_query($sql);
if ($row = mysql_fetch_assoc($rec)) {
$iProviderID = $row["ProviderID"];
mysql_free_result($rec);
} else {
$sql = "INSERT INTO SchoolProviders (`ProviderName`, `PhoneNumber`, `MobileNumber`, `FaxNumber`, `EmailAddress`,
`VATNumber`, `PostalAddress`, `Designation`, `CompanyName`, `ContactPerson`, `ProviderType`)
VALUES ('" . addslashes(stripslashes($_REQUEST["Training_Provider"])) . "', '" . $_REQUEST["Telephone_Number_Code"] . " " . $_REQUEST["Telephone_Number"] . "',
'" . $_REQUEST["Cell_Number_Code"] . " " . $_REQUEST["Cell_Number"] . "', '" . $_REQUEST["Fax_Number_Code"] . " " . $_REQUEST["Fax_Number"] . "',
'" . $_REQUEST["Email_Address"] . "', '" . $_REQUEST["VAT_Number"] . "', '" . $_REQUEST["Postal_Address"] . "', '" . $_REQUEST["Designation"] . "',
'" . addslashes(stripslashes($_REQUEST["Training_Provider"])) . "',
'" . $_REQUEST["Responsible_Person_Title"] . " " . addslashes(stripslashes($_REQUEST["Responsible_Person_First_Name"])) . " " . addslashes(stripslashes($_REQUEST["Responsible_Person_Surname"])) . "',
'Validation of Material')";
// echo $sql."<br>";
mysql_query($sql);
$sql = "SELECT * FROM SchoolProviders WHERE ProviderName='" . addslashes(stripslashes($_REQUEST["Training_Provider"])) . "'";
// echo $sql."<br>";
$rec = mysql_query($sql);
if ($row = mysql_fetch_assoc($rec)) {
$iProviderID = $row["ProviderID"];
mysql_free_result($rec);
} else {
$iProviderID = 0;
}
mysql_free_result($rec);
}
if (!empty($_REQUEST["StartDate"])) {
$dtStartDate = date("Y-m-d", strtotime($_REQUEST["StartDate"]));
} else {
$dtStartDate = "";
}
$sAccredNum = "";
$sql = "SELECT ConfigValue FROM Config WHERE ConfigName='NextAccredNum'";
// echo $sql."<br>";
$rec = mysql_query($sql);
if ($row = mysql_fetch_assoc($rec)) {
$iAccredNum = $row["ConfigValue"];
$dtValidUntil = date("Y-m-d", strtotime("+3 years"));
if (($_REQUEST["Activity_Nature"] == "Site Visits") || ($_REQUEST["Activity_Nature"] == "Conference") || ($_REQUEST["Activity_Nature"] == "Lectures")) {
if (!empty($_REQUEST["StartDate"])) {
$dtValidUntil = date("Y-m-d", strtotime("+1 month", strtotime($_REQUEST["StartDate"])));
} else {
$dtValidUntil = date("Y-m-d", strtotime("+1 month"));
}
}
$sAccredNum = "CESA-" . $iAccredNum . "-" . date("m", strtotime($dtValidUntil)) . "/" . date("Y", strtotime($dtValidUntil));
$sql = "UPDATE Config SET ConfigValue='" . (intval($iAccredNum) + 1) . "' WHERE ConfigName='NextAccredNum'";
// echo $sql."<br>";
mysql_query($sql);
}
mysql_free_result($rec);
$sql = "INSERT INTO TrainingMaterial (`Subject`, `ProviderID`, `Level`, `EventDescription`, `Duration`, `DurationUnit`,
`NQFLevel`, `AccredNum`, `Presenter1`, `Presenter2`, `Presenter3`, `Promotion`, `Motivation`, `ContactPerson`,
`ContactTel`, `ContactCell`, `ContactEmail`, `Status`, `StartDate`, `Other_Validator`, Provider_URL, National_Hours, Province,
Category_Reg, Discipline, Sub_Discipline, Activity_Nature, Instances, RemoteUpload) VALUES ('" . $_REQUEST["Course_Name"] . "', '" . $iProviderID . "',
'" . $_REQUEST["Level"] . "',
'" . addslashes(stripslashes($_REQUEST["Course_Description"])) . "', '" . floatval($_REQUEST["Activity_Duration"]) . "', '" . $_REQUEST["Hours_Days"] . "',
'" . $_REQUEST["NQF_Level"] . "', '" . $sAccredNum . "', '" . addslashes(stripslashes($_REQUEST["Presenter_Name_1"])) . "', '" . addslashes(stripslashes($_REQUEST["Presenter_Name_2"])) . "',
'" . addslashes(stripslashes($_REQUEST["Presenter_Name_3"])) . "', '" . addslashes(stripslashes($_REQUEST["Product_Promotion"])) . "', '" . addslashes(stripslashes($_REQUEST["Motivation"])) . "',
'" . $_REQUEST["Responsible_Person_Title"] . " " . addslashes(stripslashes($_REQUEST["Responsible_Person_First_Name"])) . " " . addslashes(stripslashes($_REQUEST["Responsible_Person_Surname"])) . "',
'" . $_REQUEST["Telephone_Number_Code"] . " " . $_REQUEST["Telephone_Number"] . "', '" . $_REQUEST["Cell_Number_Code"] . " " . $_REQUEST["Cell_Number"] . "',
'" . $_REQUEST["Email_Address"] . "', 'Pending', '" . $dtStartDate . "', '" . addslashes(stripslashes($_REQUEST["Other_Validator"])) . "',
'" . addslashes(stripslashes($_REQUEST["Provider_URL"])) . "', '" . addslashes(stripslashes($_REQUEST["National_Hours"])) . "',
'" . addslashes(stripslashes($_REQUEST["Province"])) . "', '" . addslashes(stripslashes($_REQUEST["Category_Reg"])) . "',
'" . addslashes(stripslashes($_REQUEST["Discipline"])) . "', '" . addslashes(stripslashes($_REQUEST["Sub_Discipline"])) . "',
'" . addslashes(stripslashes($_REQUEST["Activity_Nature"])) . "', '" . addslashes(stripslashes($_REQUEST["Instances"])) . "',
'" . addslashes($_REQUEST["RemoteUpload"]) . "')";
// echo $sql."<br>";
mysql_query($sql);
$sForm = '
<h3>APPLICATION FOR APPROVAL OF A CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ACTIVITY</h3>
<p>Please complete the on-line application form and submit the following:</p>
<ul>
<li><span style="color: #000000;">All the training material, including PowerPoint presentations and handouts, which will be used for the training, must be sent in a Drop Box folder or by WeTransfer to blessings@cesa.co.za</span></li>
<li><span style="color: #000000;">Courier a USB Flash drive of all the training material, including PowerPoint presentations and handouts, which will be used for the event. <em>[This is the archive copy]</em></span></li>
<li><span style="color: #000000;">Proof of payment</span></li>
<li><span style="color: #000000;">CV of trainer/s (3 x fields)</span></li>
<li><span style="color: #000000;">Company profile</span></li>
<li><span style="color: #000000;">Certified copy of a valid company registration certificate or equivalent</span></li>
<li><span style="color: #000000;">Valid SARS tax clearance certificate</span></li>
<li><span style="color: #000000;">BEE status</span></li>
<li><span style="color: #000000;">Proof of company address</span></li>
<li><span style="color: #000000;">A copy of a blank evaluation form for obtaining feedback from participants for rating of the relevance, quality and effectiveness of the event.</span><br>
<li><span style="color: #000000;">The above is to be submitted <strong><u>no less than six weeks prior</u></strong> to the commencement of the event date.</span></li>
</ul>
<p>
';
$sForm .= '
<table border="1" cellpadding="5" cellspacing="0">
<tbody>
<tr><td colspan=2><p style="font-weight: bold">BODY APPLYING FOR ACTIVITY APPROVAL IN TERMS OF ECSA CPD POLICY</p>
</td>
</tr>
<tr>
<td width="233"><p>Name of Training Provider:</p></td>
<td width="338"><p>' . $_REQUEST["Training_Provider"] . '
</p></td>
</tr>
<tr>
<td width="233"><p>Provider URL (Website):</p></td>
<td width="338"><p>' . $_REQUEST["Provider_URL"] . '
</p></td>
</tr>
<tr>
<td><p>Responsible Person:</p></td>
<td><table border=0>
<tr><td>Title:</td><td>' . $_REQUEST["Responsible_Person_Title"] . '</td></tr>
<tr><td>First Name:</td><td>' . $_REQUEST["Responsible_Person_First_Name"] . '</td></tr>
<tr><td>Surname:</td><td>' . $_REQUEST["Responsible_Person_Surname"] . '</td></tr>
</table>
</td>
</tr>
<tr>
<td><p>Designation:</p></td>
<td><p>
' . $_REQUEST["Designation"] . '
</p></td>
</tr>
<tr>
<td valign="top"><p>Postal Address:</p></td>
<td><p>' . $_REQUEST["Postal_Address"] . '
<br>
' . $_REQUEST["Postal_Code"] . '
</p> </td>
</tr>
<tr>
<td><p>Province:</p></td>
<td><p>
' . $_REQUEST["Province"] . '
</p></td>
</tr>
<tr>
<td><p>Telephone number:</p></td>
<td><p>' . $_REQUEST["Telephone_Number_Code"] . ' ' . $_REQUEST["Telephone_Number"] . '
</p></td>
</tr>
<tr>
<td><p>Cell No. :</p></td>
<td><p>' . $_REQUEST["Cell_Number_Code"] . ' ' . $_REQUEST["Cell_Number"] . '
</p></td>
</tr>
<tr>
<td><p>Fax number:</p></td>
<td><p>' . $_REQUEST["Fax_Number_Code"] . ' No:' . $_REQUEST["Fax_Number"] . '
</p></td>
</tr>
<tr>
<td><p>E-mail address:</p></td>
<td><p>
' . $_REQUEST["Email_Address"] . '
</p></td>
</tr>
<tr>
<td><p>Company Vat Registration Number:</p></td>
<td><p>
' . $_REQUEST["VAT_Number"] . '
</p></td>
</tr>
<tr><td colspan=2><p style="font-weight: bold">DETAILS OF ACTIVITY</p></td></tr>
<tr>
<td width="222"><p>Course Name: (Name on Certificate)</p></td>
<td width="349"><p>
' . $_REQUEST["Course_Name"] . '
</p></td>
</tr>
<tr>
<td valign="top"><p>Name/s of Presenter/s:</p>
<p>NB Presenter CVs must be emailed to <a href="mailto:blessings@cesa.co.za">blessings@cesa.co.za</a></p></td>
<td><p>
1.
' . $_REQUEST["Presenter_Name_1"] . '
<br />
2.
' . $_REQUEST["Presenter_Name_2"] . '
<br />
3.
' . $_REQUEST["Presenter_Name_3"] . '
<br />
</p></td>
</tr>
<tr>
<td><p>Duration of Activity (Hours / Days)</p></td>
<td><p>
' . $_REQUEST["Activity_Duration"] . ' ' . $_REQUEST["Hours_Days"] . '
</p></td>
</tr>
<tr>
<td><p>Notional Hours:</p></td>
<td><p>
' . $_REQUEST["National_Hours"] . '
</p></td>
</tr>
<tr>
<td><p>Course category:</p></td>
<td><p>
' . $_REQUEST["Level"] . '
</p></td>
</tr>
<tr>
<td><p>Pitched at NQF Level: (if applicable)</p></td>
<td><p>
' . $_REQUEST["NQF_Level"] . '
</p></td>
</tr>
<tr>
<td><p>Category of Registration:</p></td>
<td><p>
' . $_REQUEST["Category_Reg"] . '
</p></td>
</tr>
<tr>
<td><p>Discipline:</p></td>
<td><p>
' . $_REQUEST["Discipline"] . '
</p></td>
</tr>
<tr>
<td><p>Sub-Discipline:</p></td>
<td><p>
' . $_REQUEST["Sub_Discipline"] . '
</p></td>
</tr>
<tr>
<td><p>Nature of Activity:</p></td>
<td><p>
' . $_REQUEST["Activity_Nature"] . '
</p></td>
</tr>
<tr>
<td valign="top"><p>Description / Overview of Course:</p></td>
<td>' . $_REQUEST["Course_Description"] . '</td>
</tr>
<tr>
<td><p>Instances:</p></td>
<td><p>
' . $_REQUEST["Instances"] . '
</p></td>
</tr>
<tr>
<td><p>Is the activity promoting a product?</p></td>
<td><p>' . $_REQUEST["Product_Promotion"] . '
</p></td>
</tr>
<tr>
<td><p>Starting date (if a conference or site visit):</p></td>
<td><p>' . $_REQUEST["StartDate"] . '
</p></td>
</tr>
<tr>
<td><p>Where else have you submitted a request to have this activity validated?</p></td>
<td><p>' . $_REQUEST["Other_Validator"] . '
</p></td>
</tr>
</tbody>
</table>
<br />
<p style="font-weight: bold">MOTIVATION FOR ACTIVITY TO BE APPROVED:</p>
<p>
' . $_REQUEST["Motivation"] . '
</p><hr>
<p>WeTransfer / DropBox documentation download link: <a href="' . $_REQUEST["RemoteUpload"] . '">' . $_REQUEST["RemoteUpload"] . '</a></p>
';
$sForm .= '
<p>Evaluation forms for obtaining feedback from participants for rating of the relevance, quality and effectiveness of the activity, must be provided.</p>
<p>
I, on behalf of the
Training Provider body as specified above, hereby certify that I am fully aware of the CESA policy on the selection and appointment of training providers and the statutory requirements of continuing professional development as described in the ECSA Policy Document and undertake to comply with the requirements of serving as an approved provider for this activity.</p>
<p>I confirm that I have seen the prices and confirm that I want to go ahead
with this application</p>
';
$sSendFormTo = "cpd@cesa.co.za,brenda@cesa.co.za,blessings@cesa.co.za,cpdverification@cesa.co.za,athromethm@cesa.co.za";
//$sSendFormTo = "julia@xe.co.za";
maill($sSendFormTo, $sAccredNum . " APPLICATION FOR APPROVAL OF A CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ACTIVITY", $sForm, null, ['isHTML' => true, 'from-name' => 'CPD Verification']);
?>
<p><b>Your form has been submitted to CESA.</b> Please email <a href="mailto:cpd@cesa.co.za">cpd@cesa.co.za</a> if you have any questions. Please supply all additional documentation in both hard copy and electronic format. A copy of your form appears below.</p>
<hr />
<?php echo $sForm; ?>
<?php
}
}
if ($bShowForm) {
?>
<form action="/node/92" method="post" enctype="multipart/form-data" name="form1" id="form1">
<input type="hidden" name="go" value="1" />
<h3>APPLICATION FOR APPROVAL OF A CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ACTIVITY</h3>
<?php
if (!empty($sMsg))
echo "<p style='color:red'><b>Error:<br /><ul style='color:red'>" . $sMsg . "</ul></b></p>";
?>
<p>Please complete the on-line application form and submit the following:</p>
<ul>
<li><span style="color: #000000;">All the training material, including PowerPoint presentations and handouts, which will be used for the training, must be sent in a Drop Box folder or by WeTransfer to blessings@cesa.co.za</span></li>
<li><span style="color: #000000;">Courier a USB Flash drive of all the training material, including PowerPoint presentations and handouts, which will be used for the event. <em>[This is the archive copy]</em></span></li>
<li><span style="color: #000000;">Proof of payment</span></li>
<li><span style="color: #000000;">CV of trainer/s (3 x fields)</span></li>
<li><span style="color: #000000;">Company profile</span></li>
<li><span style="color: #000000;">Certified copy of a valid company registration certificate or equivalent</span></li>
<li><span style="color: #000000;">Valid SARS tax clearance certificate</span></li>
<li><span style="color: #000000;">BEE status</span></li>
<li><span style="color: #000000;">Proof of company address</span></li>
<li><span style="color: #000000;">A copy of a blank evaluation form for obtaining feedback from participants for rating of the relevance, quality and effectiveness of the event.</span><br>
<li><span style="color: #000000;">The above is to be submitted <strong><u>no less than six weeks prior</u></strong> to the commencement of the event date.</span></li>
</ul>
<table border="1" cellpadding="5" cellspacing="0">
<tbody>
<tr><td colspan=2><p style="font-weight: bold">BODY APPLYING FOR ACTIVITY APPROVAL IN TERMS OF ECSA CPD POLICY</p></td>
</tr>
<tr>
<td width="233"><p>Name of Training Provider:</p></td>
<td width="338"><p>
<input name="Training_Provider" type="text" id="Training_Provider" size="50" value="<?php echo $_REQUEST["Training_Provider"]; ?>" />
</p></td>
</tr>
<tr>
<td>Training Provider's Website:</td>
<td>
<input name="Provider_URL" type="text" id="Provider_URL" size="50" value="<?php echo $_REQUEST["Provider_URL"]; ?>" /></td>
</tr>
<tr>
<td><p>Responsible Person:</p></td>
<td><table border=0>
<tr><td>Title:</td><td><input name="Responsible_Person_Title" type="text" id="Responsible_Person_Title" size="50" value="<?php echo $_REQUEST["Responsible_Person_Title"]; ?>" /></td></tr>
<tr><td>First Name:</td><td><input name="Responsible_Person_First_Name" type="text" id="Responsible_Person_First_Name" value="<?php echo $_REQUEST["Responsible_Person_First_Name"]; ?>" size="50" /></td></tr>
<tr><td>Surname:</td><td><input name="Responsible_Person_Surname" type="text" id="Responsible_Person_Surname" value="<?php echo $_REQUEST["Responsible_Person_Surname"]; ?>" size="50" /></td></tr>
</table>
</td>
</tr>
<tr>
<td><p>Designation:</p></td>
<td><p>
<input name="Designation" type="text" id="Designation" size="50" value="<?php echo $_REQUEST["Designation"]; ?>" />
</p></td>
</tr>
<tr>
<td valign="top"><p>Postal Address:</p></td>
<td><p>
<textarea name="Postal_Address" id="Postal_Address" cols="45" rows="5"><?php echo stripslashes($_REQUEST["Postal_Address"]); ?></textarea><br>
Postal Code:<input type=text name="Postal_Code" size="50" value="<?php echo $_REQUEST["Postal_Code"]; ?>" />
</p> </td>
</tr>
<tr>
<td>Province:</td>
<td>
<input name="Province" type="text" id="Province" size="50" value="<?php echo $_REQUEST["Province"]; ?>" /></td>
</tr>
<tr>
<td><p>Telephone number:</p></td>
<td><p>Code:<input name="Telephone_Number_Code" type="text" id="Telephone_Number_Code" size="3" value="<?php echo $_REQUEST["Telephone_Number_Code"]; ?>" /> No:<input name="Telephone_Number" type="text" id="Telephone_Number" size="30" value="<?php echo $_REQUEST["Telephone_Number"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>Cell No. :</p></td>
<td><p>Code:<input name="Cell_Number_Code" type="text" id="Cell_Number_Code" size="3" value="<?php echo $_REQUEST["Cell_Number_Code"]; ?>" /> No:<input name="Cell_Number" type="text" id="Cell_Number" size="30" value="<?php echo $_REQUEST["Cell_Number"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>Fax number:</p></td>
<td><p>Code:<input name="Fax_Number_Code" type="text" id="Fax_Number_Code" size="3" value="<?php echo $_REQUEST["Fax_Number_Code"]; ?>" /> No:<input name="Fax_Number" type="text" id="Fax_Number" size="30" value="<?php echo $_REQUEST["Fax_Number"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>E-mail address:</p></td>
<td><p>
<input name="Email_Address" type="text" id="Email_Address" size="50" value="<?php echo $_REQUEST["Email_Address"]; ?>" />
</p></td>
</tr>
<tr>
<td><p>Company Vat Registration Number:</p></td>
<td><p>
<input name="VAT_Number" type="text" id="VAT_Number" size="50" value="<?php echo $_REQUEST["VAT_Number"]; ?>" />
</p></td>
</tr>
<tr><td colspan=2><p style="font-weight: bold">DETAILS OF ACTIVITY</p></td></tr>
<tr>
<td width="222"><p>Course Name: (Name on Certificate)</p></td>
<td width="349"><p>
<input name="Course_Name" type="text" id="Course_Name" size="50" value="<?php echo $_REQUEST["Course_Name"]; ?>" />
</p></td>
</tr>
<tr>
<td valign="top"><p>Name/s of Presenter/s:</p>
<p>NB Presenter CVs must be emailed to <a href="mailto:cpd@cesa.co.za">cpd@cesa.co.za</a></p></td>
<td><p>
1
<input name="Presenter_Name_1" type="text" id="Presenter_Name_1" size="48" value="<?php echo $_REQUEST["Presenter_Name_1"]; ?>" />
<br />
2
<input name="Presenter_Name_2" type="text" id="Presenter_Name_2" size="48" value="<?php echo $_REQUEST["Presenter_Name_2"]; ?>" />
<br />
3
<input name="Presenter_Name_3" type="text" id="Presenter_Name_3" size="48" value="<?php echo $_REQUEST["Presenter_Name_3"]; ?>" />
<br />
</p></td>
</tr>
<tr>
<td><p>Duration of Activity: (Hours)</p></td>
<td><p>
<input name="Activity_Duration" type="text" id="Activity_Duration" size="10" value="<?php echo $_REQUEST["Activity_Duration"]; ?>" required /> Hours
<input type="hidden" name="Hours_Days" value="Hours">
<!-- <select name="Hours_Days" id="Hours_Days"><option value="Hours"<?php if ($_REQUEST["Hours_Days"] == "Hours") echo " selected"; ?>>Hours</option><option value="Days"<?php if ($_REQUEST["Hours_Days"] == "Days") echo " selected"; ?>>Days</option></select> -->
</p></td>
</tr>
<tr>
<td>Notional Hours:</td>
<td>
<input name="National_Hours" type="text" id="National_Hours" size="50" value="<?php echo $_REQUEST["National_Hours"]; ?>" /></td>
</tr>
<tr>
<td><p>Course Category:</p></td>
<td><p>
<select name="Level" id="Level">
<option value="Colloquium"<?php if ($_REQUEST["Level"] == "Colloquium") echo " selected"; ?>>Colloquium</option>
<option value="Conference"<?php if ($_REQUEST["Level"] == "Conference") echo " selected"; ?>>Conference</option>
<option value="Congress"<?php if ($_REQUEST["Level"] == "Congress") echo " selected"; ?>>Congress</option>
<option value="E-learning"<?php if ($_REQUEST["Level"] == "E-learning") echo " selected"; ?>>E-learning</option>
<option value="Large Group Workshop"<?php if ($_REQUEST["Level"] == "Large Group Workshop") echo " selected"; ?>>Large Group Workshop</option>
<option value="Lecture"<?php if ($_REQUEST["Level"] == "Lecture") echo " selected"; ?>>Lecture</option>
<option value="Refresher Course"<?php if ($_REQUEST["Level"] == "Refresher Course") echo " selected"; ?>>Refresher Course</option>
<option value="Seminar"<?php if ($_REQUEST["Level"] == "Seminar") echo " selected"; ?>>Seminar</option>
<option value="Workshop"<?php if ($_REQUEST["Level"] == "Workshop") echo " selected"; ?>>Workshop</option>
</select>
</p></td>
</tr>
<tr>
<td><p>Pitched at NQF Level: (if applicable)</p></td>
<td><p>
<input name="NQF_Level" type="text" id="NQF_Level" size="50" value="<?php echo $_REQUEST["NQF_Level"]; ?>" />
</p></td>
</tr>
<tr>
<td valign="top">Piched at Category of Registration: (if applicable)</td>
<td>
<input name="Category_Reg" type="text" id="Category_Reg" size="50" value="<?php echo $_REQUEST["Category_Reg"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Engineering Discipline: (if applicable)</td>
<td>
<input name="Discipline" type="text" id="Discipline" size="50" value="<?php echo $_REQUEST["Discipline"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Engineering Sub-Discipline: (if applicable)</td>
<td>
<input name="Sub_Discipline" type="text" id="Sub_Discipline" size="50" value="<?php echo $_REQUEST["Sub_Discipline"]; ?>" /></td>
</tr>
<tr>
<td valign="top">Nature of Activity:</td>
<td>
<select name="Activity_Nature" id="Activity_Nature">
<option value="Engineering"<?php if ($_REQUEST["Activity_Nature"] == "Engineering") echo " selected"; ?>>Engineering</option>
<option value="Project Management"<?php if ($_REQUEST["Activity_Nature"] == "Project Management") echo " selected"; ?>>Project Management</option>
<option value="Technical"<?php if ($_REQUEST["Activity_Nature"] == "Technical") echo " selected"; ?>>Technical</option>
<option value="Legal"<?php if ($_REQUEST["Activity_Nature"] == "Legal") echo " selected"; ?>>Legal</option>
<option value="Office"<?php if ($_REQUEST["Activity_Nature"] == "Office") echo " selected"; ?>>Office</option>
<option value="Finance"<?php if ($_REQUEST["Activity_Nature"] == "Finance") echo " selected"; ?>>Finance</option>
<option value="Computer Skills"<?php if ($_REQUEST["Activity_Nature"] == "Computer Skills") echo " selected"; ?>>Computer Skills</option>
<option value="Interpersonal Skills"<?php if ($_REQUEST["Activity_Nature"] == "Interpersonal Skills") echo " selected"; ?>>Interpersonal Skills</option>
<option value="General Management"<?php if ($_REQUEST["Activity_Nature"] == "General Management") echo " selected"; ?>>General Management</option>
</select>
</td>
</tr>
<tr>
<td valign="top"><p>Description / Overview of Course:</p></td>
<td><textarea name="Course_Description" id="Course_Description" cols="45" rows="7" required><?php echo stripslashes($_REQUEST["Course_Description"]); ?></textarea></td>
</tr>
<tr>
<td>Instances:</td>
<td><input type="radio" name="Instances" id="Instances" value="Single"<?php if (!isset($_REQUEST["Instances"]) || ($_REQUEST["Instances"] == "Single")) echo " checked"; ?>> Single
<input type="radio" name="Instances" id="Instances" value="Multiple"<?php if (!isset($_REQUEST["Instances"]) || ($_REQUEST["Instances"] == "Multiple")) echo " checked"; ?>> Multiple
</td>
</tr>
<tr>
<td><p>Is the activity promoting a product?</p></td>
<td><p><select name="Product_Promotion" id="Product_Promotion"><option value="No"<?php if ($_REQUEST["Product_Promotion"] == "No") echo " checked"; ?>>No</option><option value="Yes"<?php if ($_REQUEST["Product_Promotion"] == "Yes") echo " checked"; ?>>Yes</option></select>
</p></td>
</tr>
<tr><td><p>If the activity is a conference or site visit, please enter the date (or starting date):</p></td>
<td><p><input type="text" name="StartDate" id="StartDate" size="30" value="<?php echo $_REQUEST["StartDate"]; ?>"></p></td></tr>
<tr><td><p>Where else have you submitted a request to have this activity validated?</p></td>
<td><p><input type="text" name="Other_Validator" id="Other_Validator" size="50" value="<?php echo $_REQUEST["Other_Validator"]; ?>" placeholder="Required"></p></td></tr>
</tbody>
</table>
<br />
<p style="font-weight: bold">MOTIVATION FOR ACTIVITY TO BE APPROVED:</p>
<p>
<textarea name="Motivation" id="Motivation" cols="60" rows="7"><?php echo stripslashes($_REQUEST["Motivation"]); ?></textarea>
</p>
<p>WeTransfer / DropBox documentation download link: <input type="text" name="RemoteUpload" value="<?php echo $_REQUEST["RemoteUpload"]; ?>" size="80"></p>
<p>Evaluation forms for obtaining feedback from participants for rating of the relevance, quality and effectiveness of the activity, must be provided.</p>
<p>
<input type="checkbox" name="Accept_Policy" id="Accept_Policy" value="yes" />
I, on behalf of the
Training Provider body as specified above, hereby certify that I am fully aware of the CESA policy on the selection and appointment of training providers and the statutory requirements of continuing professional development as described in the ECSA Policy Document and undertake to comply with the requirements of serving as an approved provider for this activity.</p>
<p>
<input type="checkbox" name="Confirm_Prices" id="Confirm_Prices" value="yes" />
I confirm that I have seen the prices and confirm that I want to go ahead
with this application</p>
<p><?php include "inc_captcha.php"; ?>
<img src="/php/CaptchaSecurityImages.php?security_code=<?php echo $_SESSION['security_code']; ?>" /><br />
<br />
Please type the verification code, exactly as you see it above, into the box below.<br />
<br />
<input id="security_code" name="security_code" type="text" />
<input type="hidden" name="ti" value="<?php echo md5($_SESSION['security_code']); ?>" />
</p>
<p>
<input type="submit" name="Submit" id="Submit" value="Submit to CESA" style="background-color:red;color:white;font-style:bold;width:150px;height:50px" />
</p>
</form>
<?php
}
?>
<br />
<p> </p>
<?php include('../inc_footer.php4'); ?>