Gecko [ v3.cesa.co.za ]

Name	Size	Permission	Date
_notes	[ DIR ]	drwxr-sr-x	2022-12-20 11:09
_vti_cnf	[ DIR ]	drwxr-sr-x	2022-12-20 11:09
certificate	[ DIR ]	drwxr-sr-x	2023-03-22 11:22
includes	[ DIR ]	drwxr-sr-x	2026-08-24 10:12
mail_interface	[ DIR ]	drwxr-sr-x	2025-06-14 09:47
security	[ DIR ]	drwxr-sr-x	2023-09-17 08:02
temp	[ DIR ]	drwxr-sr-x	2026-04-18 22:25
templates	[ DIR ]	drwxr-sr-x	2026-05-25 12:12
tests	[ DIR ]	drwxr-sr-x	2025-07-07 15:54
CaptchaSecurityImages.php	2.26 KB	-rw-r--r--	2022-12-20 11:09
Inc_calendarnew.php	8.59 KB	-rw-r--r--	2017-11-20 10:34
accredcourses.php	7.04 KB	-rw-r--r--	2023-08-22 10:55
adecquestionnaire.php	26.54 KB	-rw-r--r--	2025-08-01 10:38
advisory.php	7.21 KB	-rw-r--r--	2022-12-20 11:09
advisory_full.php	1.31 KB	-rw-r--r--	2022-12-20 11:09
annualdeclaration.php	15.28 KB	-rw-r--r--	2026-01-22 10:25
awardsentry.php	14.55 KB	-rw-r--r--	2025-08-01 10:38
awardsentry.php.bak	11.22 KB	-rw-r--r--	2016-04-13 12:45
bookdetail.php	954 B	-rw-r--r--	2022-12-20 11:09
books.php	4.4 KB	-rw-r--r--	2023-05-16 13:08
branchdocuments.php	1.14 KB	-rw-r--r--	2022-12-20 11:09
branches.php	2.82 KB	-rw-r--r--	2025-08-06 12:54
calendarpdf.php	1.75 KB	-rw-r--r--	2025-08-26 16:52
cceregister.php	55.59 KB	-rw-r--r--	2026-08-14 12:05
ccmregister.php	71.57 KB	-rw-r--r--	2022-12-20 11:09
class.phpmailer.php	44.39 KB	-rw-r--r--	2022-12-20 11:09
class.smtp.php	32.74 KB	-rw-r--r--	2022-12-20 11:09
committeedocs.php	932 B	-rw-r--r--	2022-12-20 11:09
committees.php	2.69 KB	-rw-r--r--	2025-08-06 12:58
cpdapply.php	5.73 KB	-rw-r--r--	2022-12-20 11:09
cpdapplyform.php	34.06 KB	-rw-r--r--	2025-08-01 10:38
cpdproviderapply.php	42.09 KB	-rw-r--r--	2026-02-10 10:10
cpdproviderportal.php	79.47 KB	-rw-r--r--	2025-09-08 07:23
cpdspverify.php	4.27 KB	-rw-r--r--	2025-10-10 10:45
cpdtmverify.php	4.45 KB	-rw-r--r--	2023-06-19 13:44
declineeventreg.php	3.73 KB	-rw-r--r--	2022-12-20 11:09
directorybooking.php	7.39 KB	-rw-r--r--	2022-12-20 11:09
downloadPN.php	385 B	-rw-r--r--	2025-06-26 13:02
downloadfile.php	280 B	-rw-r--r--	2025-08-01 10:38
enews.php	1.33 KB	-rw-r--r--	2022-12-20 11:09
enewsarchive.php	1.09 KB	-rw-r--r--	2022-12-20 11:09
event.php	12.39 KB	-rw-r--r--	2026-08-19 12:22
event_allvenues.php	18.93 KB	-rw-r--r--	2026-08-09 11:44
eventdecline_awards.php	11.79 KB	-rw-r--r--	2022-12-20 11:09
eventregister.php	26.85 KB	-rw-r--r--	2026-02-10 07:56
eventregister_awards.php	19.4 KB	-rw-r--r--	2025-06-20 06:38
eventregister_golf.php	28.83 KB	-rw-r--r--	2025-08-19 08:12
eventtables.php	24.13 KB	-rw-r--r--	2023-06-01 09:51
eventtables.php.bak	3.49 KB	-rw-r--r--	2022-12-20 11:09
fidicgama2018.php	1012 B	-rw-r--r--	2022-12-20 11:09
forum.php	3.25 KB	-rw-r--r--	2022-12-20 11:09
getoffices.php	799 B	-rw-r--r--	2022-12-20 11:09
hrforumsubscribe.php	2.62 KB	-rw-r--r--	2022-12-20 11:09
hrforumunsubscribe.php	1.32 KB	-rw-r--r--	2022-12-20 11:09
inc_calendarnew.php	10.56 KB	-rw-r--r--	2025-08-21 10:11
inc_captcha.php	337 B	-rw-r--r--	2022-12-20 11:09
inc_db.php	12.33 KB	-rw-r--r--	2025-06-18 12:05
inc_php7.php	6 KB	-rw-r--r--	2025-07-07 12:51
inc_practicenoteslist.php	4.1 KB	-rw-r--r--	2024-07-03 13:52
inc_scecalendar.php	8.55 KB	-rw-r--r--	2025-06-13 08:57
inc_scecalendar_backup.php	6.66 KB	-rw-r--r--	2022-12-20 11:09
inc_scecalendarnew.php	7.84 KB	-rw-r--r--	2026-05-09 09:39
jobshadowschools.php	7.26 KB	-rw-r--r--	2025-06-20 06:38
logout.php	593 B	-rw-r--r--	2025-02-25 08:19
marketingevent.php	122.75 KB	-rw-r--r--	2026-08-03 13:40
marketingeventdecline.php	15.21 KB	-rw-r--r--	2022-12-20 11:09
marketingsurvey.php	5.95 KB	-rw-r--r--	2022-12-20 11:09
matrixtemplate.htm	2.13 KB	-rw-r--r--	2022-12-20 11:09
member_portal_becs.php	2.14 KB	-rw-r--r--	2025-09-12 07:50
member_portal_transformation.php	10.45 KB	-rw-r--r--	2026-05-20 10:07
member_portal_transformation_proxy.php	538 B	-rw-r--r--	2026-05-20 09:08
memberauth.php	991 B	-rw-r--r--	2025-02-25 08:19
memberportal.php	11.79 KB	-rw-r--r--	2026-05-20 09:54
membersearch.php	22.72 KB	-rw-r--r--	2025-02-27 08:02
membersearch_smme.php	6.2 KB	-rw-r--r--	2024-11-27 11:41
memberverify.php	5.25 KB	-rw-r--r--	2022-12-20 11:09
mentors.php	21.68 KB	-rw-r--r--	2025-06-20 06:38
migratenode.php	1.26 KB	-rw-r--r--	2022-12-20 11:09
monofont.ttf	40.07 KB	-rw-r--r--	2022-12-20 11:09
nlc.php	855 B	-rw-r--r--	2022-12-20 11:09
nlcreports.php	2.51 KB	-rw-r--r--	2022-12-20 11:09
php_errors.log	1.06 KB	-rw-r--r--	2026-08-20 23:37
practicenotes.php	4.63 KB	-rw-r--r--	2022-12-20 11:09
practicenotes_full.php	1.33 KB	-rw-r--r--	2022-12-20 11:09
practicenotes_help.php	2.17 KB	-rw-r--r--	2022-12-20 11:09
practicenotes_list.php	2.03 KB	-rw-r--r--	2024-07-03 13:52
practicenotes_search.php	9.43 KB	-rw-r--r--	2022-12-20 11:09
querynlcmatrix.php	15 KB	-rw-r--r--	2022-12-20 11:09
querynlcmatrix.php4	15.38 KB	-rw-r--r--	2012-03-05 08:01
register.php	58.18 KB	-rw-r--r--	2026-05-26 14:55
relay.php	20.33 KB	-rw-r--r--	2025-06-20 06:38
relayteams.php	12.53 KB	-rw-r--r--	2022-12-20 11:09
resendcpdform.php	7.28 KB	-rw-r--r--	2025-08-01 10:38
retiredeng.php	13.45 KB	-rw-r--r--	2025-06-20 06:38
retiredeng_members.php	1.81 KB	-rw-r--r--	2022-12-20 11:09
sanitize.php	10 B	-rw-r--r--	2022-12-20 11:09
sce_survey2015.php	25.85 KB	-rw-r--r--	2022-12-20 11:09
sceallevents.php	8.13 KB	-rw-r--r--	2026-01-20 08:45
scecalendar.php	4.86 KB	-rw-r--r--	2025-06-18 11:18
scecalendar_backup.php	3.17 KB	-rw-r--r--	2025-06-18 11:18
scecalendarnew.php	5.98 KB	-rw-r--r--	2025-08-28 11:14
scecalendarnewtest.php	5.7 KB	-rw-r--r--	2022-03-04 12:37
scecalendartest.php	3.57 KB	-rw-r--r--	2022-03-04 12:38
scecategories.php	914 B	-rw-r--r--	2022-12-20 11:09
scecourses.php	7.18 KB	-rw-r--r--	2026-08-19 12:15
scelist.php	7.72 KB	-rw-r--r--	2025-08-29 07:18
scesubscribe.php	2.06 KB	-rw-r--r--	2022-12-20 11:09
sceupdate.php	1.67 KB	-rw-r--r--	2025-06-18 11:18
scevenuehire.php	6.15 KB	-rw-r--r--	2026-01-23 13:12
sendeventreg.php	19.5 KB	-rw-r--r--	2026-08-14 12:05
sendeventreg2.php	2.83 KB	-rw-r--r--	2026-07-17 14:57
sendeventreg_golf.php	20.23 KB	-rw-r--r--	2026-08-14 12:05
sendeventreg_golf.php.bak	11.69 KB	-rw-r--r--	2016-09-07 09:48
sendreg.php	35.15 KB	-rw-r--r--	2026-08-14 12:05
smsunsub.php	1.89 KB	-rw-r--r--	2025-06-18 11:18
template.php	54.36 KB	-rw-r--r--	2022-12-20 11:09
tenders.php	1.34 KB	-rw-r--r--	2022-12-20 11:09
trainerportal.php	50.27 KB	-rw-r--r--	2025-08-01 11:06
trainerportal.php.bak	2.57 KB	-rw-r--r--	2022-12-20 11:09
unempgrad_members.php	2.38 KB	-rw-r--r--	2025-06-18 11:18
unemployed.php	14.13 KB	-rw-r--r--	2025-06-20 06:38
unemployedreg.php	23.38 KB	-rw-r--r--	2025-06-20 06:38
unempreg_members.php	2.36 KB	-rw-r--r--	2025-06-18 11:18
ypfbranchcommittee.php	1.63 KB	-rw-r--r--	2022-12-20 11:09
ypfcommittees.php	1.57 KB	-rw-r--r--	2022-12-20 11:09
ypfjoin.php	30.29 KB	-rw-r--r--	2025-07-07 15:53
ypfjoin2.php	28.13 KB	-rw-r--r--	2025-06-18 11:18
ypfjoinmatches.php	9.46 KB	-rw-r--r--	2025-06-18 11:18
ypfmentees.php	20.81 KB	-rw-r--r--	2026-08-24 11:52
ypfmentees_members.php	2.42 KB	-rw-r--r--	2025-06-18 11:18

Rename

<?php
$bCourseFull = true;
if (isset($_GET["override"]) && ($_GET["override"]==1)) $bCourseFull = false;

if ($bCourseFull) {
?>
<p style='color:red'><b>Sorry, no more registrations can be accepted.</b></p>
<?php
} else {
//error_reporting(E_ALL); 
//ini_set("display_errors", 1);

$pagetitle="CCM Registration";
include_once("inc_db.php");
$sMsg = "";
$bShowForm = true;

function GenPassword() {
    // Password generation 
    $length = 8; // Must be a multiple of 2
    $conso=array("b","c","d","f","g","h","j","k","l", "m","n","p","r","s","t","v","w","x","y","z"); 
    $vocal=array("a","e","i","o","u"); 
    $password=""; 
    srand ((double)microtime()*1000000); 
    $max = $length/2; 
    for($i=1; $i<=$max; $i++) 
    { 
        $password.=$conso[rand(0,19)]; 
        $password.=$vocal[rand(0,4)]; 
    }
    
    return $password;
}

if (empty($_POST['FirstName'])) {
			$sMsg .= "<li>Please enter your first name</li>";
		}
	
		if (empty($_POST['Surname'])) {
			$sMsg .= "<li>Please enter your surname</li>";
		}
	
		if (empty($_POST['EmailAddress'])) {
			$sMsg .= "<li>Please enter your email address</li>";
		}
	
		if (empty($_POST['IDNumber'])) {
			$sMsg .= "<li>Please enter your ID Number</li>";
		}
	
		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['Accept_Policy'])) {
			$sMsg .= "<li>You have not accepted the payment terms and conditions</li>";
		}
	
		if (empty($sMsg)) {
			$bShowForm = false;
			
			$sql = "SELECT * FROM CCMStudents WHERE IDNumber='".$_REQUEST["IDNumber"]."'";
			$recCheck = mysql_query($sql);
			if ($rowCheck=mysql_fetch_assoc($recCheck)) {
				$sMsg .= "<li>The ID number you provided is already registered.</li>";
			}
			mysql_free_result($recCheck);
		}
		
		if (empty($sMsg)) {
		
			$uploaddir = 'ccmadmin/uploads/';
			$uploadID="";
			$uploadCV="";
			$uploadqual1="";
			$uploadqual2="";
			$uploadqual3="";
			$uploadmentor="";
			$uploadcandu="";
			$uploadpolicy="";
			$uploaddisability="";
			$uploadpayslip="";
			$uploadbank="";
			$uploadphoto="";
			$uploadfileID="";
			$uploadfileCV="";
			$uploadfilequal1="";
			$uploadfilequal2="";
			$uploadfilequal3="";
			$uploadfilementor="";
			$uploadfilecandu="";
			$uploadfilepolicy="";
			$uploadfiledisability="";
			$uploadfilepayslip="";
			$uploadfilebank="";
			$uploadfilephoto="";
			if (isset($_FILES['IDFile'])) {
				$uploadID = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['IDFile']['name']))));
				$uploadfileID = $uploaddir . $uploadID;
				$ifilenum=1;
				while (file_exists($uploadfileID) && !empty($uploadID)) {
					$uploadfileID = $uploaddir . $ifilenum."_".$uploadID;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['IDFile']['tmp_name'], $uploadfileID);
			}
			if (isset($_FILES['CVFile'])) {
				$uploadCV = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['CVFile']['name']))));
				$uploadfileCV = $uploaddir . $uploadCV;
				$ifilenum=1;
				while (file_exists($uploadfileCV) && !empty($uploadCV)) {
					$uploadfileCV = $uploaddir . $ifilenum."_".$uploadCV;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['CVFile']['tmp_name'], $uploadfileCV);
			}
			if (isset($_FILES['QualCertificate1'])) {
				$uploadqual1 = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['QualCertificate1']['name']))));
				$uploadfilequal1 = $uploaddir . $uploadqual1;
				$ifilenum=1;
				while (file_exists($uploadfilequal1) && !empty($uploadqual1)) {
					$uploadfilequal1 = $uploaddir . $ifilenum."_".$uploadqual1;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['QualCertificate1']['tmp_name'], $uploadfilequal1);
			}
			if (isset($_FILES['QualCertificate2'])) {
				$uploadqual2 = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['QualCertificate2']['name']))));
				$uploadfilequal2 = $uploaddir . $uploadqual2;
				$ifilenum=1;
				while (file_exists($uploadfilequal2) && !empty($uploadqual2)) {
					$uploadfilequal2 = $uploaddir . $ifilenum."_".$uploadqual2;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['QualCertificate2']['tmp_name'], $uploadfilequal2);
			}
			if (isset($_FILES['QualCertificate3'])) {
				$uploadqual3 = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['QualCertificate3']['name']))));
				$uploadfilequal3 = $uploaddir . $uploadqual3;
				$ifilenum=1;
				while (file_exists($uploadfilequal3) && !empty($uploadqual3)) {
					$uploadfilequal3 = $uploaddir . $ifilenum."_".$uploadqual3;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['QualCertificate3']['tmp_name'], $uploadfilequal3);
			}
			if (isset($_FILES['MentorUndertaking'])) {
				$uploadmentor = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['MentorUndertaking']['name']))));
				$uploadfilementor = $uploaddir . $uploadmentor;
				$ifilenum=1;
				while (file_exists($uploadfilementor) && !empty($uploadmentor)) {
					$uploadfilementor = $uploaddir . $ifilenum."_".$uploadmentor;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['MentorUndertaking']['tmp_name'], $uploadfilementor);
			}
			if (isset($_FILES['CandUUndertaking'])) {
				$uploadcandu = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['CandUUndertaking']['name']))));
				$uploadfilecandu = $uploaddir . $uploadcandu;
				$ifilenum=1;
				while (file_exists($uploadfilecandu) && !empty($uploadcandu)) {
					$uploadfilecandu = $uploaddir . $ifilenum."_".$uploadcandu;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['CandUUndertaking']['tmp_name'], $uploadfilecandu);
			}
			if (isset($_FILES['CompanyCandidatePolicy'])) {
				$uploadpolicy = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['CompanyCandidatePolicy']['name']))));
				$uploadfilepolicy = $uploaddir . $uploadpolicy;
				$ifilenum=1;
				while (file_exists($uploadfilepolicy) && !empty($uploadpolicy)) {
					$uploadfilepolicy = $uploaddir . $ifilenum."_".$uploadpolicy;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['CompanyCandidatePolicy']['tmp_name'], $uploadfilepolicy);
			}
			if (isset($_FILES['DisabilityCertificate'])) {
				$uploaddisability = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['DisabilityCertificate']['name']))));
				$uploadfiledisability = $uploaddir . $uploaddisability;
				$ifilenum=1;
				while (file_exists($uploadfiledisability) && !empty($uploaddisability)) {
					$uploadfiledisability = $uploaddir . $ifilenum."_".$uploaddisability;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['DisabilityCertificate']['tmp_name'], $uploadfiledisability);
			}
			if (isset($_FILES['Payslip'])) {
				$uploadpayslip = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['Payslip']['name']))));
				$uploadfilepayslip = $uploaddir . $uploadpayslip;
				$ifilenum=1;
				while (file_exists($uploadfilepayslip) && !empty($uploadpayslip)) {
					$uploadfilepayslip = $uploaddir . $ifilenum."_".$uploadpayslip;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['Payslip']['tmp_name'], $uploadfilepayslip);
			}
			if (isset($_FILES['BankAccountProof'])) {
				$uploadbank = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['BankAccountProof']['name']))));
				$uploadfilebank = $uploaddir . $uploadbank;
				$ifilenum=1;
				while (file_exists($uploadfilebank) && !empty($uploadbank)) {
					$uploadfilebank = $uploaddir . $ifilenum."_".$uploadbank;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['BankAccountProof']['tmp_name'], $uploadfilebank);
			}
			if (isset($_FILES['Photograph'])) {
				$uploadphoto = strtolower(str_replace(array("'","\"","(",")","#"," "), "_", basename(stripslashes($_FILES['Photograph']['name']))));
				$uploadfilephoto = $uploaddir . $uploadphoto;
				$ifilenum=1;
				while (file_exists($uploadfilephoto) && !empty($uploadphoto)) {
					$uploadfilephoto = $uploaddir . $ifilenum."_".$uploadphoto;
					$ifilenum++;
				}
				move_uploaded_file($_FILES['Photograph']['tmp_name'], $uploadfilephoto);
			}
		
			
			$sql = "INSERT INTO `CCMStudents` (`Organisation`, `Title`, `FirstName`, `Surname`, `KnownAs`, `JobTitle`, `Department`,
`IDNumber`, `DateofBirth`, `PlaceofBirth`, `CountryofBirth`, `MaleorFemale`, `RaceGroup`, `Disability`, `DisabilityNature`,
`ProfessionalCouncil`, `CategoryReg`, `CouncilRegNumber`, `LengthCandidateReg`, `YearsToProfReg`,
`FirstJobStart`, `VolAssociations`, `AreaDiscipline`, `AreaSubDiscipline`, `Telephone`, `Cellphone`, `EmailAddress`,
`WorkAddress`, `PostalAddress`, `VATNo`, `Salary`, `BankAccountName`, `BankAccountBank`, `BankAccountBranch`,
`BankAccountNo`, `Funding`, `CWDTP`, `MentorName`, `MentorDesig`, `MentorProfRegNo`, `MentorRegNo`,
`MentorTel`, `MentorCell`, `MentorEmail`, `SupervisorName`, `SupervisorDesig`, `SupervisorProfRegNo`, `SupervisorTelNo`,
`SupervisorCellNo`, `SupervisorEmail`, `HRManagerName`, `HRManagerDesignation`, `HRManagerTelNo`, `HRManagerCellNo`,
`HRManagerEmail`, `BookedByName`, `BookedByDesignation`, `BookedByTelNo`, `BookedByFaxNo`, `BookedByCellNo`, `BookedByEmail`,
`EducationalInst`, `Qualifications`, `DateFinalExam`, `BelongsTo`, `CESA_SABTACO_MemNum`, `IDFile`, `CVFile`, `QualCertificate1`, `QualCertificate2`, `QualCertificate3`,
`MentorUndertaking`, `CandUUndertaking`, `CompanyCandidatePolicy`, `DisabilityCertificate`, `Payslip`, `BankAccountProof`, `Photograph`)
VALUES ('".$_POST['Organisation']."', '".$_POST['Title']."', '".$_POST['FirstName']."', '".$_POST['Surname']."', '".$_POST['KnownAs']."', '".$_POST['JobTitle']."', '".$_POST['Department']."', '".$_POST['IDNumber']."', '".$_POST['DateofBirth']."', '".$_POST['PlaceofBirth']."', '".$_POST['CountryofBirth']."', '".$_POST['MaleorFemale']."', '".$_POST['RaceGroup']."', '".$_POST['Disability']."', '".$_POST['DisabilityNature']."', '".$_POST['ProfessionalCouncil']."', '".$_POST['CategoryReg']."', '".$_POST['CouncilRegNumber']."', '".$_POST['LengthCandidateReg']."', '".$_POST['YearsToProfReg']."', '".$_POST['FirstJobStart']."', '".$_POST['VolAssociations']."', '".$_POST['AreaDiscipline']."', '".$_POST['AreaSubDiscipline']."', '".$_POST['Telephone']."', '".$_POST['Cellphone']."', '".$_POST['EmailAddress']."', '".$_POST['WorkAddress']."', '".$_POST['PostalAddress']."', '".$_POST['VATNo']."', '".$_POST['Salary']."', '".$_POST['BankAccountName']."', '".$_POST['BankAccountBank']."', '".$_POST['BankAccountBranch']."', '".$_POST['BankAccountNo']."', '".$_POST['Funding']."', '".$_POST['CWDTP']."', '".$_POST['MentorName']."', '".$_POST['MentorDesig']."', '".$_POST['MentorProfRegNo']."', '".$_POST['MentorRegNo']."', '".$_POST['MentorTel']."', '".$_POST['MentorCell']."', '".$_POST['MentorEmail']."', '".$_POST['SupervisorName']."', '".$_POST['SupervisorDesig']."', '".$_POST['SupervisorProfRegNo']."', '".$_POST['SupervisorTelNo']."', '".$_POST['SupervisorCellNo']."', '".$_POST['SupervisorEmail']."', '".$_POST['HRManagerName']."', '".$_POST['HRManagerDesignation']."', '".$_POST['HRManagerTelNo']."', '".$_POST['HRManagerCellNo']."', '".$_POST['HRManagerEmail']."', '".$_POST['BookedByName']."', '".$_POST['BookedByDesignation']."', '".$_POST['BookedByTelNo']."', '".$_POST['BookedByFaxNo']."', '".$_POST['BookedByCellNo']."', '".$_POST['BookedByEmail']."', '".$_POST['EducationalInst']."', '".$_POST['Qualifications']."', '".$_POST['DateFinalExam']."', '".$_POST["belongsto"]."', '".$_POST["cesamemnum"]."', 
				'".str_replace($uploaddir, '', $uploadfileID)."',
				'".str_replace($uploaddir, '', $uploadfileCV)."',
				'".str_replace($uploaddir, '', $uploadfilequal1)."',
				'".str_replace($uploaddir, '', $uploadfilequal2)."',
				'".str_replace($uploaddir, '', $uploadfilequal3)."',
				'".str_replace($uploaddir, '', $uploadfilementor)."',
				'".str_replace($uploaddir, '', $uploadfilecandu)."',
				'".str_replace($uploaddir, '', $uploadfilepolicy)."',
				'".str_replace($uploaddir, '', $uploadfiledisability)."',
				'".str_replace($uploaddir, '', $uploadfilepayslip)."',
				'".str_replace($uploaddir, '', $uploadfilebank)."',
				'".str_replace($uploaddir, '', $uploadfilephoto)."')";
//echo $sql;
			mysql_query($sql);
			
			$iStudentID = mysql_insert_id();
	
			$sStudentNumber = "CCM".str_pad($iStudentID, 6, "0", STR_PAD_LEFT);
			$WebUsername = $sStudentNumber;
			$WebPassword = GenPassword();
			
			$sql = "UPDATE CCMStudents SET StudentNumber='".$sStudentNumber."', WebUsername='".$WebUsername."', WebPassword='".$WebPassword."'
			WHERE CCMStudentID=".$iStudentID;
			mysql_query($sql);
			
		$sForm = '
<table width="643" border="1" cellpadding="5" cellspacing="0">
    <tbody>
        <tr>
          <td valign="top">Organisation:</td>
          <td>'.$_REQUEST["Organisation"].'</td>
        </tr>
        <tr>
          <td>Title:</td>
          <td>'.$_REQUEST["Title"].'
          	</td>
        </tr>
        <tr>
            <td width="298"><p>First Name:</p></td>
            <td width="319">'.$_REQUEST["FirstName"].'</td>
        </tr>
        <tr>
            <td><p>Surname:</p></td>
            <td>'.$_REQUEST["Surname"].'</td>
        </tr>
        <tr>
            <td><p>Preferred Name (Known As):</p></td>
            <td>'.$_REQUEST["KnownAs"].'</td>
        </tr>
        <tr>
          <td>Job Title:</td>
          <td>'.$_REQUEST["JobTitle"].'</td>
        </tr>
        <tr>
          <td>Department:</td>
          <td>'.$_REQUEST["Department"].'</td>
        </tr>
        <tr>
          <td>South African ID Number (Only):</td>
          <td>'.$_REQUEST["IDNumber"].'</td>
        </tr>
        <tr>
          <td>Date of Birth:</td>
          <td>'.$_REQUEST["DateofBirth"].'</td>
        </tr>
        <tr>
          <td>Place of Birth:</td>
          <td>'.$_REQUEST["PlaceofBirth"].'</td>
        </tr>
        <tr>
          <td>Country of Birth:</td>
          <td>'.$_REQUEST["CountryofBirth"].'</td>
        </tr>
        <tr>
          <td>Male / Female:</td>
          <td>'.$_REQUEST["MaleorFemale"].'</td>
        </tr>
        <tr>
          <td>Race Group:</td>
          <td>'.$_REQUEST["RaceGroup"].'</td>
        </tr>
        <tr>
          <td>Do you have a disability?</td>
          <td>'.$_REQUEST["Disability"].'</td>
        </tr>
        <tr>
          <td>If so, indicate the nature:</td>
          <td>'.$_REQUEST["DisabilityNature"].'</td>
        </tr>
        <tr>
          <td>With which professional council are you registered?</td>
          <td>'.$_REQUEST["ProfessionalCouncil"].'</td>
        </tr>
        <tr>
          <td>Category of registration:</td>
          <td>'.$_REQUEST["CategoryReg"].'</td>
        </tr>
        <tr>
          <td>Council registration number (if applicable):</td>
          <td>'.$_REQUEST["CouncilRegNumber"].'</td>
        </tr>
        <tr>
          <td>How long have you been registered as a candidate?</td>
          <td>'.$_REQUEST["LengthCandidateReg"].'</td>
        </tr>
        <tr>
          <td>How many years left to professional registration?</td>
          <td>'.$_REQUEST["YearsToProfReg"].'</td>
        </tr>
        <tr>
          <td>Start date of first job post qualification:</td>
          <td>'.$_REQUEST["FirstJobStart"].'</td>
        </tr>
        <tr>
          <td>Membership of voluntary associations:</td>
          <td>'.$_REQUEST["VolAssociations"].'</td>
        </tr>
<tr>
          <td>Belongs to:</td>
          <td>'.$_REQUEST["belongsto"].'</td>
        </tr>
        <tr>
          <td>CESA / SABTACO membership number:</td>
          <td>'.$_REQUEST["cesamemnum"].'</td>
        </tr>
		        <tr>
          <td>Area of Discipline:</td>
          <td>'.$_REQUEST["AreaDiscipline"].'</td>
        </tr>
        <tr>
          <td>Area of Sub-discipline:</td>
          <td>'.$_REQUEST["AreaSubDiscipline"].'</td>
        </tr>
        <tr>
            <td><p>Telephone No:</p></td>
            <td>'.$_REQUEST["Telephone"].'</td>
            </p></td>
        </tr>
        <tr>
            <td><p>Cell No.&nbsp;:</p></td>
            <td>'.$_REQUEST["Cellphone"].'</td>
        </tr>
        <tr>
            <td><p>E-mail Address:</p></td>
            <td>'.$_REQUEST["EmailAddress"].'</td>
        </tr>
    	<tr>
    	  <td valign="top">Work Physical Address:</td>
    	  <td>'.stripslashes($_REQUEST["WorkAddress"]).'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Province:</td>
    	  <td>'.$_REQUEST["Province"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Postal Address:</td>
    	  <td>'.stripslashes($_REQUEST["PostalAddress"]).'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">VAT No:</td>
    	  <td>'.$_REQUEST["VATNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Salary (Basic):</td>
    	  <td>'.$_REQUEST["Salary"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Bank account details:</td>
    	  <td align="right">Name: '.$_REQUEST["BankAccountName"].'<br />Bank: '.$_REQUEST["BankAccountBank"].'<br />
Branch: '.$_REQUEST["BankAccountBranch"].'<br />
    	    Number: '.$_REQUEST["BankAccountNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Do you have funding from any other skills development programme/project funded by a public institution? (Describe)</td>
    	  <td>'.$_REQUEST["Funding"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Does your company have a structured Candidate Workplace Development/ Training Plan?</td>
    	  <td>'.$_REQUEST["CWDTP"].'</td>
  	  </tr>
    	<tr>
          <td valign="top"><strong>Mentor:</strong></td>
    	  <td>'.$_REQUEST["MentorName"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Designation:</td>
    	  <td>'.$_REQUEST["MentorDesig"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Professional Registration No:</td>
    	  <td>'.$_REQUEST["MentorProfRegNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Mentor\'s Registration No:</td>
    	  <td>'.$_REQUEST["MentorRegNo"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Tel No:</td>
    	  <td>'.$_REQUEST["MentorTel"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Cell No:</td>
    	  <td>'.$_REQUEST["MentorCell"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Email Address:</td>
    	  <td>'.$_REQUEST["MentorEmail"].'</td>
  	  </tr>
    	
    	<tr>
    	  <td valign="top"><strong>Supervisor:</strong></td>
    	  <td>'.$_REQUEST["SupervisorName"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Designation:</td>
    	  <td>'.$_REQUEST["SupervisorDesig"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Professional Registration No: (if applicable)</td>
    	  <td>'.$_REQUEST["SupervisorProfRegNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Tel No:</td>
    	  <td>'.$_REQUEST["SupervisorTelNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Cell No:</td>
    	  <td>'.$_REQUEST["SupervisorCellNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Email Address:</td>
    	  <td>'.$_REQUEST["SupervisorEmail"].'</td>
  	  </tr>
    	<tr>
          <td valign="top"><strong>HR Manager:</strong></td>
    	  <td>'.$_REQUEST["HRManagerName"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Designation:</td>
    	  <td>'.$_REQUEST["HRManagerDesignation"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Tel No:</td>
    	  <td>'.$_REQUEST["HRManagerTelNo"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Cell No:</td>
    	  <td>'.$_REQUEST["HRManagerCellNo"].'</td>
  	  </tr>
    	<tr>
          <td valign="top">Email Address:</td>
    	  <td>'.$_REQUEST["HRManagerEmail"].'</td>
  	  </tr>
    	
    	<tr>
    	  <td valign="top"><strong>Booked By:</strong></td>
    	  <td>'.$_REQUEST["BookedByName"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Designation:</td>
    	  <td>'.$_REQUEST["BookedByDesignation"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Tel No:</td>
    	  <td>'.$_REQUEST["BookedByTelNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Fax No:</td>
    	  <td>'.$_REQUEST["BookedByFaxNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Cell No:</td>
    	  <td>'.$_REQUEST["BookedByCellNo"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Email Address:</td>
    	  <td>'.$_REQUEST["BookedByEmail"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top"><strong>South African - Highest Examinations Passed:</strong></td>
    	  <td>&nbsp;</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Educational Institution:</td>
    	  <td>'.$_REQUEST["EducationalInst"].'<br/>'.$_REQUEST["EducationInstOther"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Qualifications Attained:</td>
    	  <td>'.$_REQUEST["Qualifications"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Date of Final Examination:</td>
    	  <td>'.$_REQUEST["DateFinalExam"].'</td>
  	  </tr>
    	<tr>
    	  <td valign="top"><strong>Documents:</strong></td>
    	  <td>&nbsp;</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Certified copy of ID or passport:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfileID).'">'.str_replace($uploaddir, '', $uploadfileID).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Curriculum Vitae (CV):</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfileCV).'">'.str_replace($uploaddir, '', $uploadfileCV).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Certified copies of qualification/s:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilequal1).'">'.str_replace($uploaddir, '', $uploadfilequal1).'</a><br>
    	  <a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilequal2).'">'.str_replace($uploaddir, '', $uploadfilequal2).'</a><br />
    	  <a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilequal3).'">'.str_replace($uploaddir, '', $uploadfilequal3).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Undertaking from Mentor:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilementor).'">'.str_replace($uploaddir, '', $uploadfilementor).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Undertaking of C&amp;U (ECSA):</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilecandu).'">'.str_replace($uploaddir, '', $uploadfilecandu).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Company Candidate Policy:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilepolicy).'">'.str_replace($uploaddir, '', $uploadfilepolicy).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Cerificate of disability (if applicable):</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfiledisability).'">'.str_replace($uploaddir, '', $uploadfiledisability).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Payslip:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilepayslip).'">'.str_replace($uploaddir, '', $uploadfilepayslip).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Proof of bank account:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilebank).'">'.str_replace($uploaddir, '', $uploadfilebank).'</a></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Photograph:</td>
    	  <td><a href="http://www.cesa.co.za/ccmadmin/uploads/'.str_replace($uploaddir, '', $uploadfilephoto).'">'.str_replace($uploaddir, '', $uploadfilephoto).'</a></td>
  	  </tr>
    </tbody>
</table>
';		
		// To send HTML mail, the Content-type header must be set
		$headers  = 'MIME-Version: 1.0' . "\r\n";
		$headers .= 'Content-type: text/html; charset=iso-8859-1' . "\r\n";
		
		// Additional headers
		$headers .= 'From: '.$_REQUEST["EmailAddress"] . "\r\n";
		$headers .= 'CC: brenda@cesa.co.za' . "\r\n";
//		$headers .= 'CC: athromethm@cesa.co.za' . "\r\n";

$sSendFormTo = "cce@cesa.co.za";
//		$sSendFormTo = "julia@xe.co.za";
	
		mail($sSendFormTo, "REGISTRATION FOR SABTACO/CESA Candidacy Programme", $sForm, $headers);
?>
<p><strong>Thank you for completing the &lsquo;Expression of Interest&rsquo; application form, for the SABTACO/CESA Candidacy Programme, to develop Graduates/Candidates towards professional registration in a range of Built Environment categories.</strong></p>
<p>Only completed application forms, with all supporting documentation, except for the Graduate/ Candidate&rsquo;s training plan, if not available at time of submitting, will be considered.</p>
<p>Please note that your submission will only be evaluated after the deadline date (1st March 2013) and you will be advised via email should your application be successful.</p>
<p><strong>DISCLAIMER:</strong></p>
<ul>
  <li>This request to submit an EOI is not an agreement and is not an offer or invitation to enter into an agreement of any kind with any party.</li>
  <li>All information contained in this Expression of Interest (EOI) or subsequently provided is done so in good faith.</li>
  <li>CESA and SABTACO reserve the right to accept/reject any Expression of Interest (EOI) from parties without assigning any reasons whatsoever.</li>
</ul>
<p>Please email <a href="mailto:cce@cesa.co.za">cce@cesa.co.za</a> if you have any questions. A copy of your form appears below.</p>
<hr />
<?php echo $sForm; ?>
<?php
		}
	}
}
if ($bShowForm) {
?>

<form action="/mentanet" method="post" enctype="multipart/form-data" name="form1" id="form1">
<input type="hidden" name="go" value="1" />
<h3>APPLICATION FORM: CETA Candidacy Programmes to Culminate in the Registration of Candidates in Designated Professions</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 below.</p>

<table width="643" border="1" cellpadding="5" cellspacing="0">
    <tbody>
        <tr>
          <td valign="top">Organisation:</td>
          <td><input name="Organisation" type="text" id="Organisation" size="50" value="<?php echo $_REQUEST["Organisation"]; ?>" /></td>
        </tr>
        <tr>
          <td>Title:</td>
          <td>
          	<select name="Title" id="Title">
            <?php
			$arr=array('Mr', 'Mrs', 'Ms', 'Miss', 'Dr', 'Prof');
			WriteOptions("Title", $arr);
			?>
          	</select>
          	</td>
        </tr>
        <tr>
            <td width="298"><p>First Name:</p></td>
            <td width="319"><p>
                <input name="FirstName" type="text" id="FirstName" size="50" value="<?php echo $_REQUEST["FirstName"]; ?>" />
            </p></td>
        </tr>
        <tr>
            <td><p>Surname:</p></td>
            <td><input name="Surname" type="text" id="Surname" size="50" value="<?php echo $_REQUEST["Surname"]; ?>" /></td>
        </tr>
        <tr>
            <td><p>Preferred Name (Known As):</p></td>
            <td><p>
                <input name="KnownAs" type="text" id="KnownAs" size="50" value="<?php echo $_REQUEST["KnownAs"]; ?>" />
            </p></td>
        </tr>
        <tr>
          <td>Job Title:</td>
          <td><input name="JobTitle" type="text" id="Designation" size="50" value="<?php echo $_REQUEST["JobTitle"]; ?>" /></td>
        </tr>
        <tr>
          <td>Department:</td>
          <td><input name="Department" type="text" id="Designation2" size="50" value="<?php echo $_REQUEST["Department"]; ?>" /></td>
        </tr>
        <tr>
          <td>South African ID Number (Only):</td>
          <td><input name="IDNumber" type="text" id="IDNumber" size="30" value="<?php echo $_REQUEST["IDNumber"]; ?>" /></td>
        </tr>
        <tr>
          <td>Date of Birth:</td>
          <td><input name="DateofBirth" type="text" id="DateofBirth" size="30" value="<?php echo $_REQUEST["DateofBirth"]; ?>" /></td>
        </tr>
        <tr>
          <td>Place of Birth:</td>
          <td><label for="PlaceofBirth"></label>
            <select name="PlaceofBirth" id="PlaceofBirth">
            <option value=""></option>
			<optgroup label="Eastern Cape">
            <?php
			$arr=array('Addo', 'Aliwal North', 'Cape St Francis', 'Cradock', 'East London', 'Graaff-Reinet', 'Grahamstown', 'Humansdorp', 'Jeffreys Bay	', 'Kenton-on-Sea', 'Middleburg', 'Nieu Bethesda', 'Oyster Bay', 'Port Alfred', 'Port Elizabeth', 'Rhodes	', 'Shelley Beach', 'Somerset East', 'St Francis Bay');
			WriteOptions("PlaceofBirth", $arr);
			?>
			</optgroup>
<optgroup label="Free State">
            <?php
			$arr=array('Bethlehem', 'Bloemfontein', 'Clarens', 'Ficksburg', 'Fouriesburg', 'Gariep Dam', 'Golden Gate', 'Harrismith', 'Heilbron', 'Kestell', 'Kroonstad', 'Ladybrand', 'Lindley', 'Parys', 'Qwa Qwa', 'Villiers', 'Warden', 'Winburg');
			WriteOptions("PlaceofBirth", $arr);
			?>
</optgroup>
<optgroup label="Gauteng">
<option>Alberton</option>
<option>Benoni</option>
<option>Bronkhorstspruit</option>
<option>Carletonville</option>
<option>Centurion</option>
<option>Cullinan</option>
<option>Germiston</option>
<option>Heidelberg</option>
<option>Johannesburg</option>
<option>Kempton Park</option>
<option>Krugersdorp</option>
<option>KwaMhlanga	</option>
<option>Midrand</option>
<option>Muldersdrift</option>
<option>Nigel</option>
<option>Pretoria</option>
<option>Randburg	</option>
<option>Roodepoort</option>
<option>Sandton</option>
<option>Saxonworld</option>
<option>Soweto</option>
<option>Springs</option>
<option>Temba</option>
<option>Vanderbijlpark</option>
<option>Vereeniging</option>
</optgroup>
<optgroup label="KwaZulu-Natal">
<option>Amanzimtoti</option>
<option>Babanago</option>
<option>Babanango</option>
<option>Ballito</option>
<option>Bergville</option>
<option>Blythedale Beach</option>
<option>Boston-Bulwer</option>
<option>Colenso</option>
<option>Dundee</option>
<option>Durban</option>
<option>Empangeni</option>
<option>Eshowe</option>
<option>Estcourt</option>
<option>Gingindlovu</option>
<option>Glencoe</option>
<option>Greytown</option>
<option>Harding</option>
<option>Hibberdene</option>
<option>Himeville</option>
<option>Hluhluwe</option>
<option>Howick</option>
<option>Ixopo</option>
<option>Jozini</option>
<option>Karkloof</option>
<option>Kokstad</option>
<option>Kosi Bay</option>
<option>Kranskop</option>
<option>Ladysmith</option>
<option>Magudu</option>
<option>Margate</option>
<option>Matatiele</option>
<option>Melmoth</option>
<option>Mkuze</option>
<option>Mooi River</option>
<option>Morningside & Berea Area</option>
<option>Mtubatuba</option>
<option>Mtunzini</option>
<option>Newcastle</option>
<option>Nongoma</option>
<option>Nottingham Road</option>
<option>Nquthu</option>
<option>Oribi Flats</option>
<option>Paulpietersburg</option>
<option>Pennington</option>
<option>Pietermaritzburg</option>
<option>Pongola</option>
<option>Port Edward</option>
<option>Port Shepstone</option>
<option>Richards Bay</option>
<option>Richmond-Bryne</option>
<option>Rosetta</option>
<option>Salt Rock</option>
<option>Scottburgh</option>
<option>Shaka's Kraal</option>
<option>Shaka's Rock</option>
<option>Sheffield Beach</option>
<option>Sodwana Bay</option>
<option>Southbroom</option>
<option>St Lucia</option>
<option>Stanger</option>
<option>Sugar Coast</option>
<option>Swartberg</option>
<option>Tinley Manor</option>
<option>Township Area's</option>
<option>Ulundi</option>
<option>Umhlanga, Umdloti etc.</option>
<option>Umkomaas</option>
<option>Underberg</option>
<option>Utrecht</option>
<option>Valley of 1000 Hills</option>
<option>Volksrust</option>
<option>Vryheid</option>
<option>Wartburg</option>
<option>Weenen</option>
<option>Winterton</option>
<option>Zimbali</option>
<option>Zinkwazi</option>
</optgroup>
<optgroup label="Limpopo">
<option>Ellisras</option>
<option>Hoedspruit</option>
<option>Kruger National Park</option>
<option>Louis Trichardt</option>
<option>Melkrivier</option>
<option>Messina</option>
<option>Naboomspruit</option>
<option>Nylstroom</option>
<option>Phalaborwa</option>
<option>Pietersburg</option>
<option>Port Nolloth	</option>
<option>Potgietersrus	</option>
<option>Queenstown</option>
<option>Rust de Winter</option>
<option>Thabazimbi</option>
<option>Tzaneen</option>
<option>Vaalwater</option>
<option>Warm Baths</option>
</optgroup>
<optgroup label="Mpumalanga">
<option>Badplaas</option>
<option>Barberton</option>
<option>Bethal</option>
<option>Blyde River Canyon</option>
<option>Dullstroom</option>
<option>Ermelo</option>
<option>Graskop</option>
<option>Groblersdal</option>
<option>Hazyview</option>
<option>Hoedspruit</option>
<option>Kaapschehoop</option>
<option>Kruger National Park</option>
<option>Lydenburg</option>
<option>Malelane</option>
<option>Marloth Park Game Reserve</option>
<option>Middelburg</option>
<option>Nelspruit</option>
<option>Piet Retief</option>
<option>Pilgrims Rest</option>
<option>Sabie</option>
<option>Skukuza</option>
<option>Standerton</option>
<option>Volksrust</option>
<option>Wakkerstroom</option>
<option>Waterval Boven	</option>
<option>White River</option>
<option>Witbank</option>
</optgroup>
<optgroup label="North West">
<option>Bloemhof</option>
<option>Brits</option>
<option>Carolina</option>
<option>Christiana</option>
<option>Groot Marico</option>
<option>Hartbeespoort Dam</option>
<option>Klerksdorp</option>
<option>Lichtenburg</option>
<option>Madikwe</option>
<option>Mafikeng</option>
<option>Magaliesberg</option>
<option>Mmabatho</option>
<option>Pilansberg</option>
<option>Potchefstroom</option>
<option>Rustenberg</option>
<option>Tosca</option>
<option>Vryburg</option>
<option>Zeerust</option>
</optgroup>
<optgroup label="Northern Cape">
<option>Barkly West</option>
<option>Britstown</option>
<option>Colesberg</option>
<option>Garies</option>
<option>Groblershoop</option>
<option>Hanover	Kalahari</option>
<option>Kakamas</option>
<option>Kanoneiland</option>
<option>Kimberley</option>
<option>Kuruman</option>
<option>Orania</option>
<option>Port Nolloth</option>
<option>Richmond</option>
<option>Springbok</option>
<option>Upington	</option>
<option>Vioolsdrift</option>
</optgroup>
<optgroup label="Western Cape">
<option>Agulhas</option>
<option>Albertinia</option>
<option>Arniston</option>
<option>Ashton</option>
<option>Aurora</option>
<option>Barrydale</option>
<option>Beaufort West</option>
<option>Betty's Bay</option>
<option>Bitterfontein</option>
<option>Bonnievale</option>
<option>Brakenfell</option>
<option>Bredasdorp</option>
<option>Caledon</option>
<option>Calitzdorp</option>
<option>Cape Town</option>
<option>Carnarvon</option>
<option>Ceres</option>
<option>Citrusdal</option>
<option>Clanwilliam</option>
<option>Darling</option>
<option>De Doorns</option>
<option>De Kelders</option>
<option>De Rust</option>
<option>Doring Bay</option>
<option>Dwarskersbos</option>
<option>Elands Bay</option>
<option>Elim</option>
<option>Franschhoek</option>
<option>Gansbaai</option>
<option>Garden Route</option>
<option>George</option>
<option>Gordon's Bay</option>
<option>Grabouw	</option>
<option>Greyton</option>
<option>Harkerville</option>
<option>Hermanus</option>
<option>Hopefield </option>
<option>Jacobs Bay</option>
<option>Jonkershoek</option>
<option>Kamieskroon</option>
<option>Kleinmond</option>
<option>Knysna</option>
<option>L'Agulhas</option>
<option>Ladismith</option>
<option>Laingsburg</option>
<option>Lamberts Bay</option>
<option>Langebaan</option>
<option>Leliefontein</option>
<option>Little Karoo</option>
<option>Loeriesfontein</option>
<option>Lutzville</option>
<option>McGregor</option>
<option>Montagu</option>
<option>Mossel Bay</option>
<option>Nature's Valley</option>
<option>Oudtshoorn</option>
<option>Paarl</option>
<option>Paternoster</option>
<option>Piketberg</option>
<option>Plettenberg Bay</option>
<option>Porterville</option>
<option>Porteville</option>
<option>Prince Albert</option>
<option>Prince Alfred Hamlet</option>
<option>Rawsonville</option>
<option>Riebeeck Kasteel</option>
<option>Riebeeck West</option>
<option>Riversdale</option>
<option>Robertson</option>
<option>Rooi Els</option>
<option>Saldanha</option>
<option>Sedgefield</option>
<option>Simonstown</option>
<option>Somerset West</option>
<option>St Helena Bay</option>
<option>Stellenbosch</option>
<option>Still Bay</option>
<option>Stormsriver</option>
<option>Strand</option>
<option>Strandfontein</option>
<option>Struisbaai</option>
<option>Sutherland</option>
<option>Swellendam</option>
<option>Touws River</option>
<option>Tulbagh</option>
<option>Uniondale</option>
<option>Vanrhynsdorp</option>
<option>Velddrif</option>
<option>Vredenburg</option>
<option>Vredendal</option>
<option>Wellington</option>
<option>West Coast</option>
<option>Wilderness</option>
<option>Winelands</option>
<option>Witsand</option>
<option>Worcester</option>
<option>Wuppertal</option>
<option>Yzerfontein</option>
<option>Zoar</option>
</optgroup>
          </select></td>
        </tr>
        <tr>
          <td>Country of Birth:</td>
          <td><select name="CountryofBirth" id="CountryofBirth">
            <option value=""></option>
<option>Afghanistan</option>
<option>Akrotiri</option>
<option>Albania</option>
<option>Algeria</option>
<option>American Samoa</option>
<option>Andorra</option>
<option>Angola</option>
<option>Anguilla</option>
<option>Antarctica</option>
<option>Antigua and Barbuda</option>
<option>Argentina</option>
<option>Armenia</option>
<option>Aruba</option>
<option>Ashmore and Cartier Islands</option>
<option>Australia</option>
<option>Austria</option>
<option>Azerbaijan</option>
<option>Bahamas, The</option>
<option>Bahrain</option>
<option>Bangladesh</option>
<option>Barbados</option>
<option>Bassas da India</option>
<option>Belarus</option>
<option>Belgium</option>
<option>Belize</option>
<option>Benin</option>
<option>Bermuda</option>
<option>Bhutan</option>
<option>Bolivia</option>
<option>Bosnia and Herzegovina</option>
<option>Botswana</option>
<option>Bouvet Island</option>
<option>Brazil</option>
<option>British Indian Ocean Territory</option>
<option>British Virgin Islands</option>
<option>Brunei</option>
<option>Bulgaria</option>
<option>Burkina Faso</option>
<option>Burma</option>
<option>Burundi</option>
<option>Cambodia</option>
<option>Cameroon</option>
<option>Canada</option>
<option>Cape Verde</option>
<option>Cayman Islands</option>
<option>Central African Republic</option>
<option>Chad</option>
<option>Chile</option>
<option>China</option>
<option>Christmas Island</option>
<option>Clipperton Island</option>
<option>Cocos (Keeling) Islands</option>
<option>Colombia</option>
<option>Comoros</option>
<option>Congo, Democratic Republic of the</option>
<option>Congo, Republic of the</option>
<option>Cook Islands</option>
<option>Coral Sea Islands</option>
<option>Costa Rica</option>
<option>Cote d'Ivoire</option>
<option>Croatia</option>
<option>Cuba</option>
<option>Cyprus</option>
<option>Czech Republic</option>
<option>Denmark</option>
<option>Dhekelia</option>
<option>Djibouti</option>
<option>Dominica</option>
<option>Dominican Republic</option>
<option>Ecuador</option>
<option>Egypt</option>
<option>El Salvador</option>
<option>Equatorial Guinea</option>
<option>Eritrea</option>
<option>Estonia</option>
<option>Ethiopia</option>
<option>Europa Island</option>
<option>Falkland Islands (Islas Malvinas)</option>
<option>Faroe Islands</option>
<option>Fiji</option>
<option>Finland</option>
<option>France</option>
<option>French Guiana</option>
<option>French Polynesia</option>
<option>French Southern and Antarctic Lands</option>
<option>Gabon</option>
<option>Gambia, The</option>
<option>Gaza Strip</option>
<option>Georgia</option>
<option>Germany</option>
<option>Ghana</option>
<option>Gibraltar</option>
<option>Glorioso Islands</option>
<option>Greece</option>
<option>Greenland</option>
<option>Grenada</option>
<option>Guadeloupe</option>
<option>Guam</option>
<option>Guatemala</option>
<option>Guernsey</option>
<option>Guinea</option>
<option>Guinea-Bissau</option>
<option>Guyana</option>
<option>Haiti</option>
<option>Heard Island and McDonald Islands</option>
<option>Holy See (Vatican City)</option>
<option>Honduras</option>
<option>Hong Kong</option>
<option>Hungary</option>
<option>Iceland</option>
<option>India</option>
<option>Indonesia</option>
<option>Iran</option>
<option>Iraq</option>
<option>Ireland</option>
<option>Isle of Man</option>
<option>Israel</option>
<option>Italy</option>
<option>Jamaica</option>
<option>Jan Mayen</option>
<option>Japan</option>
<option>Jersey</option>
<option>Jordan</option>
<option>Juan de Nova Island</option>
<option>Kazakhstan</option>
<option>Kenya</option>
<option>Kiribati</option>
<option>Korea, North</option>
<option>Korea, South</option>
<option>Kuwait</option>
<option>Kyrgyzstan</option>
<option>Laos</option>
<option>Latvia</option>
<option>Lebanon</option>
<option>Lesotho</option>
<option>Liberia</option>
<option>Libya</option>
<option>Liechtenstein</option>
<option>Lithuania</option>
<option>Luxembourg</option>
<option>Macau</option>
<option>Macedonia</option>
<option>Madagascar</option>
<option>Malawi</option>
<option>Malaysia</option>
<option>Maldives</option>
<option>Mali</option>
<option>Malta</option>
<option>Marshall Islands</option>
<option>Martinique</option>
<option>Mauritania</option>
<option>Mauritius</option>
<option>Mayotte</option>
<option>Mexico</option>
<option>Micronesia, Federated States of</option>
<option>Moldova</option>
<option>Monaco</option>
<option>Mongolia</option>
<option>Montserrat</option>
<option>Morocco</option>
<option>Mozambique</option>
<option>Namibia</option>
<option>Nauru</option>
<option>Navassa Island</option>
<option>Nepal</option>
<option>Netherlands</option>
<option>Netherlands Antilles</option>
<option>New Caledonia</option>
<option>New Zealand</option>
<option>Nicaragua</option>
<option>Niger</option>
<option>Nigeria</option>
<option>Niue</option>
<option>Norfolk Island</option>
<option>Northern Mariana Islands</option>
<option>Norway</option>
<option>Oman</option>
<option>Pakistan</option>
<option>Palau</option>
<option>Panama</option>
<option>Papua New Guinea</option>
<option>Paracel Islands</option>
<option>Paraguay</option>
<option>Peru</option>
<option>Philippines</option>
<option>Pitcairn Islands</option>
<option>Poland</option>
<option>Portugal</option>
<option>Puerto Rico</option>
<option>Qatar</option>
<option>Reunion</option>
<option>Romania</option>
<option>Russia</option>
<option>Rwanda</option>
<option>Saint Helena</option>
<option>Saint Kitts and Nevis</option>
<option>Saint Lucia</option>
<option>Saint Pierre and Miquelon</option>
<option>Saint Vincent and the Grenadines</option>
<option>Samoa</option>
<option>San Marino</option>
<option>Sao Tome and Principe</option>
<option>Saudi Arabia</option>
<option>Senegal</option>
<option>Serbia and Montenegro</option>
<option>Seychelles</option>
<option>Sierra Leone</option>
<option>Singapore</option>
<option>Slovakia</option>
<option>Slovenia</option>
<option>Solomon Islands</option>
<option>Somalia</option>
<option>South Africa</option>
<option>South Georgia and the South Sandwich Islands</option>
<option>Spain</option>
<option>Spratly Islands</option>
<option>Sri Lanka</option>
<option>Sudan</option>
<option>Suriname</option>
<option>Svalbard</option>
<option>Swaziland</option>
<option>Sweden</option>
<option>Switzerland</option>
<option>Syria</option>
<option>Taiwan</option>
<option>Tajikistan</option>
<option>Tanzania</option>
<option>Thailand</option>
<option>Timor-Leste</option>
<option>Togo</option>
<option>Tokelau</option>
<option>Tonga</option>
<option>Trinidad and Tobago</option>
<option>Tromelin Island</option>
<option>Tunisia</option>
<option>Turkey</option>
<option>Turkmenistan</option>
<option>Turks and Caicos Islands</option>
<option>Tuvalu</option>
<option>Uganda</option>
<option>Ukraine</option>
<option>United Arab Emirates</option>
<option>United Kingdom</option>
<option>United States</option>
<option>Uruguay</option>
<option>Uzbekistan</option>
<option>Vanuatu</option>
<option>Venezuela</option>
<option>Vietnam</option>
<option>Virgin Islands</option>
<option>Wake Island</option>
<option>Wallis and Futuna</option>
<option>West Bank</option>
<option>Western Sahara</option>
<option>Yemen</option>
<option>Zambia</option>
<option>Zimbabwe</option>
          </select></td>
        </tr>
        <tr>
          <td>Male / Female:</td>
          <td><input name="MaleorFemale" type="radio" id="MaleorFemale" value="M" />
          <label for="MaleorFemale">Male<br />
            <input type="radio" name="MaleorFemale" id="MaleorFemale2" value="F" />
            Female
          </label></td>
        </tr>
        <tr>
          <td>Race Group:</td>
          <td><input name="RaceGroup" type="radio" id="MaleorFemale3" value="Asian" />
            Asian<br />
            <input name="RaceGroup" type="radio" id="MaleorFemale4" value="African" /> 
          African<br />
          <input name="RaceGroup" type="radio" id="MaleorFemale5" value="Coloured" /> 
          Coloured<br />
          <input name="RaceGroup" type="radio" id="MaleorFemale6" value="White" /> 
          White
</td>
        </tr>
        <tr>
          <td>Do you have a disability?</td>
          <td><input name="Disability" type="radio" id="MaleorFemale7" value="Y" /> 
          Yes<br />
          <input name="Disability" type="radio" id="MaleorFemale8" value="N" /> 
          No
</td>
        </tr>
        <tr>
          <td>If so, indicate the nature:</td>
          <td>Nature: <input name="DisabilityNature" type="text" id="DisabilityNature" size="40" value="<?php echo $_REQUEST["DisabilityNature"]; ?>" /></td>
        </tr>
        <tr>
          <td>With which professional council are you registered?</td>
          <td><select name="ProfessionalCouncil" id="ProfessionalCouncil">
<option>None</option>
<option>The South African Council for the Architectural Profession (SACAP)</option>
<option>The South African Council for the Quantity surveying profession (SACPLAN)</option>
<option>Engineering Council of South Africa (ECSA)</option>
<option>The South African Council for the Quantity surveying profession (SACQSP)</option>
          </select></td>
        </tr>
        <tr>
          <td>Belongs to:</td>
          <td><input type="radio" name="belongsto" id="belongsto" value="CESA" />
          <label for="belongsto">CESA<br />
            <input type="radio" name="belongsto" id="belongsto2" value="SABTACO" /> 
            SABTACO<br />
            <input type="radio" name="belongsto" id="belongsto3" value="CESA/SABTACO" />
            CESA/SABTACO<br />
            <input type="radio" name="belongsto" id="belongsto4" value="Neither" />
          Neither </label></td>
        </tr>
        <tr>
          <td>CESA / SABTACO membership number:</td>
          <td><label for="cesamemnum"></label>
          <input type="text" name="cesamemnum" id="cesamemnum" /></td>
        </tr>
        <tr>
          <td>Category of registration:</td>
          <td><select name="CategoryReg" id="CategoryReg">
<optgroup label="Architects">
<option>Candidate Architect</option>
<option>Candidate Senior Architectural Technologist</option>
<option>Candidate Architectural Technologist</option>
<option>Candidate Architectural Draughtsperson</option>
</optgroup>
<optgroup label="Town Planners">
<option>Professional Planner</option>
<option>Technical Planner</option>
</optgroup>
<optgroup label="Engineers">
<option>Candidate Engineer</option>
<option>Engineer</option>
<option>Engineering Technologist</option>
<option>Engineering Technician</option>
</optgroup>
<optgroup label="Quantity Surveyors">
<option>ND Building</option>
<option>BTech QS</option>
<option>BSc QS</option>
<option>BSc Hon QS</option>
</optgroup>
          </select></td>
        </tr>
        <tr>
          <td>Council registration number (if applicable):</td>
          <td><input name="CouncilRegNumber" type="text" id="CouncilRegNumber" size="30" value="<?php echo $_REQUEST["CouncilRegNumber"]; ?>" /></td>
        </tr>
        <tr>
          <td>How long have you been registered as a candidate?</td>
          <td><input name="LengthCandidateReg" type="text" id="LengthCandidateReg" size="50" value="<?php echo $_REQUEST["LengthCandidateReg"]; ?>" /></td>
        </tr>
        <tr>
          <td>How many years left to professional registration?</td>
          <td><input name="YearsToProfReg" type="text" id="YearsToProfReg" size="50" value="<?php echo $_REQUEST["YearsToProfReg"]; ?>" /></td>
        </tr>
        <tr>
          <td>Start date of first job post qualification:</td>
          <td><input name="FirstJobStart" type="text" id="FirstJobStart" size="50" value="<?php echo $_REQUEST["FirstJobStart"]; ?>" /></td>
        </tr>
        <tr>
          <td>Voluntary association to which candidate / firm belongs:</td>
          <td><select name="VolAssociations" id="VolAssociations">
<optgroup label="Architects">
<option>South African Institute of Architects (SAIA)</option>
<option>South African Insitute of Architectural Technologists (SAIAT)</option>
<option>South African Institute of Interior Design Professions (IID)</option>
<option>South African Institute of Building Designers (SAIBD)</option>
<option>South African Institute of Draughting (SAID)</option>
<option>Border-Kei Institute of Architects (BKIA)</option>
<option>Cape Institute for Architecture (CIfA)</option>
<option>Eastern Cape Institute of Architects (ECIA)</option>
<option>Free State Institute of Architects (FSIA)</option>
<option>Gauteng Institute for Architecture (GIfA)</option>
<option>KwaZulu-Natal Institute for Architecture (KZNIA)</option>
<option>Pretoria Institute of Architects (PIA)</option>
</optgroup>
<optgroup label="Town Planners">
<option>South African Planning institute (SAPI)</option>
<option>South African Association of Consulting Professional Planners - North Region (SAACPP)</option>
<option>South African Association of Consulting Professional Planners - South Region (SAACPP)</option>
</optgroup>
<optgroup label="Engineers">
<option>Aeronautical Society of South Africa (AeSSA) </option>
<option>Association of Mine Managers of South Africa (AMMSA) </option>
<option>Association of Mine Resident Engineers (AMRE) </option>
<option>Association of Municipal Electricity Undertakings (AMEU) </option>
<option>Built Environment Professions Export Council (BEPEC) </option>
<option>Clinical Engineering Association Of South Africa (CEASA) </option>
<option>Concrete Society of Southern Africa (CSSA) </option>
<option>Consulting Engineers South Africa (CESA ) </option>
<option>Illumination Engineering Society of South Africa (IESSA) </option>
<option>Institute of Electrical and Electronic Engineers South African Section (IEEE) </option>
<option>Institute of Professional Engineering Technologists (IPET) </option>
<option>Institute of Quarrying Southern Africa (IQSA) </option>
<option>Institute of Timber Construction (ITC) </option>
<option>Institution of Certificated Mechanical and Electrical Engineering (ICMEESA ) </option>
<option>Institution of Municipal Engineering of Southern Africa (IMESA) </option>
<option>International Council on Systems Engineering (SA Chapter) (INCOSE SA) </option>
<option>Lift Inspectors Association of South Africa (LIASA) </option>
<option>National Society of Black Engineers (NSBE) </option>
<option>Society For Asphalt Technology (SAT) </option>
<option>Society of Telkom Engineers (STE) </option>
<option>South African Colliery Engineers’ Association (SACEA) </option>
<option>South African Colliery Managers Association (SACMA) </option>
<option>South African Federation of Civil Engineering Contractors (SAFCEC) </option>
<option>South African Federation of Hospital Engineers (SAFHE) </option>
<option>South African Flameproof Association (SAFA) </option>
<option>South African Fluid Power Association (SAFPA) </option>
<option>South African Institute of Agricultural Engineers (SAIAE) </option>
<option>South African Institute of Draughting (SAID) </option>
<option>South African Institute of Electrical Engineers (SAIEE) </option>
<option>South African Institute of Marine Engineers and Naval Architects (SAIMENA) </option>
<option>South African Institute of Measurement and Control (SAIMC) </option>
<option>South African Institute of Refrigeration and Air-Conditioning (SAIRAC) </option>
<option>South African Institute of Steel Construction (SAISC) </option>
<option>South African Institute of Welding (SAIW) </option>
<option>South African Institution of Chemical Engineers (SAIChE) </option>
<option>South African Institution of Civil Engineering (SAICE) </option>
<option>South African Road Federation (SARF) </option>
<option>Southern African Asset Management Association (SAAMA) </option>
<option>Southern African Institute for Industrial Engineers (SAIIE) </option>
<option>Southern African Institute of Mining And Metallurgy (SAIMM) </option>
<option>Southern African Society For Trenchless Technology (SASTT)        </option>
<option>The Chamber of Engineering Technology (COET) </option>
<option>The South African Institution of Mechanical Engineering (SAIMechE) </option>
<option>Water Institute of Southern Africa (WISA) </option>
</optgroup>
<optgroup label="Quantity Surveyors">
<option>The Association of South African Quantity Surveyors (ASAQS)</option>
<option>South African Property Owners Association (SAPOA)</option>
<option>Chartered Institute of Building (CIOB)</option>
</optgroup>
          </select></td>
        </tr>
        <tr>
          <td>Area of Discipline:</td>
          <td><select name="AreaDiscipline" id="AreaDiscipline">
<optgroup label="Chemical engineering">
<option>Biomolecular engineering</option>
<option>Materials engineering</option>
<option>Molecular engineering</option>
<option>Process engineering</option>
</optgroup><optgroup label="Civil engineering">
<option>Architectural engineering</option>
<option>Environmental engineering</option>
<option>Geotechnical engineering</option>
<option>Infrastructure</option>
<option>Structural engineering</option>
<option>Transport engineering</option>
</optgroup><optgroup label="Electrical engineering">
<option>Computer engineering</option>
<option>Hardware engineering</option>
<option>Electronic engineering</option>
<option>Telecommunications engineering</option>
<option>Power engineering</option>
</optgroup><optgroup label="Mechanical engineering">
<option>Aerospace Engineering</option>
<option>Acoustical engineering</option>
<option>Manufacturing engineering</option>
<option>Thermal engineering</option>
<option>Vehicle engineering</option>
</optgroup><optgroup label="Interdisciplinary and specialized fields">
<option>Agricultural engineering</option>
<option>Applied engineering	</option>
<option>Biological engineering</option>
<option>Building services engineering</option>
<option>Energy engineering</option>
<option>Industrial engineering</option>
<option>Mechatronics</option>
<option>Nano engineering</option>
<option>Nuclear engineering</option>
</optgroup><optgroup label="Architects">
<option>System/Product architect</option>
<option>Domain Architect</option>
<option>Solution Architect</option>
<option>Applied Architect</option>
<option>Enterprise architect</option>
</optgroup><optgroup label="Town Planners">
<option>Transportation Planning </option>
<option>Urban Planning </option>
<option>Rural/ Regional planning </option>
<option>Geographic Information System (GIS)</option>
<option>Development planning</option>
<option>Development economics </option>
</optgroup><optgroup label="Architects">
<option>Rehabilitation </option>
<option>Urban rehabilitation </option>
<option>Project management </option>
</optgroup>
</select>
          </td>
        </tr>
        <tr>
          <td>Area of Sub-discipline:</td>
          <td><input name="AreaSubDiscipline" type="text" id="AreaSubDiscipline" size="50" value="<?php echo $_REQUEST["AreaSubDiscipline"]; ?>" /></td>
        </tr>
        <tr>
            <td><p>Telephone No:</p></td>
            <td><p>
              <input name="Telephone" type="text" id="Telephone" size="30" value="<?php echo $_REQUEST["Telephone"]; ?>" />
            </p></td>
        </tr>
        <tr>
            <td><p>Cell No.&nbsp;:</p></td>
            <td><p>
              <input name="Cellphone" type="text" id="Cellphone" size="30" value="<?php echo $_REQUEST["Cellphone"]; ?>" />
            </p></td>
        </tr>
        <tr>
            <td><p>E-mail Address:</p></td>
            <td><p>
                <input name="EmailAddress" type="text" id="EmailAddress" size="50" value="<?php echo $_REQUEST["EmailAddress"]; ?>" />
            </p></td>
        </tr>
    	<tr>
    	  <td valign="top">Work Physical Address:</td>
    	  <td><textarea name="WorkAddress" id="WorkAddress" cols="45" rows="5"><?php echo stripslashes($_REQUEST["WorkAddress"]); ?>
          </textarea></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Province:</td>
    	  <td><select name="Province" id="Province">
<option>Eastern Cape</option>
<option>Free State</option>
<option>Gauteng</option>
<option>KwaZulu-Natal</option>
<option>Limpopo</option>
<option>Mpumalanga</option>
<option>North West</option>
<option>Northern Cape</option>
<option>Western Cape</option>
  	    </select></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Postal Address:</td>
    	  <td><textarea name="PostalAddress" id="PostalAddress" cols="45" rows="5"><?php echo stripslashes($_REQUEST["PostalAddress"]); ?>
          </textarea></td>
  	  </tr>
    	<tr>
    	  <td valign="top">VAT No:</td>
    	  <td><input name="VATNo" type="text" id="VATNo" size="30" value="<?php echo $_REQUEST["VATNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Salary (Basic):</td>
    	  <td><input name="Salary" type="text" id="Salary" size="30" value="<?php echo $_REQUEST["Salary"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Bank account details:</td>
    	  <td align="right">Name: <input name="BankAccountName" type="text" id="BankAccountName" size="40" value="<?php echo $_REQUEST["BankAccountName"]; ?>" /><br />Bank:
<input name="BankAccountBank" type="text" id="BankAccountBank" size="40" value="<?php echo $_REQUEST["BankAccountBank"]; ?>" /><br />
Branch: 
    	    <input name="BankAccountBranch" type="text" id="BankAccountBranch" size="40" value="<?php echo $_REQUEST["BankAccountBranch"]; ?>" /><br />
    	    Number: 
    	    <input name="BankAccountNo" type="text" id="BankAccountNo" size="40" value="<?php echo $_REQUEST["BankAccountNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Do you have funding from any other skills development programme/project funded by a public institution? (Describe)</td>
    	  <td><textarea name="Funding" id="Funding" cols="45" rows="2"><?php echo stripslashes($_REQUEST["Funding"]); ?></textarea></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Does your company have a structured Candidate Workplace Development/ Training Plan?</td>
    	  <td><input name="CWDTP" type="radio" id="MaleorFemale11" value="Y" />
Yes<br />
<input name="CWDTP" type="radio" id="MaleorFemale12" value="N" />
No </td>
  	  </tr>
    	<tr>
          <td valign="top"><strong>Mentor:</strong></td>
    	  <td><input name="MentorName" type="text" id="MentorName" size="50" value="<?php echo $_REQUEST["MentorName"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Designation:</td>
    	  <td><input name="MentorDesig" type="text" id="MentorDesig" size="50" value="<?php echo $_REQUEST["MentorDesig"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Professional Registration No:</td>
    	  <td><input name="MentorProfRegNo" type="text" id="MentorProfRegNo" size="50" value="<?php echo $_REQUEST["MentorProfRegNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Mentor's Registration No:</td>
    	  <td><input name="MentorRegNo" type="text" id="MentorRegNo" size="50" value="<?php echo $_REQUEST["MentorRegNo"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Tel No:</td>
    	  <td><input name="MentorTel" type="text" id="MentorTel" size="30" value="<?php echo $_REQUEST["MentorTel"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Cell No:</td>
    	  <td><input name="MentorCell" type="text" id="MentorCell" size="30" value="<?php echo $_REQUEST["MentorCell"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Email Address:</td>
    	  <td><input name="MentorEmail" type="text" id="MentorEmail" size="50" value="<?php echo $_REQUEST["MentorEmail"]; ?>" /></td>
  	  </tr>
    	
    	<tr>
    	  <td valign="top"><strong>Supervisor:</strong></td>
    	  <td><input name="SupervisorName" type="text" id="SupervisorName" size="50" value="<?php echo $_REQUEST["SupervisorName"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Designation:</td>
    	  <td><input name="SupervisorDesig" type="text" id="SupervisorDesig" size="50" value="<?php echo $_REQUEST["SupervisorDesig"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Professional Registration No: (if applicable)</td>
    	  <td><input name="SupervisorProfRegNo" type="text" id="SupervisorProfRegNo" size="50" value="<?php echo $_REQUEST["SupervisorProfRegNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Tel No:</td>
    	  <td><input name="SupervisorTelNo" type="text" id="SupervisorTelNo" size="30" value="<?php echo $_REQUEST["SupervisorTelNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Cell No:</td>
    	  <td><input name="SupervisorCellNo" type="text" id="SupervisorCellNo" size="30" value="<?php echo $_REQUEST["SupervisorCellNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Email Address:</td>
    	  <td><input name="SupervisorEmail" type="text" id="SupervisorEmail" size="50" value="<?php echo $_REQUEST["SupervisorEmail"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top"><strong>HR Manager:</strong></td>
    	  <td><input name="HRManagerName" type="text" id="HRManagerName" size="50" value="<?php echo $_REQUEST["HRManagerName"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Designation:</td>
    	  <td><input name="HRManagerDesignation" type="text" id="HRManagerDesignation" size="50" value="<?php echo $_REQUEST["HRManagerDesignation"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Tel No:</td>
    	  <td><input name="HRManagerTelNo" type="text" id="HRManagerTelNo" size="30" value="<?php echo $_REQUEST["HRManagerTelNo"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Cell No:</td>
    	  <td><input name="HRManagerCellNo" type="text" id="HRManagerCellNo" size="30" value="<?php echo $_REQUEST["HRManagerCellNo"]; ?>" /></td>
  	  </tr>
    	<tr>
          <td valign="top">Email Address:</td>
    	  <td><input name="HRManagerEmail" type="text" id="HRManagerEmail" size="50" value="<?php echo $_REQUEST["HRManagerEmail"]; ?>" /></td>
  	  </tr>
    	
    	<tr>
    	  <td valign="top"><strong>Booked By:</strong></td>
    	  <td><input name="BookedByName" type="text" id="BookedByName" size="50" value="<?php echo $_REQUEST["BookedByName"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Designation:</td>
    	  <td><input name="BookedByDesignation" type="text" id="BookedByDesignation" size="50" value="<?php echo $_REQUEST["BookedByDesignation"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Tel No:</td>
    	  <td><input name="BookedByTelNo" type="text" id="BookedByTelNo" size="30" value="<?php echo $_REQUEST["BookedByTelNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Fax No:</td>
    	  <td><input name="BookedByFaxNo" type="text" id="BookedByFaxNo" size="30" value="<?php echo $_REQUEST["BookedByFaxNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Cell No:</td>
    	  <td><input name="BookedByCellNo" type="text" id="BookedByCellNo" size="30" value="<?php echo $_REQUEST["BookedByCellNo"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Email Address:</td>
    	  <td><input name="BookedByEmail" type="text" id="BookedByEmail" size="50" value="<?php echo $_REQUEST["BookedByEmail"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top"><strong>South African - Highest Examinations Passed:</strong></td>
    	  <td>&nbsp;</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Educational Institution:</td>
    	  <td><select name="EducationalInst" id="EducationalInst">
<optgroup label="University">
<option>University of Johannesburg</option>
<option>University of Cape Town</option>
<option>Rhodes University</option>
<option>University of KwaZulu Natal</option>
<option>University of Pretoria</option>
<option>Stellenbosch University</option>
<option>University of the Witwatersrand</option>
<option>North West University </option>
<option>University of the Free State</option>
<option>University of Venda</option>
<option>University of the Western Cape</option>
<option>University of Limpopo</option>
<option>University of Fort Hare</option>
<option>University of South Africa</option>
<option>Walter Sisulu University</option>
<option>Nelson Mandela Metropolitan University</option>
</optgroup>
<optgroup label="University of Technikons">
<option>Cape Peninsula University of Technology</option>
<option>Durban University of Technology </option>
<option>Central University of Technology </option>
<option>Mangosutho University of Technology </option>
<option>Tshwane University of Technology </option>
<option>Vaal University of Technology</option>
</optgroup>
<optgroup label="Technikons">
<option>Border Technikon</option>
<option>Cape Technikon</option>
<option>Natal Technikon</option>
<option>ML Sultan Technikon</option>
<option>Eastern Cape Technikon</option>
<option>Free State Technikon</option>
<option>Mangosutho Technikon</option>
<option>Northern  Technikon</option>
<option>Peninsula Technikon</option>
<option>Port Elizabeth Technikon</option>
<option>Pretoria Technikon</option>
<option>Technikon SA</option>
<option>Vaal Technikon</option>
<option>Technikon Witwatersrand</option>
</optgroup>
<option>Other</option>
  	    </select><br/>
			<input type="text" name="EducationInstOther" id="EducationInstOther" value="<?php echo $_REQUEST["EducationInstOther"]; ?>" />
  	    </td>
  	  </tr>
    	<tr>
    	  <td valign="top">Qualifications Attained:</td>
    	  <td><label for="Qualifications"></label>
   	      <textarea name="Qualifications" id="Qualifications" cols="45" rows="2"><?php echo $_REQUEST["Qualifications"]; ?></textarea></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Date of Final Examination:</td>
    	  <td><input name="DateFinalExam" type="text" id="DateFinalExam" size="10" value="<?php echo $_REQUEST["DateFinalExam"]; ?>" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top"><strong>Documents:</strong></td>
    	  <td>&nbsp;</td>
  	  </tr>
    	<tr>
    	  <td valign="top">Certified copy of ID or passport:</td>
    	  <td><input type="file" name="IDFile" id="IDFile" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Curriculum Vitae (CV):</td>
    	  <td><label>
   	      <input type="file" name="CVFile" id="CVFile" />
    	  </label></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Certified copies of qualification/s:</td>
    	  <td><input type="file" name="QualCertificate1" id="QualCertificate1" />
   	      <br />
   	      <input type="file" name="QualCertificate2" id="QualCertificate2" />
   	      <br />
   	      <input type="file" name="QualCertificate3" id="QualCertificate3" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Undertaking from Mentor (if applicable):</td>
    	  <td><input type="file" name="MentorUndertaking" id="MentorUndertaking" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Undertaking of C&amp;U (ECSA):</td>
    	  <td><input type="file" name="CandUUndertaking" id="CandUUndertaking" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Company Candidate Policy:</td>
    	  <td><input type="file" name="CompanyCandidatePolicy" id="CompanyCandidatePolicy" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Cerificate of disability (if applicable):</td>
    	  <td><input type="file" name="DisabilityCertificate" id="DisabilityCertificate" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Payslip:</td>
    	  <td><input type="file" name="Payslip" id="Payslip" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Proof of bank account:</td>
    	  <td><input type="file" name="BankAccountProof" id="BankAccountProof" /></td>
  	  </tr>
    	<tr>
    	  <td valign="top">Photograph of candidate:</td>
    	  <td><input type="file" name="Photograph" id="Photograph" /></td>
  	  </tr>
    </tbody>
</table>
<br />
<p><strong>Terms and Conditions:</strong></p>
<ul>
	<li>The Candidate must be a full time staff member of a CESA and/or SABTACO member firm.</li>
	<li>The Candidate, Mentor, supervisor and organisation will be required to enter into a Cooperative Agreement.</li>
<li>The annual membership subscriptions to CESA and/or SABTACO must be up to date and the firm must be in good standing.</li>
<li>The organisation must ensure  the following:
	<ul><li>The Candidate has a Mentor to oversee the implementation and completion of the programme. A registered Mentor will only be required if it is a requirement of the relevant Council.</li>
		<li>Be able to provide a project/s and a technical supervisor/s oversight or agree for the Candidate to be rotated or transferred to other departments to able to provide the required project experience and supervision.</li>
	<li>Ensure that the candidate submits all reports and documents on time, which are comprehensible and of a high standard, as required by CESA/SABTACO and the relevant professional Council for registration.</li>
	<li>A minimum of 50 hours mentoring per annum per candidate, depending on locality, must be provided to the candidate.</li>
	<li>Provide the graduate with an e-mail address and access to the internet for purposes of research, assignments and monthly reporting.</li>
<li>If not already done so, support the candidate to register as a candidate with their relevant professional Council</li>
<li>Allow the Candidate to attend any supplementary technical or soft skills courses considered necessary - these would normally not exceed 6 days of training per annum.</li>
<li>Allow the Mentor and one Supervisor to attend a Road to Registration for Mentor and Supervisors Courses. This course is subsidised by the funding grant.</li>
</ul></li>
<li>If your organisation does not have a training plan, it will be your responsibility to use a portion of its funding to appoint an outside service provider to assist with this process. A list of approved service providers can be requested from the CESA/SCE website (www.cesa.co.za/mentanet).</li>
<li>All candidates selected for support should be South African citizens and must have a South African degree or diploma from a University, University of Technology or former Technikon.</li>
<li>It is a requirement of the CETA that we check that all candidates are earning more than R2 500.00 per month and have a bank account into which their salaries are being paid, and that the correct statutory deductions are being made. We would therefore also ask for payslips to be submitted.</li>
</ul>
<p>
  <input type="checkbox" name="Accept_Policy" id="Accept_Policy" value="yes" />
  I have read and accept the terms and conditions</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" />&nbsp;<b>Please be patient, submission can take time if the documents to upload are large.</b>
</p>
</form>
<?php
}
?>
<br />
<p>&nbsp;</p>
<?php include('../inc_footer.php4'); ?>
<?php
}
?>