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205.251.139.155  Public Scan

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Submitted URL: https://connect.southwest.org/
Effective URL: https://www.southwest.org/connect/index.html
Submission: On March 05 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

Name: form1 — POST https://www.southwest.org/cgi-bin/formail2.pl

<form action="https://www.southwest.org/cgi-bin/formail2.pl" method="post" name="form1" class="formformat" id="form1">
  <input type="hidden" name="redirect" value="https://www.southwest.org/letusknow/formcomfirmation.html">
  <input type="hidden" name="env_report" value="REMOTE_HOST,HTTP_USER_AGENT,REMOTE_ADDR,REMOTE_USER,HTTP_REFERER">
  <input type="hidden" name="subject" value="[Connect Card]">
  <input type="hidden" name="recipient" value="mcollier@churchsouthwest.onmicrosoft.com,webform@churchsouthwest.onmicrosoft.com,cmashburn@churchsouthwest.onmicrosoft.com,cbooker@churchsouthwest.onmicrosoft.com">
  <div class="resizableinput">
    <label for="realname">Name:</label>
    <div class="resizableinput2">
      <input name="realname" type="text" id="realname">
    </div><!-- "resizableinput2 -->
  </div><!-- "resizableinput -->
  <div class="birthdateinput">
    <label for="Birthday">Birthday:</label>
    <div class="birthdateinput2"><input name="Month" type="number" pattern="\d*" id="Month" size="2" placeholder="Month">/<input name="Day" type="number" pattern="\d*" id="Day" size="2" placeholder="Day">/<input name="Year" type="number"
        pattern="\d*" id="Year" size="4" placeholder="Year"></div>
  </div><!-- "birthdateinput -->
  <div class="status">
    <div class="status2"><input name="Married" type="checkbox" value="Yes"><label for="Married"> Married</label></div>
    <div class="status3"><input name="Widowed" type="checkbox" value="Yes"><label for="Widowed"> Widowed</label></div>
    <div class="status2"><input name="SingleAdult" type="checkbox" value="Yes"><label for="SingleAdult"> Single Adult</label></div>
    <div class="status3"><input name="Student" type="checkbox" value="Yes"><label for="Student"> Student</label></div>
    <div class="status2"><input name="SingleAgain" type="checkbox" value="Yes"><label for="SingleAgain"> Single Again</label></div>
    <div class="clear"></div>
  </div><!-- status -->
  <div class="resizableinput">
    <label for="Address">Address:</label>
    <div class="resizableinput2">
      <input name="Address" type="text" id="Address">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="resizableinput">
    <label for="CityStateZip">City, State, Zip:</label>
    <div class="resizableinput2">
      <input name="CityStateZip" type="text" id="CityStateZip">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="resizableinput">
    <label for="Phone">Phone:</label>
    <div class="resizableinput2">
      <input name="Phone" type="tel" id="Phone">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="resizableinput">
    <label for="email">E-mail:</label>
    <div class="resizableinput2">
      <input name="email" type="email" id="email">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <p>&nbsp;</p>
  <div class="resizableinput">
    <label for="SpouseName">Spouse Name:</label>
    <div class="resizableinput2">
      <input name="SpouseName" type="text" id="SpouseName">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="birthdateinput">
    <label for="SpouseBirthday">Birthday:</label>
    <div class="birthdateinput2"><input name="SpouseMonth" type="number" pattern="\d*" id="SpouseMonth" size="2" placeholder="Month">/<input name="SpouseDay" type="number" pattern="\d*" id="SpouseDay" size="2" placeholder="Day">/<input
        name="SpouseYear" type="number" pattern="\d*" id="SpouseYear" size="4" placeholder="Year"></div>
  </div><!-- "birthdateinput -->
  <div class="resizableinput">
    <label for="SpousePhone">Spouse Phone:</label>
    <div class="resizableinput2">
      <input name="SpousePhone" type="tel" id="SpousePhone">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="resizableinput">
    <label for="Spouseemail">Spouse E-mail:</label>
    <div class="resizableinput2">
      <input name="Spouseemail" type="email" id="Spouseemail">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <p>&nbsp;</p>
  <div class="resizableinput">
    <label for="Child1Name">Child Name:</label>
    <div class="resizableinput2">
      <input name="Child1Name" type="text" id="Child1Name">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="birthdateinput">
    <label for="Child1Birthday">Birthday:</label>
    <div class="birthdateinput2"><input name="Child1Month" type="number" pattern="\d*" id="Child1Month" size="2" placeholder="Month">/<input name="Child1Day" type="number" pattern="\d*" id="Child1Day" size="2" placeholder="Day">/<input
        name="Child1Year" type="number" pattern="\d*" id="Child1Year" size="4" placeholder="Year"></div>
  </div><!-- "birthdateinput -->
  <div class="resizableinput">
    <label for="Child1Grade">Grade:</label>
    <div class="resizableinput2">
      <input name="Child1Grade" type="number" pattern="\d*" id="Child1Grade">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <p>&nbsp;</p>
  <div class="resizableinput">
    <label for="Child2Name">Child Name:</label>
    <div class="resizableinput2">
      <input name="Child2Name" type="text" id="Child2Name">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="birthdateinput">
    <label for="Child2Birthday">Birthday:</label>
    <div class="birthdateinput2"><input name="Child2Month" type="number" pattern="\d*" id="Child2Month" size="2" placeholder="Month">/<input name="Child2Day" type="number" pattern="\d*" id="Child2Day" size="2" placeholder="Day">/<input
        name="Child2Year" type="number" pattern="\d*" id="Child2Year" size="4" placeholder="Year"></div>
  </div><!-- "birthdateinput -->
  <div class="resizableinput">
    <label for="Child2Grade">Grade:</label>
    <div class="resizableinput2">
      <input name="Child2Grade" type="number" pattern="\d*" id="Child2Grade">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <p>&nbsp;</p>
  <div class="resizableinput">
    <label for="Child3Name">Child Name:</label>
    <div class="resizableinput2">
      <input name="Child3Name" type="text" id="Child3Name">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div class="birthdateinput">
    <label for="Child3Birthday">Birthday:</label>
    <div class="birthdateinput2"><input name="Child3Month" type="number" pattern="\d*" id="Child3Month" size="2" placeholder="Month">/<input name="Child3Day" type="number" pattern="\d*" id="Child3Day" size="2" placeholder="Day">/<input
        name="Child3Year" type="number" pattern="\d*" id="Child3Year" size="4" placeholder="Year"></div>
  </div><!-- "birthdateinput -->
  <div class="resizableinput">
    <label for="Child3Grade">Grade:</label>
    <div class="resizableinput2">
      <input name="Child3Grade" type="number" pattern="\d*" id="Child3Grade">
    </div><!-- resizableinput2 -->
  </div><!-- resizableinput -->
  <div id="cardbreak"></div><!-- cardbreak -->
  <div id="backbluebox">
    <div class="checkbox1">
      <input name="StartingPoint" type="checkbox" value="SignUp"><label for="StartingPoint">Sign me up for Starting Point class</label>
      <h1>Finding your place in the family</h1>
    </div><!-- "checkbox1 -->
    <div class="checkbox1">
      <input name="SmallGroup" type="checkbox" value="Interested"><label for="SmallGroup">I am interested in a Small Group</label>
      <h1>Finding your home base</h1>
    </div><!-- "checkbox1 -->
  </div><!-- backbluebox -->
  <div class="checkbox2">
    <input name="PlaceMembership" type="checkbox" value="Yes"><label for="PlaceMembership">I want to place membership at Southwest</label>
  </div><!-- "checkbox2 -->
  <div class="checkbox2">
    <input name="ShepherdContact" type="checkbox" value="Yes"><label for="ShepherdContact">I would like a call or visit from a Southwest Shepherd</label>
  </div><!-- "checkbox2 -->
  <h1>I want to know more about...</h1>
  <div class="checkbox1">
    <input name="StudentMinistry" type="checkbox" value="MoreInfo"><label for="StudentMinistry">Student Ministry</label>
  </div><!-- "checkbox1 -->
  <div class="checkbox1">
    <input name="ChildrensMinistry" type="checkbox" value="More Info"><label for="ChildrensMinistry">Children's Ministry</label>
  </div><!-- "checkbox1 -->
  <div class="checkbox1">
    <input name="CouselingSupport" type="checkbox" value="More Info">
    <label for="CouselingSupport">Counseling and support services</label>
  </div><!-- "checkbox1 -->
  <h1>Comments</h1>
  <textarea name="Comments"></textarea>
  <input name="Submit" type="submit" class="button" value="Submit Card">
</form>

Text Content

CONNECT

Name:

Birthday:
//
Married
Widowed
Single Adult
Student
Single Again

Address:

City, State, Zip:

Phone:

E-mail:


 

Spouse Name:

Birthday:
//
Spouse Phone:

Spouse E-mail:


 

Child Name:

Birthday:
//
Grade:


 

Child Name:

Birthday:
//
Grade:


 

Child Name:

Birthday:
//
Grade:


Sign me up for Starting Point class


FINDING YOUR PLACE IN THE FAMILY

I am interested in a Small Group


FINDING YOUR HOME BASE

I want to place membership at Southwest
I would like a call or visit from a Southwest Shepherd


I WANT TO KNOW MORE ABOUT...

Student Ministry
Children's Ministry
Counseling and support services


COMMENTS


SOUTHWEST CHURCH OF CHRIST


4515 CORNELL STREET, AMARILLO, TEXAS 79109


806.352.5647 | CHURCHMAIL@SOUTHWEST.ORG


All Content © Copyright Southwest Church of Christ