<% strFirstName = Request.Form("FirstName") strMiddleInitial = Request.Form("MiddleInitial") strLastName = Request.Form("LastName") strAddress1 = Request.Form("Address1") strAddress2 = Request.Form("Address2") strCity = Request.Form("City") strState = Request.Form("State") strZipCode = Request.Form("ZipCode") strEmail = Request.Form("Email") strPassword = Request.Form("Password") strPasswordVerify = Request.Form("PasswordVerify") %> Prosthetic Eye Institute: User Registration
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