This is the whole form, I have put output for captcha on test.cfm
<cfif isDefined("form.entrydate")>
<cfquery datasource="ASME2" name="insert">
INSERT INTO wsfeedback
(entrydate, refurl, reftitle, email, feedbacktype, feedbackregard, <cfif IsDefined("form.feedbackregard_specify")>feedbackregard_specify,</cfif> feedback, <cfif IsDefined("form.member")>member,</cfif> <cfif IsDefined("form.comptype")>comptype,</cfif> <cfif IsDefined("form.browser")>browser,</cfif> firstname, lastname, member_id)
VALUES
(#Now()#, '#form.prevurl#', '#form.reftitle#', '#form.email#', '#form.feedbacktype#', '#form.feedbackregard#', <cfif IsDefined("form.feedbackregard_specify")>'#form.feedbackregard_specify#',</cfif> '#form.feedback#', <cfif IsDefined("form.member")>'#form.member#',</cfif> <cfif IsDefined("form.comptype")>'#form.comptype#',</cfif> '#form.browser#', '#form.firstname#', '#form.lastname#', '#form.member_id#')
</cfquery>
<CFINCLUDE template="test.cfm">
<cfabort>
</cfif>
<Cfoutput>
<cfset currURL = "#CGI.HTTPS#">
</CFOUTPUT><cfoutput><!--- <cfif #currURL# is "off">
<cflocation url="
</cfif> --->
<cfif IsDefined("CGI.HTTP_REFERER")><cfif #CGI.HTTP_REFERER# is not "">
<cfhttp method="get" redirect="true" url="#CGI.HTTP_REFERER#" throwonerror="true"></cfhttp>
<cfset st = REFindNoCase("<title>.*?</title>",cfhttp.fileContent,1,"True")>
<cfif st.pos[1] is not 0>
<cfset wholetag="#mid(cfhttp.fileContent, st.pos[1], st.len[1])#">
<cfset begintitletag="#left(mid(cfhttp.fileContent, st.pos[1], st.len[1]), 7)#">
<cfset endtitletag ="#right(mid(cfhttp.fileContent, st.pos[1], st.len[1]), 8)#">
<cfset removedbeginning="#RemoveChars(wholetag, 1, 7)#">
<cfset titlelen="#Evaluate(Len(removedbeginning) - Len(endtitletag))#">
<cfif titlelen is not "0">
<cfset pagetitle="#left(removedbeginning, titlelen)#">
<cfelse>
<cfset pagetitle="">
</cfif></cfif>
</cfif></cfif></cfoutput>
</p>
<html>
<head>
<title>Web Site Feedback Form</title>
<style type="text/css">
.fstyle
{
display: none;
}
</style>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<script type="text/javascript">
function validate(f) {
if(f.feedbackregard.selectedIndex=="")
{
alert("Please tell us what is the Feedback regarding");
f.feedbackregard.focus();
return false;
}
if(f.feedbackregard.selectedIndex=="6")
{
if(f.feedbackregard_specify.value=="")
{
alert("Please tell us what is the Feedback regarding?");
f.feedbackregard_specify.focus();
return false;
}
}
if(f.feedback.value=="")
{
alert("Please let us know your thoughts");
f.feedback.focus();
return false;
}
if( ! (/^\w+([\.-]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,3})+$/.test
(f.email.value)))
{
alert("Please enter valid Email address!")
return false;
}
return true;
}
</script>
<script type="text/javascript" src="multiValue.js"></script>
</head>
<body bgcolor="#FFFFFF">
<!--- recaptcha code--->
<cf_recaptcha action="check"
privateKey="6Ld7l7oSAAAAANeJkL7MGfEgB6AVYo7QHVXFkgaG"
publicKey="6Ld7l7oSAAAAAOxY9FHq-vpjMHh9IMARx04-8U-l">
<p ><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
<cfoutput><cfif #Left(CGI.HTTP_REFERER, 26)# is "
<table width="740"><tr><td><img src="images/15798.jpg"></td></tr><!--- <tr><td><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
</font></td></tr> ---></table>
<cfelseif #Left(CGI.HTTP_REFERER, 24)# is "
<table border="0" width="640" cellspacing="5" cellpadding="2" ><tr><td><img src="images/asmenewslogo.jpg"></td></tr>
<!--- <tr><td><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
</font></td></tr> ---></table>
<cfelse>ASME would like to know what you think. Let us know by submitting the following form. <br></font></b><font face="Verdana, Arial, Helvetica, sans-serif" size="2"><b>All
fields with <font color="ff0000">*</font> are required.</cfif></cfoutput><Br><!--- <Cfoutput>#currURL#</CFOUTPUT> ---> </b></font></p>
<cfform method="post" action="feedbackform.cfm" name="form" onSubmit="return validate(_CF_this)">
<input type="hidden" name="id">
<input type="hidden" name="entrydate" value="#DateFormat(Now(),"mm/dd/yyyy")#">
<p class="fstyle"><input name="subject" type="text" value=""/> </p>
<cfoutput>
<input type="hidden" name="prevurl" value="#CGI.HTTP_REFERER#">
<input type="hidden" name="browser" value="#CGI.HTTP_USER_AGENT#">
<table border="0" width="640" cellspacing="5" cellpadding="2" >
<cfoutput>
<cfif (#Left(CGI.HTTP_REFERER, 26)# is "
or (#Left(CGI.HTTP_REFERER, 24)# is "
<tr>
<td width="30%" valign="top" height="163" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Your feedback helps us determine content and areas of coverage. Please take a moment to comment on the article you have just read.<font color="ff0000">*</font></td><td valign="top">
<textarea name="feedback" cols="40" rows="8"></textarea>
</font></td>
</tr>
<tr>
<td width="30%" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
First Name: </td><td>
<input type="text" name="firstname" size="25">
</font></td>
</tr>
<tr>
<td width="30%" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Last Name:</td><td>
<input type="text" name="lastname" size="25">
</font></td>
</tr>
</cfif>
</cfoutput>
<tr>
<td width="30%" bgcolor="F7F7F7" ><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Please enter Page Title/URL: </td><td>
<cfoutput><input type="text" name="reftitle" size="50" value="#CGI.HTTP_REFERER#"></cfoutput><!--- <cfif IsDefined("CGI.HTTP_REFERER")><cfif IsDefined("pagetitle") and pagetitle is not "">value="#pagetitle#"<cfelse></cfif></cfif> --->
</font></td>
</tr>
<tr>
<td width="30%" valign="top" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Feedback type:<font color="ff0000">*</font></td><td>
<select id="feedbacktype" name="feedbacktype" onChange="ShowReg2(this.selectedIndex)">
<option value='0'> -- select--
<option value="Report a bug"> Report a bug</option>
<option value="Complaint"> Complaint</option>
<option value="Compliment"> Compliment</option>
<option value="Comment"> Comment</option>
<option value="Question"> Question</option>
</select>
<br><div id="Report a bug" style="display:none">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">What computer platform are you using?</font>
<input type="text" name="Comptype" value=""></div>
<div id="Complaint" style="display:none">
<input type="hidden" name="Complaint" value=""></div>
<div id="Compliment" style="display:none">
<input type="Hidden" name="Compliment" value=""></div>
<div id="Comment" style="display:none">
<input type="hidden" name="Comment" value=""></div>
<div id="Question" style="display:none">
<input type="hidden" name="Question" value=""></div>
</td>
</tr>
tr>
<td width="30%" valign="top" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
What is the Feedback regarding:<font color="ff0000">*</font> </td><td>
<!--- <textarea name="comment1" cols="40" rows="8"></textarea> --->
<select name="feedbackregard" onChange="ShowReg(this.selectedIndex)">
<option value=""> -- select--
<option value="Membership">Membership</option>
<option value="Product">Product</option>
<option value="Event">Event</option>
<option value="Service">Service</option>
<option value="ASME Search Engine">ASME Search Engine</option>
<option value="Other">Other</option>
</select><br>
<div id="Membership" style="display:none">
<input type="hidden" name="membernum" value=""></div>
<div id="Product" style="display:none">
<input type="Hidden" name="product" value=""></div>
<div id="Event" style="display:none">
<input type="hidden" name="event" value=""></div>
<div id="Service" style="display:none">
<input type="hidden" name="Service" value=""></div>
<div id="ASME Search Engine" style="display:none">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">What specific keyword or phrase did you enter into the search engine? </font><input type="text" name="feedbackregard_specify" value="" size="40">
</div>
<div id="Other" style="display:none">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">If other, please describe</font> <input type="text" name="feedbackregard_specify" size="25">
</td>
</tr>
<tr>
<td width="30%" valign="top" height="163" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Please let us know your thoughts <font color="ff0000">*</font> </td><td valign="top">
<textarea name="feedback" cols="40" rows="8"></textarea>
</font></td>
</tr>
<cfoutput>
<cfif (#Left(CGI.HTTP_REFERER, 26)# is not "
and (#Left(CGI.HTTP_REFERER, 24)# is not "
<tr>
<td width="30%" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
First Name: </td><td>
<input type="text" name="firstname" size="25">
</font></td>
</tr>
<tr>
<td width="30%" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Last Name:</td><td>
<input type="text" name="lastname" size="25">
</font></td>
</tr>
</cfif>
</cfoutput>
<tr>
<td width="30%" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Email Address:<font color="ff0000">*</font></td><td>
<input type="text" name="email" size="25">
</font></td>
</tr>
<tr>
<td width="30%" valign="top" height="32" bgcolor="F7F7F7"><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
Are you a member of ASME? </td><td>
<input type="radio" name="member" value="Yes">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">Yes </font>
<input type="radio" name="member" value="No">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">No </font>
<cfoutput>
<cfif (#Left(CGI.HTTP_REFERER, 26)# is not "
or (#Left(CGI.HTTP_REFERER, 24)# is not "
<input type="radio" name="member" value="Student">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">I am a student member</font><br>
</font></td>
</tr>
<tr>
<td width="30%" valign="top" bgcolor="F7F7F7">
<font face="Verdana, Arial, Helvetica, sans-serif"size="2">If submitting a membership related question please include your membership ID.
</td><td valign="top">
<input type="Text" name="member_id" size="25">
</font> </td>
</tr>
</cfif>
</cfoutput>
<tr>
<td width="100%" colspan="2">
<div ><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
</font></div>
</td>
</tr>
<tr>
<td colspan="2">
<div >
<table bgcolor="#c0c0c0"><tr><td>
<p><font face="Verdana, Arial, Helvetica, sans-serif"size="1">
To protect against form SPAM, we're requiring that feedback form submissions be validated by entering the image value in the field below. If the image's value is too hard to read, press the refresh button to the right.</font>
</p><font face="Verdana, Arial, Helvetica, sans-serif"size="2">
<!--- end part of recaptcha code --->
<cf_recaptcha
privateKey="6Ld7l7oSAAAAANeJkL7MGfEgB6AVYo7QHVXFkgaG"
publicKey="6Ld7l7oSAAAAAOxY9FHq-vpjMHh9IMARx04-8U-l">
<input type="Submit" name="submit">
<br>
</font></td></tr></table>
</cfform>
<img src="../images/Plock.gif" alt="Secure" width="20" height="20"></div>
</td>
</tr>
<tr>
<td colspan="2">
<cfoutput>
<cfif (#Left(CGI.HTTP_REFERER, 26)# is not "
or (#Left(CGI.HTTP_REFERER, 24)# is "
face="Verdana, Arial, Helvetica, sans-serif"size="1">All
data collected is for ASME internal use only.<br></cfif></cfoutput>
</td>
</tr>
</table>
</body>
</html>