Prescription Drug Discount Program

Savings up to 70%. No monthly fee.

Rx pricing » Register

Whoops\Exception\ErrorException [ Warning ]: Undefined variable $form

APPPATH/views/Default/Interim/enrollment.en.php [ 13 ]

 8 ?>
 9 				<h2>Member Registration</h2>
10 <?php } ?>
11 				
12 				<form id="enrollmentForm"
13 					action="<?= (defined('MAINTENANCE_MODE') && MAINTENANCE_MODE === false)? $form->submit_uri: '#' ?>"
14 					method="post" class="rpc-request form-horizontal"
15 					data-rpc-form="enroll"
16 				>
17 					<input type="hidden" id="<?= $form->viewstate_id ?>" name="<?= $form->viewstate_id ?>" value="<?= $form->viewstate ?>">
18 					<h4>Primary Information	</h4>
  1. APPPATH/views/Default/Interim/enrollment.en.php [ 13 ] » Whoops\Run->handleError(arguments)

  2. SYSPATH/classes/Kohana/View.php [ 62 ] » include(arguments)

  3. SYSPATH/classes/Kohana/View.php [ 359 ] » Kohana_View::capture(arguments)

  4. SYSPATH/classes/Kohana/View.php [ 236 ] » Kohana_View->render()

  5. APPPATH/views/Default/Interim/HOST_MODEL_1_1/ApplicationShell.php [ 36 ] » Kohana_View->__toString()

  6. SYSPATH/classes/Kohana/View.php [ 62 ] » include(arguments)

  7. SYSPATH/classes/Kohana/View.php [ 359 ] » Kohana_View::capture(arguments)

  8. SYSPATH/classes/Kohana/View.php [ 236 ] » Kohana_View->render()

  9. APPPATH/views/Default/Interim/HOST_MODEL_1_1/Template.php [ 75 ] » Kohana_View->__toString()

  10. SYSPATH/classes/Kohana/View.php [ 62 ] » include(arguments)

  11. SYSPATH/classes/Kohana/View.php [ 359 ] » Kohana_View::capture(arguments)

  12. SYSPATH/classes/Kohana/View.php [ 236 ] » Kohana_View->render()

  13. SYSPATH/classes/Kohana/Response.php [ 160 ] » Kohana_View->__toString()

  14. APPPATH/classes/VirtualController.php [ 42 ] » Kohana_Response->body(arguments)

  15. SYSPATH/classes/Kohana/Controller.php [ 87 ] » Controller_SiteController->after()

  16. {PHP internal call} » Kohana_Controller->execute()

  17. SYSPATH/classes/Kohana/Request/Client/Internal.php [ 93 ] » ReflectionMethod->invoke(arguments)