function checkForm() {

	var formError = Boolean(false);
	var fieldList = new Array();
	
	if(document.getElementById('firstname').value == "") {
		formError = true;
		fieldList.push("Member's First Name");
	}
	
	if(document.getElementById('lastname').value == "") {
		formError = true;
		fieldList.push("Last Name");
	}
	
	if(document.getElementById('address').value == "") {
		formError = true;
		fieldList.push("Address");
	}
	
	if(document.getElementById('city').value == "") {
		formError = true;
		fieldList.push("City");
	}
	
	if(document.getElementById('state').value == "") {
		formError = true;
		fieldList.push("State");
	}
	
	if(document.getElementById('zipcode').value == "") {
		formError = true;
		fieldList.push("Zip");
	}
	
	if(document.getElementById('contact_name').value == "") {
		formError = true;
		fieldList.push("Contact Name");
	}
	
	if(document.getElementById('email').value == "") {
		formError = true;
		fieldList.push("Email Address");
	}
	
	if(document.getElementById('Member_ID').value == "") {
		formError = true;
		fieldList.push("Presbyterian Member # or SSN");
	}
	
	var cbBenefits = document.getElementById('Benefits').checked;
	var cbClaims = document.getElementById('Claims').checked;
	var cbOther = document.getElementById('Other').checked;
	var cbContact = document.getElementById('Contact_me').checked;
	var cbSuggestion = document.getElementById('Suggestion').checked;
	if(!cbBenefits && !cbClaims && !cbOther && !cbContact && !cbSuggestion) {
		formError = true;
		fieldList.push("Type of assistance needed");
	}
	
	if(cbClaims && document.getElementById('Date_of_Service').value == "") {
		formError = true;
		fieldList.push("Presbyterian Date of Service");
	}
	
	if(cbBenefits && document.getElementById('Benefit_Type').value == "") {
		formError = true;
		fieldList.push("Type of Benefit");
	}
	
	if(formError) {
		alert("Please check the listed fields, and try again:\n\n" + fieldList.join("\n"));
		return false;
	} else {
		return true;
	}
	
}