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{txt_script_name}

{message}

{fields}
{txt_firstname}     {firstname}
{txt_lastname} *     {lastname}
{txt_email} *     {email}
{txt_subject} *     {subject}
{txt_comment}     {comment}
{txt_subscribe_newsletter}   {checkbox:newsletter}
{txt_receive_information}   {checkbox:information}
{txt_salutation}   {radiobutton:salutation}
{txt_vote}   {select:Vote}
{txt_firstname}    
{txt_lastname} *    
{txt_email} *    
{txt_subject} *    
{txt_comment}    
{txt_subscribe_newsletter}   {txt_yes}
{txt_receive_information}   {txt_yes}
{txt_salutation}   Mr
Ms
{txt_vote}  
     

* = {txt_mandatory_fields}