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| <form action="email" id="TfacsSubmission" no_submit_on_return >
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| <_email template="SubmissionEmailTemplate"></_email>
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| {| class="smwtable-clean th-top-right border"
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| |-
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| ! <label for="firstname">Name {{r|*}}</label>
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| | <input style="width: 50%;" type="text" name="firstname" placeholder="first name" required="required" />
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| <input style="width: 50%;" type="text" name="lastname" placeholder="last name" required="required" />
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| |}
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| <input type="submit" value="submit" />
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| </form>{{#widget:FlexForm.css}}
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