<form action="http://campaigns.icecreates.com/t/r/s/pihllk/" method="post" id="subForm">
<div>
<label for="name">Name:</label><br /><input type="text" name="cm-name" id="name" /><br />
<label for="pihllk-pihllk">Email:</label><br /><input type="text" name="cm-pihllk-pihllk" id="pihllk-pihllk" /><br />

<input type="submit" value="Subscribe" />
</div>
</form>