{include file="layouts/forceLoggedIn.tpl"}
{assign var="pgLayout" value="layouts/withLeftNav.tpl"}
{include_php file="shared:submitYourSuccess"}
<h1>{$page.title}</h1>
<h2>{$page.description}</h2>

<form name="submitYourSuccessForm" action="index.php" method="post">
<input type="hidden" name="pg" value="{$page.name}">
<input type="hidden" name="no_expire" value="true">

<table>
<tr>
	<td><span>Your Name:</span></td>
	<td><input type="text" name="Name" value="{$smarty.request.Name|default:$user->firstName|stripslashes|htmlspecialchars}"></td>
</tr>
<tr>
	<td><span>Your E-mail Address:</span></td>
	<td><input type="text" name="Email" value="{$smarty.request.Email|default:$user->email|stripslashes|htmlspecialchars}"></td>
</tr>
<tr>
	<td><span>Your Phone:</span></td>
	<td><input type="text" name="Phone" value="{$smarty.request.Phone|default:$user->phone|stripslashes|htmlspecialchars}"></td>
</tr>

<tr>
	<td><span>Your Story:</span></td>
	<td><textarea cols="55" rows="16" name="Story">{$smarty.request.Story|stripslashes|htmlspecialchars}</textarea></td>
</tr>
<tr>
	<td><span>&nbsp;</span></td>
	<td><input type="submit" value="Send Now"></td>
</tr>
</table>

</form>
