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<h2>Please fill in the form:</h2>
<form action="%%=RequestParameter('PAGEURL')=%%" method="post">
<label>First name: </label><input type="text" name="firstname" required="" value="%%=v(@firstName)=%%"><br>
<label>Last name: </label><input type="text" name="lastname" required="" value="%%=v(@lastName)=%%"><br>
<label>Email: </label><input type="text" name="email" required="" value="%%=v(@email)=%%"><br><br>
<h2>Update your subscriptions:</h2>
<input name="newsletters" type="checkbox" %%=v(@Newsletters)=%%><label>Newsletters</label><br>
<input name="events" type="checkbox" %%=v(@Events)=%%><label>Events</label><br>
<input name="offers" type="checkbox" %%=v(@Offers)=%%><label>Special Offers</label><br>
<input name="surveys" type="checkbox" %%=v(@Surveys)=%%><label>Surveys</label><br>
<input name="promotions" type="checkbox" %%=v(@Promotions)=%%><label>Promotions</label><br>
<input name="submitted" type="hidden" value="true"><br>
<input type="submit" value="Submit">
</form>
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