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<form action="%wakeup_link%&action=create" method="post">
<table>
<tr>
<td align="right">
%date_text%:
</td>
<td>
<input type="text" name="Date" value="%date_value%">
</td>
</tr>
<tr>
<td align="right">
%place_text%
</td>
<td>
<input type="text" name="Ort" value="">
</td>
</tr>
<tr>
<td align="right">
%comment_text%
</td>
<td>
<textarea name="Bemerkung" rows="5" cols="40">%comment_value%</textarea>
</td>
</tr>
</table>
<input type="submit" name="submit" value="%submit_text%" />
</form>
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