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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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