<form action="%wakeup_link%&amp;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>