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joemckameyFlag for United States of America

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I need a simple form for a website...

I have a lead page at http://teamfitnesstrain.com/webinars/did-you-love-insanity/ for my business.

The opt-in form on the right is customizable.  I can integrate with my email mailing or I can put a "raw" form in the "box".

Can anyone help with the raw form...I am assuming all that it has to do it is post to somewhere...I would like for it to just send me an email with the user's name, last name, email, and IP address.  My mailing list service requires a secondary opt in but I really don't plan on sending these people emails other than what they asked for on the page.

So, any ideas for a simple form that will send me an email?

Thanks...
Joe
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Gary
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quizwedge
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Thank you guys...

Gary - I can and have successful set up with Mailchimp...no problem.  However, I want to avoid the double opt in process so I can see who actually entered their email.  They aren't really signing up for one of my lists just a notification when the program comes out.

quizwedge - I have been using word press...it seems as though the Submit button on this does whatever the submit or post process is for them form - but only if it is somewhat simple and not in java or something like that.  It is smart enough to find the fields and allows you to match them with whatever form you create so I am hoping/assuming that is smart enough to submit a simple form.  I know that wordpress sends me notifications using its own abilities already without a true mailserver.

Thanks again...
So you don't want to use MailChimp like you currently are?
Correct...I probably wasn't quite clear enough in my initial description...sorry.  I am trying to avoid the double opt in process.  So many times that gets sent to junk/spam or people just decide not to do it...don't want to lose them.

Thanks...
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As a plug in it still doesn't really give me clean raw code.
What do you mean raw code?
The plugin creates a form that you can do whatever with - add to a db, email you the info etc.
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I appreciate your guys trying to help!!
I may not have given enough initial info and it was a pretty specific problem to a very specific lead capture page builder...