root/includes/autoresponder_subscribe_form.tt
<form id="subscribe" action="[% c.uri_for( '/newsletters/autoresponder/subscribe' ) %]" method="post">
<p>
<label for="subscribe_name">Name</label>
<br><input type="text" class="textshort" id="subscribe_name" name="name">
</p>
<p>
<label for="subscribe_email">Email address</label>
<br><input type="text" class="textshort" id="subscribe_email" name="email">
</p>
<p>
<input name="autoresponder" type="hidden" value="example">
<input name="subscribe" type="submit" value="Subscribe">
</p>
</form>