_template

%%form_data{description}%%

Special lasts until %%form_data{month}%% %%form_data{day}%%, %%form_data{year}%%

====
[[form]]
fields:
  month:
    label: Expires on:
    type: select
    values:
      1: January
      2: February
      3: March
      4: April
      5: May
      6: June
      7: July
      8: August
      9: September
      10: October
      11: November
      12: December
  day:
    join: true
    type: select
    values:
      1: 1
      2: 2
      3: 3
      4: 4
      5: 5
      6: 6
      7: 7
      8: 8
      9: 9
      10: 10
      11: 11
      12: 12
      13: 13
      14: 14
      15: 15
      16: 16
      17: 17
      18: 18
      19: 19
      20: 20
      21: 21
      22: 22
      23: 23
      24: 24
      25: 25
      26: 26
      27: 27
      28: 28
      29: 29
      30: 30
      31: 31
  year:
    label: Year:
    type: text
    default: '2010'
  description:
    label: Description
    type: wiki
    width: 50
    height: 10
[[/form]]

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