{set layout="one_column_layout"}

<div id="st_application-newsletter-index" class="box roundies" >

   <div class="title">
      <h2>{__ text="Newsletter"}</h2>
      <p>{__ text="Prośba o wypisanie z listy"}</p>
   </div>
   <div class="st_content">
      <form action="{$form.action}" method="post" style="width: 172px; margin: 0 auto">
         <p>
            <label for="newsletter_email">{__ text="Adres e-mail"}</label><br />
            <input type="text" name="newsletter[email]" value="{$form.email}" id="newsletter_email" style="width: 164px" />
            {if $form.errors.email}
            <span style="color: red">{$form.errors.email}</span>
            {/if}            
         </p>
         <p>{$form.captcha}</p>
         <p>
            <label for="newsletter_captcha">{__ text="Cyfry z obrazka"}</label><br />
            <input type="text" name="newsletter[captcha]" id="newsletter_captcha" style="width: 164px" />
            {if $form.errors.captcha}
            <span style="color: red">{$form.errors.captcha}</span>
            {/if}
         </p>
         <div class="buttons right" style="margin-top:10px;">
            <button type="submit" class="regular roundies" >
               {__ text="Wyślij"}
            </button>
         </div>              
      </form>
      <div class="st_clear_all"></div>
   </div>

</div>