Enter Info for [% uri.host %]

<form action="[% c.uri_for() %]" method="POST">
<input type="hidden" name="url" value="[% uri | html %]">
<input type="hidden" name="hostinfo" value="1">

[% location.name %] / [% location.continent %]<br>

Country:
<select name="country">
<option value="">--</option>
[% FOREACH country = c.model('Mirrors').country_list %]
<option value="[% country.code %]" [% "selected=select" IF country.code == location.code %]>[% country.name | html %]</option>
[% END %]
</select>

City: <input type="text" name="city">
<input type="submit">
</form>