{{include file="file:{{$field_input}}" field=$baseurl}}
{{include file="file:{{$field_input}}" field=$siteid}}
{{include file="file:{{$field_checkbox}}" field=$optout}}
{{include file="file:{{$field_checkbox}}" field=$async}}
<div class="submit"><input type="submit" name="page_site" value="{{$submit}}" /></div>