Submit A Question Widget

We need a very simple script that we can embed on a event web page that allows viewers to submit a question. Ideally, the user flow would look like this: 1. User clicks a "Submit Question" button. When doing this, an area above the button expands to reveal the following fields: - Name (required) - Email (required) - Your Question (required) - Close (not a field, just a button to close the dialog) 2. When the user has completed all the required fields and clicks the Submit Question button, the contents of the form are sent via email to an email address that we have set up, and the dialog closes. 3. The user can submit more than one question (meaning they can use the form more than one time). Because this is accompanying a live video broadcast, we want the feature to have the least possible intrusion on the page. We need this quickly.