Copy this code for the "Sign Up for New Jersey Email Updates" widget.
<form action="https://public.govdelivery.com/accounts/USDHSFEMA/subscribers/qualify">
<input id="topic_id" name="topic_id" type="hidden" value="USDHSFEMA_1006" />
<fieldset>
<legend>
NJ Hurricane Sandy Email Updates
</legend>
<div>
<p>To sign up for updates or to access your subscriber preferences, please enter your contact information below.</p>
</div>
<ol class='form'>
<li class='email_fields' style='display: block'>
<label for="email"><img alt="Required" class="required" src="https://public.govdelivery.com/images/required.gif?1215719772" />Email Address</label>
<input class="long" id="email" name="email" type="text" />
</li>
</ol>
<div class='button_panel'>
<input class="form_button" name="commit" type="submit" value="Submit" />
</div>
</fieldset>
</form>
