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+[%# This Source Code Form is subject to the terms of the Mozilla Public
+ # License, v. 2.0. If a copy of the MPL was not distributed with this
+ # file, You can obtain one at http://mozilla.org/MPL/2.0/.
+ #
+ # This Source Code Form is "Incompatible With Secondary Licenses", as
+ # defined by the Mozilla Public License, v. 2.0.
+ #%]
+
+[% USE Bugzilla %]
+[% cgi = Bugzilla.cgi +%]
+:: Internet Public Policy Issue
+
+Region/Country: [% cgi.param("region") %]
+
+:: Description
+
+[%+ cgi.param("desc") %]
+
+:: Relevance
+
+[%+ cgi.param("relevance") %]
+
+Goal: [% cgi.param("goal") %]
+When: [% cgi.param("when") %]
+
+[% IF cgi.param("additional") %]
+:: Additional Information
+
+[%+ cgi.param("additional") %]
+[% END %]