455906 quick html/javascript example

I need a piece of example code that does the follow... HTML page with a small icon img tag. When the img is clicked I would like a javascript modal dialog to pop up. The dialog will have * a label email * a text box to collect the email address * a button labelled send When the send button is press it should validate the email address and report any issues. If the email is ok the script should redirect the browser to a url such as [login to view URL];Email address given> Replacing <Email address given> with the email address supplied in the dialog. I do not require you to send an email or anything else... just collect the email address and call the url. You can use a modal javascript library or whatever to make this reasonably nice looking and quick to do. Nice easy task for someone with javascript skills.