Adding an email form???

I'm using vb 3.5.4 with CMPS 2.1.0. I want to add a .php form into a module that will email me once visitors fill it out. I have the form written and it works fine on a normal .html page.

Everytime I try to add my form I get the error:

The following error occurred when attempting to evaluate this template:

Parse error: parse error, unexpected T_ENCAPSED_AND_WHITESPACE, expecting T_STRING or T_VARIABLE or T_NUM_STRING in html/forums/includes/adminfunctions_template.php(3537) : eval()'d code on line 12

This is likely caused by a malformed conditional statement. It is highly recommended that you fix this error before continuing, but you may continue as-is if you wish.

Does anyone know how to add an email for in a module?