Not sure if this should be in PHP or HTML forum...

In 2005 I had someone make a form on my website that is emailed to me. Problem is that the hosting company is upgrading to PHP 5.4 and this form does not work with 5.4

Any assistance in correcting this to comply with 5.4 is greatly appreciated. Again, the form works fine with PHP 4.

This is the HTML:
<form id="signup" action="mail.php" method="post" onsubmit="return validate_form ( );">


Here is the mail.php that the html form uses:
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<?
if (empty($email))
exit();

$to = 'gemaine@dvimest.org';
$subject = 'Form Request';
$message = 'State: ' . $_REQUEST['State'] .

"\n Name " . $_REQUEST['nameself'] .
"\n " .
"\n Spouse " . $_REQUEST['namespouse'] .
"\n " .
"\n Phone-- " . $_REQUEST['phone'] .
"\n " .
"\n Email " . $_REQUEST['email'] .
"\n\n " .

$email = $_REQUEST['email'];
$headers = 'From: ' . $email . "\r\n" .
'Reply-To: ' . $email . "\r\n" .
'X-Mailer: PHP/' . phpversion();

mail ($to, $subject, $message, $headers);
header("Location: formresponse.html");
?>

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