Here is the code I currently have. I don't need a form because I will be accessing these elements with javascript and using ajax to send data to the server, but as far as I read that is perfectly valid HTML.
<div style="height:30px; font-size:smaller; vertical-align:middle;">
<span style="float:right;">Save as: </span>
<input id="new_name" type="text" value="" />
<input type="button" value="Save" />
</div>