Is the PR sender form on www.netbsd.org broken?

[Benny Siegert <bsiegert%gmail.com@localhost>]

This is the second time that I tried to submit a PR via the web form,
fill out all the fields and get

"Bad Data

You need to specify at least your electronic mail address, your name,
a synopsis of the of the problem and choose an appropriate selection
for category, severity, priority and class. Please return to the form
and add the missing information. Thank you."

Unfortunately, with this level of detail, it is hard what I am
missing. Does this work for anyone else?

-- 
Benny