jQuery Mobile small task

I have developed mobile web app in jQuery Mobile ([login to view URL]). I am stuck on one thing and need help with it. I have a form with few check boxes which users can select and then submit the form. This form then should ask user to provide their email address which then gets submitted to a php script which then send an email to users. I need to capture which options user selected. On the mobile app then confirmation message is shown. I can do the php bit myself (if you do not know the php). The problem I am having is that when I submit the form it shows me undefined screen. Can anyone help? Please let me know if you have any questions. Thanks