Is there any way to pop up the below information if a certain checkbox is checked and submited, and the main menu go to a thank you page?

<p align="left"><input TYPE="hidden" NAME="list" VALUE="freethingz"><input TYPE="hidden" NAME="align_in_table:" VALUE><input TYPE="hidden" NAME="use_sans_serif_fonts:" VALUE>
<input TYPE="text" NAME="email_address" VALUE SIZE="15"><input TYPE="submit" NAME="server_action:Subscribe" VALUE="Subscribe"><br>
<input TYPE="hidden" NAME="sublist:" VALUE="2">
<input TYPE="hidden" NAME="align_in_table:" VALUE>
<input TYPE="hidden" NAME="use_sans_serif_fonts:" VALUE>
<input TYPE="hidden" NAME="deferred:" VALUE="1">
<input TYPE="hidden" NAME="subscribe_button_name:" VALUE="Subscribe/Update">

<input type="hidden" name="pid" value="656783">
<input type="hidden" name="url" value="">
<input type="hidden" name="aid" value="1128255">