HTML only form with confirmation email?

Hi.
I only have access to editing the HTML of this site, so any solution will have to be strictly in HTML (if it’s even possible).
I want to have a form, which the users can use to email the contents of the form to the administrator (given email-adress), but i also want it to send the same (or slightly differently formatted version) email to the email adress that the user enters, as a type of confirmation email. Is this possible? In that case, how?

Thanks so much in advance!