Would you be kind to help with this:

I have subscription script, and beside email I want to input 2 more fields where people will put their name and country, and all that to be submitted into subscription file.

2. self.$container.on("click", ".ssCountdownSubscribeSelector", function(e){
3. if (e && e.preventDefault) {
4. e.preventDefault();
5. }
7. var $this = $(this),
8. $form = $this.closest('form'),
9. $emailAddress = $form.find("input[name='email_address']"),
10. $errorContainer = $form.find(".ss-error-container");
11. $errorContainer.css({"color": "#FF0000"}).html("").hide();
12. if($emailAddress.val() == "") {
13. $errorContainer.html("Please fill in your email address.").fadeIn();
14. }
15. else {
16. var re = /([0-9a-zA-Z\.\-\_]+)@([0-9a-zA-Z\.\-\_]+)\.([0-9a-zA-Z\.\-\_]+)/,
17. email_address = $emailAddress.val();
18. if(email_address.match(re) == null) {
19. $errorContainer.html("Invalid email address.").fadeIn();
20. }
21. else {
22. $.ajax({
23. type: "POST",
24. data: {
25. email: email_address
26. },
27. url: "subscribe/subscribe.php",
28. success: function(){
29. $emailAddress.val("");
30. $errorContainer.css({"color": "#39F"}).html("Thank you for subscribing.").fadeIn();
31. setTimeout(function(){
32. $errorContainer.css({"color": "#FF0000"}).html("").hide();
33. }, 3000);
34. }
35. });
36. }
37. }
39. return false;
40. });