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Hmmm ... I'm thinking maybe a "form to email" script you can find somewhere, customize it to your liking, then wrap it into a custom block, or TinyContent, or one of the other content modules. Haven't tried anything like that yet, but that might work. Heck, that's what I would try first if I was gonna do something like that. But, then again, I am not the brightest bulb in the chandelier ... so be warned. lol
Edit: I seem to recall that these scripts are often called "form mailers" on the script sites.