I received an email failure, why?

--index.php--

 <form action="process.php" method="get">

        <input type="text" name="name" id="name" value="NAME " onclick="this.value=''"/><br/>
        <input type="text"  name="email"  id="email" value="E-MAIL " onclick="this.value=''"/>
        <input type="text"  name="contact" id="contact" value="CONTACT " onclick="this.value=''"/> 

        <select  name="program" id="program" /> 
        <option value=""  selected >PROGRAM - Select - </option>
         <option value="MEDICINE" >MEDICINE </option>
         <option value="DENTAL" onclick="this.value=''">DENTAL </option>
         <option value="PHARMACY" onclick="this.value=''">PHARMACY  </option>
        </select>

        <select type="text"  name="country"  id="country" /> 
          <option value="" selected="selected">COUNTRY - Select - </option>
             <option value="RUSSIA " >RUSSIA  </option>
            <option value="INDONESIA " >INDONESIA  </option>
         <option value="INDIA " >INDIA   </option>
        </select>


        <select type="text"  name="scholarship"  id="scholarship"/> 
        <option value="" selected="selected">SCHOLARSHIP - Select - </option>
           <option value="FULL " onclick="this.value=''">FULL  </option>
           <option value="PARTIAL " onclick="this.value=''">PARTIAL   </option>
        </select>
      </div>
      <div class="d-blank"></div>
      <div class="d-login"><input type="image" alt="Login" title="Login" src="images/icon-register-red.png" style="margin-top:210px; margin-left:-120px;"/></div>
    </div>
    <!-- End of Login Dialog -->  



    </form>

--process.php--

$name= $_GET["name开发者_运维百科"];
$email= $_GET["email"];
$contact= $_GET["contact"];
$program= $_GET["program"];
$country= $_GET["country"];
$scholarship= $_GET["scholarship"];





require_once('lib/class.phpmailer.php');

$mail             = new PHPMailer(); // defaults to using php "mail()"


$mail->AddReplyTo("rusly@iconcept.com.my","Rusly-iconcept");

$mail->SetFrom('rusly@iconcept.com.my', 'Rusly-iconcept');

$mail->AddReplyTo("rusly@iconcept.com.my","Rusly-iconcept");

$address = "rusly@iconcept.com.my";
$mail->AddAddress($address, "rusly");

$mail->Subject    = "RUTRA MEDIC";

$mail->AltBody    = "To view the message, please use an HTML compatible email viewer!"; // optional, comment out and test

$mail->Body = "RUTRA MEDIC  Scholarship Form <br><br> 
Name : $name<br>
Email : $email<br> 
Contact : $contact<br> 
Program : $program<br> 
Country : $country<br> 
Scholarship : $scholarship<br> 

Thank You!<br>


";


if(!$mail->Send()) {
  echo "Mailer Error: " . $mail->ErrorInfo;
} else {
  echo "Please Wait...!<br>
  Name : $name<br>
Email : $email<br> 
Contact : $contact<br> 
Program : $program<br> 
Country : $country<br> 
Scholarship : $scholarship<br> 

Thank You!<br>

  ";
}

?>

--error--

This message was created automatically by mail delivery software.

A message that you sent could not be delivered to one or more of its recipients. This is a permanent error. The following address(es) failed:

rusly@iconcept.com.my retry time not reached for any host after a long failure period

------ This is a copy of the message, including all the headers. ------

Return-path: Received: from rutramed by coyote.ip-asia.com with local (Exim 4.69) (envelope-from ) id 1PiIXM-0005cz-W5 for rusly@iconcept.com.my; Thu, 27 Jan 2011 11:28:45 +0800 To: rusly Subject: RUTRA MEDIC X-PHP-Script: www.rutramedic.com.my/process.php for 175.144.213.43 Date: Thu, 27 Jan 2011 11:28:44 +0800 From: Rusly-iconcept Reply-to: Rusly-iconcept Message-ID: X-Priority: 3 X-Mailer: PHPMailer 5.1 (phpmailer.sourceforge.net) MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="b1_e0d5b365dd6553295af0433ac71fc4c4"

--b1_e0d5b365dd6553295af0433ac71fc4c4 Content-Type: text/plain; charset = "iso-8859-1" Content-Transfer-Encoding: 8bit

To view the message, please use an HTML compatible email viewer!

--b1_e0d5b365dd6553295af0433ac71fc4c4 Content-Type: text/html; charset = "iso-8859-1" Content-Transfer-Encoding: 8bit

RUTRA MEDIC Scholarship Form

Name : MUHAMMAD HAFIZ BIN AZMI

Email : www.half_peace@yahoo.com.my

Contact : 014-5172017

Program : MEDICINE

Country : RUSSIA

Scholarship :

Thank You!

--b1_e0d5b365dd6553295af0433ac71fc4c4--

$address = "rusly@iconcept.com.my";
$mail->AddAddress($address, "rusly");

According to this, $address shouldn't be your email address, it should be $email, and "rusly" should be $name. I think.

$address = $email;
$mail->AddAddress($address, $name); 

Try sending to a different email, such as an xxxx@gmail.com or xxxx@yahoo.com, and see if it works. You're sending it to rusly@iconcept.com.my no matter what you put in the form, though, because you set that as a "To Address". You'll have to fix that, first. It should send to $email, which is the email the user enters into the form.