you had set the forms action to post to the WU Settings page in the web assist/email folder. the action needed to be set to pot the page the form is on.
i also need to change the from address.
you had set it to use the email address element in the form, most hosts require the from address to be a valid email for your domain, otherwise they treat it as spam.
i edited the from address to:
$MailFrom = "email@example.com";
i add my email in the to section and was able to receive the message once i changed the from address and the forms action.