Can I have one sign up form two newsletters from the same client

One client, has two email lists for two different email newsletters.

He wants a form that says:
Sign up here blah, blah
Name: (fill in)
Email address (fill in)

Newsletter 1 (choose)
Newsletter 2 (choose)
Both Newsletters (choose)

PS if the form just asks for a name (seems to be uneditable in CM) and they put 'Fred Smith' will the newsletter go to Fred or Fred Smith - lets assume I've set the name replacement thingy up right on the template! Ideally I want it to go to Fred only... but I don't seem to be able to ask for just a first name... mmmm



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