vas happenin form

<div style="text-transform:uppercase; padding:0px 20px;font-size:10px;color: 99d8f7;"><img src="http://i.imgur.com/LKTBywg.png" width=400><div style="padding: 0px 40px; ">
[]manip []simple []minimalistic
<br>title:
<br>subtitle*:
<br>author:
<br>mood/genre:
<br>short summary:
<br>ideas:
<br>anything else?