lydia martin forms

form below do not steal coding.
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<div style="background:430448;color:822075;font-size:11px;line-height:11px'padding:20px"><Br><span style="font-size:32px"><B>REQUESTING</span><Br>
<b>Title:</b>
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<b>Subtitle (optional):</b>
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<b>Body Text:</b>
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<b>Mood/Theme/Color scheme:</b>
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<b>Ideas/Pictures:</b>
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<b>Anything else? :</b>