<iframe width="460" height="240" src="http://cdn.livestream.com/embed/adefstv?layout=4&amp;height=240&amp;width=460&amp;autoplay=false" style="border:0;outline:0" frameborder="0" scrolling="no"></iframe><div style="font-size: 11px;padding-top:10px;text-align:center;width:460px">Watch <a href="http://www.livestream.com/?utm_source=lsplayer&amp;utm_medium=embed&amp;utm_campaign=footerlinks" title="live streaming video">live streaming video</a> from <a href="http://www.livestream.com/adefstv?utm_source=lsplayer&amp;utm_medium=embed&amp;utm_campaign=footerlinks" title="Watch adefstv at livestream.com">adefstv</a> at livestream.com</div>

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<form method="post"
action="http://www.hashemian.com/tools/form-grabber.php">

<!-- Place form elements and submit button below -->
Name: <input type="text" name="Name"><br>
Travel by: <select name="TravelType">
<option value="Plane">Plane</option>
<option value="Train">Train</option>
<option value="Bus">Bus</option>
</select><p>
<input type="submit" value="Submit">
<!-- Place form elements and submit button above -->

<input type="hidden" name="__FG_SITE_IDENTIFIER__"
value="$1$0DF9bCaK$7KYyq8gyB/JLa5XUfb.S4/">
<input type="hidden" name="__FG_THANKS_PAGE_RDR__"
value="http://www.example.com/thank-you.html">
</form>