Hack Day Form

I have not posted a shot in a long time so I figured that I would post this simple form I designed for our hackday project.

I hope that you guys enjoy!

The background is from @Matt Gentile :
http://dribbble.com/shots/759748-12-Blurred-Backgrounds?list=users

The Chrome is by @keyners :
http://dribbble.com/shots/904089-Browser-freebie-from-keyners?list=searches&tag=browser_freebie

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