<form method="post" action="http://lpctunb.entregadeemails.com/recebeForm.php">
<input type="hidden" name="uniqid" value="11191471842283788" />
<input type="hidden" name="senha" value="9e36f3e716d43afb90c7340d499b3ef4" />
<input type="hidden" name="id_sender_email" value="4024" />
<input type="hidden" name="urlredir" value="http://www.lpct.com.br" />
<table id="tabelaDados" cellspacing="0" >
              <col style="width:35%" />
                  <tr>
                      <td >E-mail*</td>
                      <td ><input name="email" type="text"  value="" /></td>
                  </tr>
                <tr>
                       <td colspan="2">&nbsp;</td>
                  </tr>
                <tr>
                        <td   >
                  <h5>Mais informações</h5>
                </td><tr id="row_DadosAvancados" >
                  <td colspan="2">&nbsp;</td>
              </tr><tr id="row_DadosAvancados" >
                      <td >Nome</td>
                      <td ><input name="nome" type="text"  value="" /></td>
                  </tr><tr id="row_DadosAvancados" >
              <td >Sobrenome</td>
              <td ><input type="text" name="attribute[2]" value="" style="width: 98%" /></td>
            </tr><tr id="row_DadosAvancados" >
              <td >Data de Nascimento</td>
              <td ><input type="hidden" name="dateattribute[3]" value="Data de Nascimento" /><input type=hidden name="Data de Nascimento" value="1"><!-- 31 / 12 / 1969 --><select class="combo_estilo" id="day_Data de Nascimento" name="day[Data de Nascimento]" style="width:4em;"><option value=""></option>
<option value="01" >1</option>
<option value="02" >2</option>
<option value="03" >3</option>
<option value="04" >4</option>
<option value="05" >5</option>
<option value="06" >6</option>
<option value="07" >7</option>
<option value="08" >8</option>
<option value="09" >9</option>
<option value="10" >10</option>
<option value="11" >11</option>
<option value="12" >12</option>
<option value="13" >13</option>
<option value="14" >14</option>
<option value="15" >15</option>
<option value="16" >16</option>
<option value="17" >17</option>
<option value="18" >18</option>
<option value="19" >19</option>
<option value="20" >20</option>
<option value="21" >21</option>
<option value="22" >22</option>
<option value="23" >23</option>
<option value="24" >24</option>
<option value="25" >25</option>
<option value="26" >26</option>
<option value="27" >27</option>
<option value="28" >28</option>
<option value="29" >29</option>
<option value="30" >30</option>
<option value="31" selected>31</option>
</select>&nbsp;&nbsp;<select class="combo_estilo" id="month_Data de Nascimento" name="month[Data de Nascimento]" style="width:9em;"><option value=""></option>
<option value="01" >Janeiro</option>
<option value="02" >Fevereiro</option>
<option value="03" >Março</option>
<option value="04" >Abril</option>
<option value="05" >Maio</option>
<option value="06" >Junho</option>
<option value="07" >Julho</option>
<option value="08" >Agosto</option>
<option value="09" >Setembro</option>
<option value="10" >Outubro</option>
<option value="11" >Novembro</option>
<option value="12" selected>Dezembro</option></select> &nbsp;<input type=text name="year[Data de Nascimento]" size=4 maxlength=4 class="text2" value="1969"></td>
            </tr><tr id="row_DadosAvancados" >
              <td >Sexo</td>
              <td ><select name="attribute[4]" style="attributeinput" ><option value="0">nenhum</option><option value="4" >Feminino</option><option value="3" >Masculino</option></select></td>
            </tr><tr id="row_DadosAvancados" >
                  <td colspan="2">&nbsp;</td>
              </tr>
                <tr id="row_DadosAvancados" >
                    <td   ><h5>Dados Profissionais</h5></td></tr><tr id="row_DadosAvancados" >
                  <td colspan="2">&nbsp;</td>
              </tr><tr id="row_DadosAvancados" >
                      <td >Empresa</td>
                      <td ><input type="text" name="attribute[5]" value="" style="width: 98%" /></td>
                  </tr><tr id="row_DadosAvancados" >
                      <td >Departamento</td>
                      <td ><input type="text" name="attribute[6]" value="" style="width: 98%" /></td>
                  </tr><tr id="row_DadosAvancados" >
                      <td >Cargo</td>
                      <td ><input type="text" name="attribute[7]" value="" style="width: 98%" /></td>
                  </tr><tr id="row_DadosAvancados" >
                  <td colspan="2">&nbsp;</td>
              </tr>
                <tr id="row_DadosAvancados" >
                    <td   ><h5>Endereço</h5></td></tr><tr id="row_DadosAvancados" >
                  <td colspan="2">&nbsp;</td>
              </tr><tr id="row_DadosAvancados" >
                <td >Endereço</td>
                <td ><input type="text" name="attribute[9]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Número</td>
                <td ><input type="text" name="attribute[10]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Complemento</td>
                <td ><input type="text" name="attribute[11]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Bairro</td>
                <td ><input type="text" name="attribute[12]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Cidade</td>
                <td ><input type="text" name="attribute[13]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Estado</td>
                <td ><select name="attribute[14]" style="attributeinput" ><option value="0">nenhum</option><option value="1" >AC</option><option value="2" >AL</option><option value="3" >AM</option><option value="4" >AP</option><option value="5" >BA</option><option value="6" >CE</option><option value="7" >DF</option><option value="8" >ES</option><option value="9" >GO</option><option value="10" >MA</option><option value="11" >MG</option><option value="12" >MS</option><option value="13" >MT</option><option value="14" >PA</option><option value="15" >PB</option><option value="16" >PE</option><option value="17" >PI</option><option value="18" >PR</option><option value="19" >RJ</option><option value="20" >RN</option><option value="21" >RO</option><option value="22" >RR</option><option value="23" >RS</option><option value="24" >SC</option><option value="25" >SE</option><option value="26" >SP</option><option value="27" >TO</option></select></td>
              </tr><tr id="row_DadosAvancados" >
                <td >CEP</td>
                <td ><input type="text" name="attribute[15]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Telefone Residencial</td>
                <td ><input type="text" name="attribute[16]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Telefone Comercial</td>
                <td ><input type="text" name="attribute[17]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Telefone Celular</td>
                <td ><input type="text" name="attribute[18]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Fax</td>
                <td ><input type="text" name="attribute[19]" value="" style="width: 98%" /></td>
              </tr><tr id="row_DadosAvancados" >
                <td >Anotações</td>
                <td ><textarea name="attribute[20]" rows="6" cols="40" style="width: 98%"></textarea></td>
              </tr></table> <input type="submit" value="enviar" />
</form>

the early days

... and then she looked at them, planning on the trip of their lives while she was stuck inside herself, while she was feeling blue and everything was going grey. She knew she was going to be left behind if she didn't make any move. "She's got the money, she's got the will, she's got nothing to lose", she sang to herself mentally. But she just kept looking at them without speaking a word, miserably. She felt like she didn't belong there and when she looked at him she was sure she didn't. Out of nowhere she got up and went away, nobody noticed the dramatic act. Everything was plain grey, the university building was all concrete grey, the floor was concrete grey, she was concrete and she was grey as well - no surprises.