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<div align="center" style="font-family: Tahoma, Verdana, Arial, Helvetica, sans-serif; font-size: 10pt;"><form action="http://quizzes.blogquiz.net/fun-quizzes/LiveJournal-Memes/Your-LJ-Funeral-livejournal-meme-quiz_aWQ9MzcxNg.html" method="post" name="quiz3716"><table border="1" cellspacing="0" cellpadding="0"><tr><td><table style="font-family: Tahoma, Verdana, Arial, Helvetica, sans-serif; font-size: 10pt;" border="0" cellspacing="0" cellpadding="3"><tr bgcolor="#003366"><td colspan="2" align="center" valign="middle"><div align="center" style="color: #FFFFFF; font-weight: bold;"><a href="http://quizzes.blogquiz.net/fun-quizzes/LiveJournal-Memes/Your-LJ-Funeral-livejournal-meme-quiz_aWQ9MzcxNg.html" style="color: #FFFFFF; text-decoration: none;">Your LJ Funeral</a></div></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">LiveJournal Username</td><td align="left" valign="middle"><input type="textbox" name="ljusername" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">Song you'd like played at your funeral</td><td align="left" valign="middle"><input type="textbox" name="input:0" value="" size="20" maxlength="64"></td></tr><tr bgcolor="#6699CC"><td align="left" valign="middle" style="color: #FFFFFF;">You will probably die from:</td><td align="left" valign="middle"><select name="input:1"><option value="0" selected>a drunken driver</option><option value="1" >murder</option><option value="2" >suicide</option><option value="3" >cancer</option><option value="4" >old age</option></select></td></tr><tr bgcolor="#003366" height="5"><td colspan="2"></td></tr><tr bgcolor="#003366"><td colspan="2" align="center" valign="middle"><div align="center"><input type="submit" name="submit" value="Fill in your answers and click here!" style="font-size: 9pt;"></div></td></tr><tr bgcolor="#003366"><td colspan="2" align="center" valign="middle"><div style="color: #FFFFFF;" align="center">This <a href="http://www.blogquiz.net/" style="color: #FFFFFF;">Fun Quiz</a> created by <a href="http://www.blogquiz.net/users/cdaae" style="color: #FFFFFF;">Christine</a> at <strong>BlogQuiz.Net</strong><img src="http://70.84.102.91/x/blogquiz.net-blog/22" border="0" width="1" height="1"></div></td></tr></table></td></tr></table><a href="http://weightlosstips.tv/">Weight Loss Tips and Diet Advice</a> from WeightLossTips.TV</form><br></div>
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