http://kirradive.com
<form id='freeform' method="post" action="http://kirradive.com/"  >
<div class='hiddenFields'>
<input type="hidden" name="ACT" value="22" />
<input type="hidden" name="URI" value="/forms/simple/" />
<input type="hidden" name="XID" value="82acfadae210b6bc0140e48fc6e317bb64d56d1c" />
<input type="hidden" name="status" value="open" />
<input type="hidden" name="return" value="forms/simple/" />
<input type="hidden" name="redirect_on_duplicate" value="" />
<input type="hidden" name="RET" value="http://kirradive.com/forms/simple/" />
<input type="hidden" name="form_name" value="test" />
<input type="hidden" name="id" value="freeform" />
<input type="hidden" name="params_id" value="6752639" />
<input type="hidden" name="site_id" value="1" />
</div>


	<p>Name</p>
	<input type="text" name="name" value="" />
	<p>Contact email or phone</p>
	<input type="text" name="email" value="" />
	<p>How interested are you?</p>
	<input type="radio" name="interest_level" value="Really interested, count me as definite" /> Really interested, count me as definite<br />
	<input type="radio" name="interest_level" value="I'll have to check a few things first" /> I'll have to check a few things first<br />
	<input type="radio" name="interest_level" value="Just fishing for information" /> Just fishing for information
	<p>Comments</p>
	<textarea name="comments"></textarea>
	<input name="event" type="hidden" value="{title}" />
	<input type="submit" name="submit" value="Submit" class="submit"/>
</form>