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Small FaceBook App. by LindaReady4U

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I need Facebook App that show FORM when anyone click on like button, I mean the only fans can view the FORM, and the FORM will be Located in my website , and is to enter basic data such as Name, Email, Telephone, Date of Birth (with Calender), then Register All Data in MySQL Table… (Budget: $2-$8 USD, Jobs: Facebook)

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