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Serve User INPUT FORMS as adverts in Revive Adserver

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Is there a way of placing a simple email input subscription form as an Advert (e.g. banner/ popup) in Revive Adserver. The idea is to create a form that end users can input their email through the "FORM ADVERT", clicksubmit, and the form contents posted/ submitted to a specified server/ script. How can I achieve this in Revive Adserver?

Edited by meetbushe
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