Code:
<div class="PostContent">
<form action="" method="post" name="form1" class="style6" id="form1">
<label>First Name:
<input type="text" name="textfield" />
</label>
<br />
<label>Last Name:
<input type="text" name="textfield2" />
</label>
<br />
<br />
Gender
<label>
<select name="select9">
<option>Male</option>
<option>Female</option>
<option selected="selected"> </option>
</select>
</label>
<br />
<br />
Date Of Birth [mm/dd/yyyy]:
<label>
<select name="select4" size="1">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option selected="selected"> </option>
</select>
</label>
<label>
<select name="select5" size="1">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
<option selected="selected"> </option>
</select>
</label>
<label>
<select name="select6">
<option>1930</option>
<option>1931</option>
<option>1932</option>
<option>1933</option>
<option>1934</option>
<option>1935</option>
<option>1936</option>
<option>1937</option>
<option>1938</option>
<option>1939</option>
<option>1940</option>
<option>1941</option>
<option>1942</option>
<option>1943</option>
<option>1944</option>
<option>1945</option>
<option>1946</option>
<option>1947</option>
<option>1948</option>
<option>1949</option>
<option>1950</option>
<option>1951</option>
<option>1952</option>
<option>1953</option>
<option>1954</option>
<option>1955</option>
<option>1956</option>
<option>1957</option>
<option>1958</option>
<option>1959</option>
<option>1960</option>
<option>1961</option>
<option>1962</option>
<option>1963</option>
<option>1964</option>
<option>1965</option>
<option>1966</option>
<option>1967</option>
<option>1968</option>
<option>1969</option>
<option>1970</option>
<option>1971</option>
<option>1972</option>
<option>1973</option>
<option>1974</option>
<option>1975</option>
<option>1976</option>
<option>1977</option>
<option>1978</option>
<option>1979</option>
<option>1980</option>
<option>1981</option>
<option>1982</option>
<option>1983</option>
<option>1984</option>
<option>1985</option>
<option>1986</option>
<option>1987</option>
<option>1988</option>
<option>1989</option>
<option>1999</option>
<option selected="selected"> </option>
</select>
<br />
</label>
<br />
Phone Number:
<label>
<input name="textfield3" type="text" value="" size="3" maxlength="3" />
</label>
-
<label>
<input name="textfield4" type="text" size="3" maxlength="3" />
</label>
-
<label>
<input name="textfield5" type="text" size="4" maxlength="4" />
</label>
<br />
<br />
E-Mail:
<label>
<input type="text" name="textfield6" />
</label>
<br />
<br />
<label>Marital Status
<select name="select">
<option>Single</option>
<option>Married</option>
<option>Divorced</option>
<option>Widowed</option>
<option selected="selected"> </option>
</select>
</label>
<br />
If you are married is you spouse interested:
<select name="select2">
<option>Yes</option>
<option>No</option>
<option selected="selected"> </option>
</select>
<br />
<br />
Do You Have Children:
<label>
<select name="select3">
<option>Yes</option>
<option>No</option>
<option selected="selected"> </option>
</select>
</label>
<br />
If Yes, How Many:
<label>
<select name="select7" size="1">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option selected="selected"> </option>
</select>
</label>
<br />
<br />
Religious Affiliation*:
<label>
<select name="select8">
<option>Protestant</option>
<option>Catholic</option>
<option>Agnostic</option>
<option>Muslim</option>
<option>Jewish</option>
<option>Buddhist</option>
<option>Pagan</option>
<option>Wiccan</option>
<option>Hindu</option>
<option>Christianity - Other</option>
<option>Other</option>
<option>No Preferance</option>
<option>I Dont Know</option>
<option>Prefer Not To Say</option>
<option selected="selected"> </option>
</select>
</label>
<br />
<br />
Do you have any paranormal experience [i.e. Other Groups]
<label>
<select name="select10">
<option>Yes</option>
<option>No</option>
<option selected="selected"> </option>
</select>
</label>
<br />
If Yes, how many years:
<label>
<select name="select11">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>20+</option>
<option selected="selected"> </option>
</select>
</label>