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Old 08-15-2008, 10:36 AM
disbrowpr disbrowpr is offline
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Join Date: Aug 2008
Location: Rolla, Mo
Posts: 14
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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>

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Last edited by disbrowpr : 08-15-2008 at 10:41 AM.
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