<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd">
<html>
<head>
<title>Example 14-1. Sample form to illustrate JavaScript manipulation.</title>
<meta http-equiv="content-type" content="text/xml; charset=utf-8" />
</head>
<body>
<form id="myForm" name="myForm" action="self" method="post">
<div>
<label for="birthMonth">Month: </label>
<select id="birthMonth" name="birthMonth">
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
<label for="birthDay">Day: </label>
<select id="birthDay" name="birthDay">
<option value="1">1</option><option value="2">2</option>
<option value="3">3</option><option value="4">4</option>
<option value="5">5</option><option value="6">6</option>
<option value="7">7</option><option value="8">8</option>
<option value="9">9</option><option value="10">10</option>
<option value="11">11</option><option value="12">12</option>
<option value="13">13</option><option value="14">14</option>
<option value="15">15</option><option value="16">16</option>
<option value="17">17</option><option value="18">18</option>
<option value="19">19</option><option value="20">20</option>
<option value="21">21</option><option value="22">22</option>
<option value="23">23</option><option value="24">24</option>
<option value="25">25</option><option value="26">26</option>
<option value="27">27</option><option value="28">28</option>
<option value="29">29</option><option value="30">30</option>
<option value="31">31</option>
</select>
<label for="birthYear">Year: </label> <input id="birthYear" name="birthYear" type="text" value="" size="4" />
</div>
<div>
<div>Choose all that apply:</div>
<label for="chkHighSchool"><input id="chkHighSchool" name="chkHighSchool" type="checkbox" value="1" />High School/GED</label><br />
<label for="chkSomeCollege"><input id="chkSomeCollege" name="chkSomeCollege" type="checkbox" value="2" />Some College</label><br />
<label for="chkCollegeDegree"><input id="chkCollegeDegree" name="chkCollegeDegree" type="checkbox" value="4" />College Degree</label><br />
<label for="chkGradSchool"><input id="chkGradSchool" name="chkGradSchool" type="checkbox" value="8" />Graduate School</label><br />
<label for="chkPhD"><input id="chkPhD" name="chkPhD" type="checkbox" value="16" />PhD</label><br />
<label for="chkJD"><input id="chkJD" name="chkJD" type="checkbox" value="32" />JD</label><br />
<label for="chkMD"><input id="chkMD" name="chkMD" type="checkbox" value="64" />MD</label>
</div>
<div>
<div>Marital Status:</div>
<label for="radSingle"><input id="radSingle" name="maritalStatus" type="radio" value="1" />Single</label><br />
<label for="radMarried"><input id="radMarried" name="maritalStatus" type="radio" value="2" />Married</label><br />
<label for="radWidowed"><input id="radWidowed" name="maritalStatus" type="radio" value="3" />Widowed</label><br />
<label for="radDivorced"><input id="radDivorced" name="maritalStatus" type="radio" value="4" />Divorced</label><br />
<label for="radOther"><input id="radOther" name="maritalStatus" type="radio" value="5" />Other</label>
</div>
<div>
<input type="submit" value="Submit Information" />
<input type="reset" value="Reset Form" />
</div>
</form>
</body>
</html>