State:
<select name=”state”>
<option value=”” selected=”selected”>Select a state…</option>
<option value=”AL”>Alabama</option>
<option value=”AK”>Alaska</option>
<option value=”AZ”>Arizona</option>
<option value=”AR”>Arkansas</option>
<option value=”CA”>California</option>
<option value=”CO”>Colorado</option>
<option value=”CT”>Connecticut</option>
<option value=”DC”>District of Columbia</option>
<option value=”DE”>Delaware</option>
<option value=”FL”>Florida</option>
<option value=”GA”>Georgia</option>
<option value=”HI”>Hawaii</option>
<option value=”ID”>Idaho</option>
<option value=”IL”>Illinois</option>
<option value=”IN”>Indiana</option>
<option value=”IA”>Iowa</option>
<option value=”KS”>Kansas</option>
<option value=”KY”>Kentucky</option>
<option value=”LA”>Louisiana</option>
<option value=”ME”>Maine</option>
<option value=”MD”>Maryland</option>
<option value=”MA”>Massachusetts</option>
<option value=”MI”>Michigan</option>
<option value=”MN”>Minnesota</option>
<option value=”MS”>Mississippi</option>
<option value=”MO”>Missouri</option>
<option value=”MT”>Montana</option>
<option value=”NE”>Nebraska</option>
<option value=”NV”>Nevada</option>
<option value=”NH”>New Hampshire</option>
<option value=”NJ”>New Jersey</option>
<option value=”NM”>New Mexico</option>
<option value=”NY”>New York</option>
<option value=”NC”>North Carolina</option>
<option value=”ND”>North Dakota</option>
<option value=”OH”>Ohio</option>
<option value=”OK”>Oklahoma</option>
<option value=”OR”>Oregon</option>
<option value=”PA”>Pennsylvania</option>
<option value=”RI”>Rhode Island</option>
<option value=”SC”>South Carolina</option>
<option value=”SD”>South Dakota</option>
<option value=”TN”>Tennessee</option>
<option value=”TX”>Texas</option>
<option value=”UT”>Utah</option>
<option value=”VT”>Vermont</option>
<option value=”VA”>Virginia</option>
<option value=”WA”>Washington</option>
<option value=”WV”>West Virginia</option>
<option value=”WI”>Wisconsin</option>
<option value=”WY”>Wyoming</option>
</select>
Year (this uses PHP to automatically update to the current year)
<select name=”year”>
<option value=”<? echo date(‘Y’); ?>”><? echo date(‘Y’); ?></option>
<option value=”<? echo date(‘Y’)-1; ?>”><? echo date(‘Y’)-1; ?></option>
<option value=”<? echo date(‘Y’)-2; ?>”><? echo date(‘Y’)-2; ?></option>
<option value=”<? echo date(‘Y’)-3; ?>”><? echo date(‘Y’)-3; ?></option>
<option value=”<? echo date(‘Y’)-4; ?>”><? echo date(‘Y’)-4; ?></option>
<option value=”<? echo date(‘Y’)-5; ?>”><? echo date(‘Y’)-5; ?></option>
<option value=”<? echo date(‘Y’)-6; ?>”><? echo date(‘Y’)-6; ?></option>
<option value=”<? echo date(‘Y’)-7; ?>”><? echo date(‘Y’)-7; ?></option>
<option value=”<? echo date(‘Y’)-8; ?>”><? echo date(‘Y’)-8; ?></option>
<option value=”<? echo date(‘Y’)-9; ?>”><? echo date(‘Y’)-9; ?></option>
<option value=”<? echo date(‘Y’)-10; ?>”><? echo date(‘Y’)-10; ?></option>
<option value=”<? echo date(‘Y’)-11; ?>”><? echo date(‘Y’)-11; ?></option>
<option value=”<? echo date(‘Y’)-12; ?>”><? echo date(‘Y’)-12; ?></option>
<option value=”<? echo date(‘Y’)-13; ?>”><? echo date(‘Y’)-13; ?></option>
<option value=”<? echo date(‘Y’)-14; ?>”><? echo date(‘Y’)-14; ?></option>
<option value=”<? echo date(‘Y’)-15; ?>”><? echo date(‘Y’)-15; ?></option>
<option value=”<? echo date(‘Y’)-16; ?>”><? echo date(‘Y’)-16; ?></option>
<option value=”<? echo date(‘Y’)-17; ?>”><? echo date(‘Y’)-17; ?></option>
</select>
Month:
<select name=”month”>
<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>
Day:
<select name=”day”>
<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>