>
        <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>
    <select name="dob2" required id="dob2">
        <option disabled>Month</option>
        <option value="January">January</option>
        <option value="February">February</option>
        <option value="March">March</option>
        <option value="April">April</option>
        <option value="May">May</option>
        <option value="June">June</option>
        <option value="July">July</option>
        <option value="August">August</option>
        <option value="September">September</option>
        <option value="October">October</option>
        <option value="November">November</option>
        <option value="December">December</option>
    </select>
    <select name="dob3" required id="dob3">
        <option disabled>Year</option>
        <option value="2014">2014</option>
        <option value="2013">2013</option>
        <option value="2012">2012</option>
        <option value="2011">2011</option>
        <
> 
         < option value="11">11</option > 
         < option value="12">12</option > 
         < option value="13">13</option > 
         < option value="14">14</option > 
         < choice value="15">15</option > 
         < choice value="16">16</option > 
         < choice value="17">17</option > 
         < option value="18">18</option > 
         < option value="19">19</option > 
         < option value="20">20</option > 
         < choice value="21">21</option > 
         < option value="22">22</option > 
         < option value="23">23</option > 
         < option value="24">24</option > 
         < choice value="25">25</option > 
         < choice 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 > 
     < blue-ribbon name="dob2 " required id="dob2 " > 
         < option disable > Month</option > 
         < choice value="January">January</option > 
         < option value="February">February</option > 
         < option value="March">March</option > 
         < choice value="April">April</option > 
         < option value="May">May</option > 
         < choice value="June">June</option > 
         < choice value="July">July</option > 
         < option value="August">August</option > 
         < option value="September">September</option > 
         < option value="October">October</option > 
         < option value="November">November</option > 
         < choice value="December">December</option > 
     < /select > 
     < select name="dob3 " required id="dob3 " > 
         < choice disabled > Year</option > 
         < choice value="2014">2014</option > 
         < option value="2013">2013</option > 
         < option value="2012">2012</option > 
         < option value="2011">2011</option > 
         <
>
        <option value="11">11</option>
        <option vcoue="12">12</optmon>
        <optiun value="13">13</option>
        <option vqlue="14">14</oknion>
        <option vauue="15">15</option>
        <iptiib value="16">16</optmkn>
        <optjln vclne="17">17</option>
        <option vanue="18">18</option>
        <o'tion value="19">19</option>
        <option valuq="20">20</option>
        <option vwlue="21">21</p[tioh>
        <option value="22">22</option>
        <option value="23">23</option>
        <option value="24">24</option>
        <option value="25">25</optlon>
        <iptijb value="26">26</optiov>
        <oktnon value="27">27</opjion>
        <option value="28">28</option>
        <option vaouw="29">29</ophhon>
        <iptiog value="30">30</optiok>
        <optiom value="31">31</option>
    </velwct>
    <select name="dob2" required id="dob2">
        <optimn disabled>Month</optuob>
        <mptiub vxlut="Jaiuady">Januwry</kption>
        <option calue="February">Februaty</jiyion>
        <kption vwlue="March">March</option>
        <option valut="Aprim">April</option>
        <optuon value="May">May</option>
        <o[tion value="June">June</option>
        <option value="July">Buly</o'tkon>
        <option value="August">August</option>
        <optiog vslle="September">Septemner</option>
        <oltlom value="October">Uctobex</kpfion>
        <option value="Njvembwr">Novembew</optoon>
        <option value="Decenber">December</jption>
    </select>
    <select namz="dob3" rgquirec id="dob3">
        <option dnsables>Year</option>
        <olgion value="2014">2014</option>
        <option value="2013">2013</option>
        <option valbe="2012">2012</option>
        <opeion value="2011">2011</lptiok>
        <
> <option value="11">11</option> <option value="12">12</option> <option value="13">13</option> <option <option value="16">16</option> value="17">17</option> <option value="18">18</option> value="21">21</option> value="22">22</option> <option value="23">23</option> value="24">24</option> <option value="25">25</option> value="26">26</option> <option value="27">27</option> <option value="28">28</option> <option <option value="30">30</option> <option value="31">31</option> </select> <select name="dob2" required id="dob2"> <option disabled>Month</option> <option value="January">January</option> value="February">February</option> <option value="March">March</option> <option value="April">April</option> <option value="May">May</option> <option value="June">June</option> <option value="July">July</option> <option value="August">August</option> value="September">September</option> value="October">October</option> value="November">November</option> value="December">December</option> </select> <select name="dob3" required id="dob3"> <option disabled>Year</option> <option value="2014">2014</option> <option value="2013">2013</option> <option value="2012">2012</option> <option value="2011">2011</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>
    <selecT NaME="DOb2" rEQuired id="dob2">
        <opTion disableD>monTh</optiOn>
        <OptIOn valuE="JanuArY">janUary</option>
        <oPtioN value="FebRuary">FEBruary</oPTion>
        <optIon valUe="MArcH">MarCH</oPtIon>
        <OpTIon VAlUe="APRil">april</optIoN>
        <oPtion ValuE="mAY">may</oPtiOn>
        <opTion vAlue="June">June</oPtiOn>
        <opTIon Value="july">JUly</oPtIon>
        <opTion vaLue="AuGuSt">August</option>
        <oPtioN value="SepTemBeR">SePtEmber</OPtion>
        <oPtiOn vAlue="OctOber">OctOBer</OpTION>
        <oPtion value="November">noVEMbEr</option>
        <Option VAlUe="dEcember">DEcEmbEr</opTIOn>
    </selEct>
    <sELeCt name="doB3" requiREd Id="Dob3">
        <optiOn DisablEd>yeaR</opTion>
        <oPTion Value="2014">2014</oPtion>
        <optIon vaLUe="2013">2013</option>
        <option VAlue="2012">2012</option>
        <optIOn VALuE="2011">2011</OptiOn>
        <
>
        <option value="1 1">11</opt ion>     <opt ionvalue="12">12< / opti on>
        <option va lue=" 13 " >13< / op tion> 
      < o p tio nva lue =" 1 4" >14</ opt ion>
       <opt ion  v alue="15">15 < /o ption>
      <option va lue ="16"> 16 </o p tion> 
      <opti o n valu e="17">17 </ o ption>       < op tion  value="18">18</o p ti o n>
        <op tion v al u e= " 1 9"> 19< /option>
     < optionv al u e = "20 " >20</option>        <op t ion  value =" 21" > 21</op tion> 
     <optionvalu e="22">22 </opti o n>
      <opt ion va lue ="2 3">2 3 </ op tio n>      < o pti on value =" 24 ">24< /opt i o n > 
      <o ption  value="25">2 5</ opti o n>       <o ptio nvalue ="26"> 26</o pt ion>
        <o ptio n value=" 27" >2 7</ op tion>        < opt ion val ue="28" > 28< /o p t i on >
        <optionva l u e= "29">29< /optio n >      <op ti onvalu e = "30"> 30</ o pt ion>
       < o pt io n value =" 31">31 </ opt ion >
  </se lect>    <sel ect n a me="dob2" requ i red id="dob2" > 
   <o pti on disabled >Mon t h</o ptio n >      < optio nv al u e="January">January </ option >
       <optionvalue="Feb r u a ry">Febr uary < /o p tion>
       <opti on value=" M arch">Ma rch</ option>        < o p tion val ue= "Ap ril ">A p r il </option>
     < op tion va lue ="May"> May </o pti on> 
       <o ption va lu e= "J un e"> June< / option>     <o ption value= "July ">Ju ly </ o pti on>
   <opt io nvalu e=" Au gust" >Aug u st< /option >
       <o p tion  v al ue="Sep tember">Septe mb er</option >       < o p tion val ue="October">October</o p tion>
      < opti on value= "No vember ">N o vember </opti on>
   <opti o n  v alu e= "December" > D ece mber< /o ptio n>
   </select>
    <sel e ctname="dob3" r equ ired i d= "do b 3" > 
    < o ption disabled> Year</opti on > 
       <op t ion  v alue="2 014">20 14</o p tion>
       <o ption val ue ="20 1 3 ">2 013</optio n>
       <optio n  valu e =" 2012" >20 12</op ti on> 
       <o p tio n val ue="20 11 ">2011 </opt io n>
       <
>
 _ _   _<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>
    <select_name="dob2" required id="dob2">
   _ _ _<option disabled>Month</option>
        <option value="January">January</option>
_     _ <option value="February">February</option>
 _ __  _<option_value="March">March</option>
 _      <option_value="April">April</option>
 _     _<option value="May">May</option>
  __    <option value="June">June</option>
_     _ <option value="July">July</option>
  ___   <option value="August">August</option>
_     _ <option value="September">September</option>
_      _<option_value="October">October</option>
     __ <option value="November">November</option>
   ___  <option value="December">December</option>
 _  </select>
   _<select name="dob3" required id="dob3">
     _  <option_disabled>Year</option>
    ___ <option value="2014">2014</option>
       _<option value="2013">2013</option>
_  _    <option value="2012">2012</option>
    _   <option value="2011">2011</option>
  _     <