A Sample Form

        Name:        
        Phone:         

    Status: singlemarrieddivorced mixtures: VanillaStrawberryRocky RoadPecan Surprise

            Vanilla
            Strawberry
            Rocky Road
            Pecan Surprise

Text Area <textarea cols=20>
and more  <textarea rows=5 cols=41>

<input type="submit">  <input type="reset">
</PRE>
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