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Assignment 3
Assignment 3
requested a
form
be implemented on a page, with validation, that can be submitted to my e-mail address.
Well,
here it is!
A3 Form
First Name:
Last Name:
Street Address:
City:
State:
-- select an option --
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP Code:
Phone Number:
Email Address:
Enter a year to continue.
Birth Year:
Month:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day:
Day
Message:
Verify you're human with the following question:
How many times does "r" appear in the word "strawberry?"