Código PHP:
<option value="Las Antillas">Las Antillas</option>
<option value="Lebanon">Lebanon</option>
<option value="Libya">Libya</option>
<option value="Lituania">Lituania</option>
<option value="Luxemburgo">Luxemburgo</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malasia">Malasia</option>
<option value="Maldivas">Maldivas</option>
<option value="Malta">Malta</option>
<option value="Marruecos">Marruecos</option>
<option value="Mauritania">Mauritania</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldavia">Moldavia</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Mozambique">Mozambique</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Nigeria">Nigeria</option>
<option value="Noruega">Noruega</option>
<option value="Nueva Zelanda">Nueva Zelanda</option>
<option value="Oman">Oman</option>
<option value="Pais de Gales">Pais de Gales</option>
<option value="Pakistan">Pakistan</option>
<option value="Panama">Panama</option>
<option value="Paragüay">Paragüay</option>
<option value="Peru">Peru</option>
<option value="Polonia">Polonia</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republica Checa">Republica Checa</option>
<option value="Republica de Korea">Republica de Korea</option>
<option value="Republica Dominicana">Republica Dominicana</option>
<option value="Rumania">Rumania</option>
<option value="Rusia">Rusia</option>
<option value="Santa Lucia">Santa Lucia</option>
<option value="Senegal">Senegal</option>
<option value="Sierra Leona">Sierra Leona</option>
<option value="Singapur">Singapur</option>
<option value="Siria">Siria</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Somalia">Somalia</option>
<option value="Sudan">Sudan</option>
<option value="Suecia">Suecia</option>
<option value="Suiza">Suiza</option>
<option value="Surinam">Surinam</option>
<option value="Tailandia">Tailandia</option>
<option value="Taiwan">Taiwan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailandia">Thailandia</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad y Tobago">Trinidad y Tobago</option>
<option value="Tunez">Tunez</option>
<option value="Turquia">Turquia</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Ucrania">Ucrania</option>
<option value="Uganda">Uganda</option>
<option value="Uruguay">Uruguay</option>
<option value="Vaticano">Vaticano</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Yugoslavia">Yugoslavia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Cabo Verde">Cabo Verde</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Islas Cook">Islas Cook</option>
<option value="Sudafrica">Sudafrica</option>
</select>
<img src="themes/images/paises/cuba.gif" id="bandera" class="cursor" border="0">
</td>
</tr>
<tr>
<td align="right">Sexo:</td>
<td align="left"><input name="usexo" type="radio" value="0"/>Masculino: <input name="usexo" type="radio" value="1"/>Femenino</td>
</tr>
<tr>
<td align="right">Fecha de Nacimiento:</td>
<td align="left"><Select Name="FechaMonth">
<Option Label="Enero" Value="01">Enero</Option>
<Option Label="Febrero" Value="02">Febrero</Option>
<Option Label="Marzo" Value="03">Marzo</Option>
<Option Label="Abril" Value="04">Abril</Option>
<Option Label="Mayo" Value="05">Mayo</Option>
<Option Label="Junio" Value="06" Selected="Selected">Junio</Option>
<Option Label="Julio" Value="07">Julio</Option>
<Option Label="Agosto" Value="08">Agosto</Option>
<Option Label="Septiembre" Value="09">Septiembre</Option>
<Option Label="Octubre" Value="10">Octubre</Option>
<Option Label="Noviembre" Value="11">Noviembre</Option>
<Option Label="Diciembre" Value="12">Diciembre</Option>
</Select>