Código PHP:
<Select Name="FechaDay">
<Option Label="01" Value="1">01</Option>
<Option Label="02" Value="2">02</Option>
<Option Label="03" Value="3">03</Option>
<Option Label="04" Value="4">04</Option>
<Option Label="05" Value="5">05</Option>
<Option Label="06" Value="6">06</Option>
<Option Label="07" Value="7">07</Option>
<Option Label="08" Value="8">08</Option>
<Option Label="09" Value="9">09</Option>
<Option Label="10" Value="10">10</Option>
<Option Label="11" Value="11">11</Option>
<Option Label="12" Value="12">12</Option>
<Option Label="13" Value="13" Selected="Selected">13</Option>
<Option Label="14" Value="14">14</Option>
<Option Label="15" Value="15">15</Option>
<Option Label="16" Value="16">16</Option>
<Option Label="17" Value="17">17</Option>
<Option Label="18" Value="18">18</Option>
<Option Label="19" Value="19">19</Option>
<Option Label="20" Value="20">20</Option>
<Option Label="21" Value="21">21</Option>
<Option Label="22" Value="22">22</Option>
<Option Label="23" Value="23">23</Option>
<Option Label="24" Value="24">24</Option>
<Option Label="25" Value="25">25</Option>
<Option Label="26" Value="26">26</Option>
<Option Label="27" Value="27">27</Option>
<Option Label="28" Value="28">28</Option>
<Option Label="29" Value="29">29</Option>
<Option Label="30" Value="30">30</Option>
<Option Label="31" Value="31">31</Option>
</Select>
<Select Name="FechaYear">
<Option Label="1950" Value="1950">1950</Option>
<Option Label="1951" Value="1951">1951</Option>
<Option Label="1952" Value="1952">1952</Option>
<Option Label="1953" Value="1953">1953</Option>
<Option Label="1954" Value="1954">1954</Option>
<Option Label="1955" Value="1955">1955</Option>
<Option Label="1956" Value="1956">1956</Option>
<Option Label="1957" Value="1957">1957</Option>
<Option Label="1958" Value="1958">1958</Option>
<Option Label="1959" Value="1959">1959</Option>
<Option Label="1960" Value="1960">1960</Option>
<Option Label="1961" Value="1961">1961</Option>
<Option Label="1962" Value="1962">1962</Option>
<Option Label="1963" Value="1963">1963</Option>
<Option Label="1964" Value="1964">1964</Option>
<Option Label="1965" Value="1965">1965</Option>
<Option Label="1966" Value="1966">1966</Option>
<Option Label="1967" Value="1967">1967</Option>
<Option Label="1968" Value="1968">1968</Option>
<Option Label="1969" Value="1969">1969</Option>
<Option Label="1970" Value="1970">1970</Option>
<Option Label="1971" Value="1971">1971</Option>
<Option Label="1972" Value="1972">1972</Option>
<Option Label="1973" Value="1973">1973</Option>
<Option Label="1974" Value="1974">1974</Option>
<Option Label="1975" Value="1975">1975</Option>
<Option Label="1976" Value="1976">1976</Option>
<Option Label="1977" Value="1977">1977</Option>
<Option Label="1978" Value="1978">1978</Option>
<Option Label="1979" Value="1979">1979</Option>
<Option Label="1980" Value="1980">1980</Option>
<Option Label="1981" Value="1981">1981</Option>
<Option Label="1982" Value="1982">1982</Option>
<Option Label="1983" Value="1983">1983</Option>
<Option Label="1984" Value="1984">1984</Option>
<Option Label="1985" Value="1985">1985</Option>
<Option Label="1986" Value="1986">1986</Option>
<Option Label="1987" Value="1987">1987</Option>
<Option Label="1988" Value="1988">1988</Option>
<Option Label="1989" Value="1989">1989</Option>
<Option Label="1990" Value="1990">1990</Option>
<Option Label="1991" Value="1991">1991</Option>
<Option Label="1992" Value="1992">1992</Option>
<Option Label="1993" Value="1993">1993</Option>
<Option Label="1994" Value="1994">1994</Option>
<Option Label="1995" Value="1995">1995</Option>
<Option Label="1996" Value="1996">1996</Option>
<Option Label="1997" Value="1997">1997</Option>
<Option Label="1998" Value="1998">1998</Option>
<Option Label="1999" Value="1999">1999</Option>
<Option Label="2000" Value="2000">2000</Option>
<Option Label="2001" Value="2001">2001</Option>
<Option Label="2002" Value="2002">2002</Option>
<Option Label="2003" Value="2003">2003</Option>
<Option Label="2004" Value="2004">2004</Option>
<Option Label="2005" Value="2005" Selected="Selected">2005</Option>
<Option Label="2006" Value="2006">2006</Option>
</Select></td>
</tr>
<tr>
<td align="right">Número ICQ:</td>
<td align="left">
<input name="uicq" type="text" id="uicq" size="16" maxlength="16"/>
</td>
</tr>
<tr>
<td align="right">Yahoo Messenger:</td>
<td align="left">
<input name="uyim" type="text" id="uyim" size="25" maxlength="35"/>
</td>
</tr>
<tr>
<td align="right">MSN Messenger:</td>
<td align="left">
<input name="umsn" type="text" id="umsn" size="25" maxlength="35"/>
</td>
</tr>
<tr>
<td align="right">AOL Messenger:</td>
<td align="left">
<input name="uaol" type="text" id="uaol" size="25" maxlength="35"/>
</td>
</tr>
<tr>
<td align="right">Sitio Web:</td>
<td align="left">
<input name="uweb" type="text" id="uweb" size="50" maxlength="500"/>
</td>
</tr>
<tr>
<td valign="top" align="right">Intereses:</td>
<td align="left">
<textarea name="uintereses" cols="50" rows="5" wrap="VIRTUAL" id="uintereses"></textarea>
</td>
</tr>
<tr>
<td valign="top" align="right">Ocupación:</td>
<td align="left">
<textarea name="uocupacion" cols="50" rows="5" wrap="VIRTUAL" id="uocupacion"></textarea>
</td>
</tr>