Encontré el FORM, ahora tengo un problemita !!!!!

[CYBERUSO]

<option value=39>43</option>

<option value=40>44</option>
<option value=40>45</option>
<option value=40>46</option>
<option value=38>47</option>

<option value=39>48</option>

<option value=40>49</option>
<option value=40>50</option>
<option value=38>51</option>

<option value=39>52</option>

<option value=40>53</option>
<option value=40>54</option>
<option value=38>55</option>

<option value=39>56</option>

<option value=40>57</option>
<option value=40>58</option>
<option value=40>59</option>
<option value=40>60</option>
<option value=38>61</option>

<option value=39>62</option>

<option value=40>63</option>
<option value=40>64</option>
<option value=40>65</option>
<option value=38>66</option>

<option value=39>67</option>

<option value=40>68</option>
<option value=40>69</option>
<option value=40>70</option>

</select>
Años</p>
</td>
</tr>




<tr>
<td><font size="2" face="Arial" color="#ffffff">Estado: (*)</font></td>
<td>
<input type="text" name="estado" size="20">
</td>
</tr>


<tr>
<td><font size="2" face="Arial" color="#ffffff">Ciudad: (*)</font></td>
<td>
<input type="text" name="ciudad" size="20">
</td>
</tr>



<tr>
<td><font size="2" face="Arial" color="#ffffff">Fecha de nacimiento: (*)</font></td>
<td>
<input type="text" name="ciudad" size="20">