<tr valign="baseline">
<td nowrap="nowrap" align="right">Provincia:</td>
<td><select name="Provincia" style="background:#CCC; color:#000; border-color:#666">
<option value="Ciudad de Buenos Aires" <?php if (!(strcmp("Ciudad de Buenos Aires", ""))) {echo "SELECTED";} ?>>Ciudad de Buenos Aires</option>
<option value="Buenos Aires" <?php if (!(strcmp("Buenos Aires", ""))) {echo "SELECTED";} ?>>Buenos Aires</option>
<option value="Catamarca" <?php if (!(strcmp("Catamarca", ""))) {echo "SELECTED";} ?>>Catamarca</option>
<option value="Chaco" <?php if (!(strcmp("Chaco", ""))) {echo "SELECTED";} ?>>Chaco</option>
<option value="Chubut" <?php if (!(strcmp("Chubut", ""))) {echo "SELECTED";} ?>>Chubut</option>
<option value="Córdoba" <?php if (!(strcmp("Córdoba", ""))) {echo "SELECTED";} ?>>Córdoba</option>
<option value="Corrientes" <?php if (!(strcmp("Corrientes", ""))) {echo "SELECTED";} ?>>Corrientes</option>
<option value="Entre Ríos" <?php if (!(strcmp("Entre Ríos", ""))) {echo "SELECTED";} ?>>Entre Ríos</option>
<option value="Formosa" <?php if (!(strcmp("Formosa", ""))) {echo "SELECTED";} ?>>Formosa</option>
<option value="Jujuy" <?php if (!(strcmp("Jujuy", ""))) {echo "SELECTED";} ?>>Jujuy</option>
<option value="La Pampa" <?php if (!(strcmp("La Pampa", ""))) {echo "SELECTED";} ?>>La Pampa</option>
<option value="La Rioja" <?php if (!(strcmp("La Rioja", ""))) {echo "SELECTED";} ?>>La Rioja</option>
<option value="Mendoza" <?php if (!(strcmp("Mendoza", ""))) {echo "SELECTED";} ?>>Mendoza</option>
<option value="Misiones" <?php if (!(strcmp("Misiones", ""))) {echo "SELECTED";} ?>>Misiones</option>
<option value="Neuquén" <?php if (!(strcmp("Neuquén", ""))) {echo "SELECTED";} ?>>Neuquén</option>
<option value="Río Negro" <?php if (!(strcmp("Río Negro", ""))) {echo "SELECTED";} ?>>Río Negro</option>
<option value="Salta" <?php if (!(strcmp("Salta", ""))) {echo "SELECTED";} ?>>Salta</option>
<option value="San Juan" <?php if (!(strcmp("San Juan", ""))) {echo "SELECTED";} ?>>San Juan</option>
<option value="San Luis" <?php if (!(strcmp("San Luis", ""))) {echo "SELECTED";} ?>>San Luis</option>
<option value="Santa Cruz" <?php if (!(strcmp("Santa Cruz", ""))) {echo "SELECTED";} ?>>Santa Cruz</option>
<option value="Santa Fe" <?php if (!(strcmp("Santa Fe", ""))) {echo "SELECTED";} ?>>Santa Fe</option>
<option value="Santiago del Estero" <?php if (!(strcmp("Santiago del Estero", ""))) {echo "SELECTED";} ?>>Santiago del Estero</option>
<option value="Tierra del Fuego" <?php if (!(strcmp("Tierra del Fuego", ""))) {echo "SELECTED";} ?>>Tierra del Fuego</option>
<option value="Tucumán" <?php if (!(strcmp("Tucumán", ""))) {echo "SELECTED";} ?>>Tucumán</option>
</select></td>
</tr>
<tr valign="baseline">
<td nowrap="nowrap" align="right">Localidad:</td>
<td><input type="text" name="Localidad" value="" size="32" style="background:#CCC; color:#000; border-color:#666"/></td>
</tr>
<tr valign="baseline">
<td nowrap="nowrap" align="right">Teléfono:</td>
<td><input type="text" name="Telfono" value="" size="32" style="background:#CCC; color:#000; border-color:#666"/></td>
</tr>
<tr valign="baseline">
<td nowrap="nowrap" align="right">Alt. Teléfono:</td>
<td><input type="text" name="Alt_Telfono" value="" size="32" style="background:#CCC; color:#000; border-color:#666"/><br /><br /></td>
</tr>
<tr valign="baseline">
<td nowrap="nowrap" align="right"> </td>
<td><input type="submit" value="Enviar" id="enviar" /></td>
</tr>
</table>
<input type="hidden" name="MM_insert" value="form1" />
</form>
<p> </p>
<script type="text/javascript">
function validarPasswd() {
var p1 = document.getElementById("passwd").value;
var p2 = document.getElementById("passwd2").value;
if (p1 != p2) {
alert("Las contraseñas deben de coincidir");
return false;
} else {
return true;
}
}
</script>
</body>
</html>