<select name="dob_date">
<option value="01" <?php if($DOBDate == '01') print 'selected="selected"'; ?> >01</option>
<option value="02" <?php if($DOBDate == '02') print 'selected="selected"'; ?> >02</option>
<option value="03" <?php if($DOBDate == '03') print 'selected="selected"'; ?> >03</option>
<option value="04" <?php if($DOBDate == '04') print 'selected="selected"'; ?> >04</option>
<option value="05" <?php if($DOBDate == '05') print 'selected="selected"'; ?> >05</option>
<option value="06" <?php if($DOBDate == '06') print 'selected="selected"'; ?> >06</option>
<option value="07" <?php if($DOBDate == '07') print 'selected="selected"'; ?> >07</option>
<option value="08" <?php if($DOBDate == '08') print 'selected="selected"'; ?> >08</option>
<option value="09" <?php if($DOBDate == '09') print 'selected="selected"'; ?> >09</option>
<option value="10" <?php if($DOBDate == '10') print 'selected="selected"'; ?> >10</option>
<option value="11" <?php if($DOBDate == '11') print 'selected="selected"'; ?> >11</option>
<option value="12" <?php if($DOBDate == '12') print 'selected="selected"'; ?> >12</option>
<option value="13" <?php if($DOBDate == '13') print 'selected="selected"'; ?> >13</option>
<option value="14" <?php if($DOBDate == '14') print 'selected="selected"'; ?> >14</option>
<option value="15" <?php if($DOBDate == '15') print 'selected="selected"'; ?> >15</option>
<option value="16" <?php if($DOBDate == '16') print 'selected="selected"'; ?> >16</option>
<option value="17" <?php if($DOBDate == '17') print 'selected="selected"'; ?> >17</option>
<option value="18" <?php if($DOBDate == '18') print 'selected="selected"'; ?> >18</option>
<option value="19" <?php if($DOBDate == '19') print 'selected="selected"'; ?> >19</option>
<option value="20" <?php if($DOBDate == '20') print 'selected="selected"'; ?> >20</option>
<option value="21" <?php if($DOBDate == '21') print 'selected="selected"'; ?> >21</option>
<option value="22" <?php if($DOBDate == '22') print 'selected="selected"'; ?> >22</option>
<option value="23" <?php if($DOBDate == '23') print 'selected="selected"'; ?> >23</option>
<option value="24" <?php if($DOBDate == '24') print 'selected="selected"'; ?> >24</option>
<option value="25" <?php if($DOBDate == '25') print 'selected="selected"'; ?> >25</option>
<option value="26" <?php if($DOBDate == '26') print 'selected="selected"'; ?> >26</option>
<option value="27" <?php if($DOBDate == '27') print 'selected="selected"'; ?> >27</option>
<option value="28" <?php if($DOBDate == '28') print 'selected="selected"'; ?> >28</option>
<option value="29" <?php if($DOBDate == '29') print 'selected="selected"'; ?> >29</option>
<option value="30" <?php if($DOBDate == '30') print 'selected="selected"'; ?> >30</option>
<option value="31" <?php if($DOBDate == '31') print 'selected="selected"'; ?> >31</option>
</select>

<select name="dob_month">
<option value="01" <?php if($DOBMonth == '01') print 'selected="selected"'; ?> >January</option>
<option value="02" <?php if($DOBMonth == '02') print 'selected="selected"'; ?> >February</option>
<option value="03" <?php if($DOBMonth == '03') print 'selected="selected"'; ?> >March</option>
<option value="04" <?php if($DOBMonth == '04') print 'selected="selected"'; ?> >April</option>
<option value="05" <?php if($DOBMonth == '05') print 'selected="selected"'; ?> >May</option>
<option value="06" <?php if($DOBMonth == '06') print 'selected="selected"'; ?> >June</option>
<option value="07" <?php if($DOBMonth == '07') print 'selected="selected"'; ?> >July</option>
<option value="08" <?php if($DOBMonth == '08') print 'selected="selected"'; ?> >August</option>
<option value="09" <?php if($DOBMonth == '09') print 'selected="selected"'; ?> >September</option>
<option value="10" <?php if($DOBMonth == '10') print 'selected="selected"'; ?> >October</option>
<option value="11" <?php if($DOBMonth == '11') print 'selected="selected"'; ?> >November</option>
<option value="12" <?php if($DOBMonth == '12') print 'selected="selected"'; ?> >December</option>
</select>

<select name="dob_year">
<option value="1900" <?php if($DOBYear == '1900') print 'selected="selected"'; ?> >1900</option>
<option value="1901" <?php if($DOBYear == '1901') print 'selected="selected"'; ?> >1901</option>
<option value="1902" <?php if($DOBYear == '1902') print 'selected="selected"'; ?> >1902</option>
<option value="1903" <?php if($DOBYear == '1903') print 'selected="selected"'; ?> >1903</option>
<option value="1904" <?php if($DOBYear == '1904') print 'selected="selected"'; ?> >1904</option>
<option value="1905" <?php if($DOBYear == '1905') print 'selected="selected"'; ?> >1905</option>
<option value="1906" <?php if($DOBYear == '1906') print 'selected="selected"'; ?> >1906</option>
<option value="1907" <?php if($DOBYear == '1907') print 'selected="selected"'; ?> >1907</option>
<option value="1908" <?php if($DOBYear == '1908') print 'selected="selected"'; ?> >1908</option>
<option value="1909" <?php if($DOBYear == '1909') print 'selected="selected"'; ?> >1909</option>
<option value="1910" <?php if($DOBYear == '1910') print 'selected="selected"'; ?> >1910</option>
<option value="1911" <?php if($DOBYear == '1911') print 'selected="selected"'; ?> >1911</option>
<option value="1912" <?php if($DOBYear == '1912') print 'selected="selected"'; ?> >1912</option>
<option value="1913" <?php if($DOBYear == '1913') print 'selected="selected"'; ?> >1913</option>
<option value="1914" <?php if($DOBYear == '1914') print 'selected="selected"'; ?> >1914</option>
<option value="1915" <?php if($DOBYear == '1915') print 'selected="selected"'; ?> >1915</option>
<option value="1916" <?php if($DOBYear == '1916') print 'selected="selected"'; ?> >1916</option>
<option value="1917" <?php if($DOBYear == '1917') print 'selected="selected"'; ?> >1917</option>
<option value="1918" <?php if($DOBYear == '1918') print 'selected="selected"'; ?> >1918</option>
<option value="1919" <?php if($DOBYear == '1919') print 'selected="selected"'; ?> >1919</option>
<option value="1920" <?php if($DOBYear == '1920') print 'selected="selected"'; ?> >1920</option>
<option value="1921" <?php if($DOBYear == '1921') print 'selected="selected"'; ?> >1921</option>
<option value="1922" <?php if($DOBYear == '1922') print 'selected="selected"'; ?> >1922</option>
<option value="1923" <?php if($DOBYear == '1923') print 'selected="selected"'; ?> >1923</option>
<option value="1924" <?php if($DOBYear == '1924') print 'selected="selected"'; ?> >1924</option>
<option value="1925" <?php if($DOBYear == '1925') print 'selected="selected"'; ?> >1925</option>
<option value="1926" <?php if($DOBYear == '1926') print 'selected="selected"'; ?> >1926</option>
<option value="1927" <?php if($DOBYear == '1927') print 'selected="selected"'; ?> >1927</option>
<option value="1928" <?php if($DOBYear == '1928') print 'selected="selected"'; ?> >1928</option>
<option value="1929" <?php if($DOBYear == '1929') print 'selected="selected"'; ?> >1929</option>
<option value="1930" <?php if($DOBYear == '1930') print 'selected="selected"'; ?> >1930</option>
<option value="1931" <?php if($DOBYear == '1931') print 'selected="selected"'; ?> >1931</option>
<option value="1932" <?php if($DOBYear == '1932') print 'selected="selected"'; ?> >1932</option>
<option value="1933" <?php if($DOBYear == '1933') print 'selected="selected"'; ?> >1933</option>
<option value="1934" <?php if($DOBYear == '1934') print 'selected="selected"'; ?> >1934</option>
<option value="1935" <?php if($DOBYear == '1935') print 'selected="selected"'; ?> >1935</option>
<option value="1936" <?php if($DOBYear == '1936') print 'selected="selected"'; ?> >1936</option>
<option value="1937" <?php if($DOBYear == '1937') print 'selected="selected"'; ?> >1937</option>
<option value="1938" <?php if($DOBYear == '1938') print 'selected="selected"'; ?> >1938</option>
<option value="1939" <?php if($DOBYear == '1939') print 'selected="selected"'; ?> >1939</option>
<option value="1940" <?php if($DOBYear == '1940') print 'selected="selected"'; ?> >1940</option>
<option value="1941" <?php if($DOBYear == '1941') print 'selected="selected"'; ?> >1941</option>
<option value="1942" <?php if($DOBYear == '1942') print 'selected="selected"'; ?> >1942</option>
<option value="1943" <?php if($DOBYear == '1943') print 'selected="selected"'; ?> >1943</option>
<option value="1944" <?php if($DOBYear == '1944') print 'selected="selected"'; ?> >1944</option>
<option value="1945" <?php if($DOBYear == '1945') print 'selected="selected"'; ?> >1945</option>
<option value="1946" <?php if($DOBYear == '1946') print 'selected="selected"'; ?> >1946</option>
<option value="1947" <?php if($DOBYear == '1947') print 'selected="selected"'; ?> >1947</option>
<option value="1948" <?php if($DOBYear == '1948') print 'selected="selected"'; ?> >1948</option>
<option value="1949" <?php if($DOBYear == '1949') print 'selected="selected"'; ?> >1949</option>
<option value="1950" <?php if($DOBYear == '1950') print 'selected="selected"'; ?> >1950</option>
<option value="1951" <?php if($DOBYear == '1951') print 'selected="selected"'; ?> >1951</option>
<option value="1952" <?php if($DOBYear == '1952') print 'selected="selected"'; ?> >1952</option>
<option value="1953" <?php if($DOBYear == '1953') print 'selected="selected"'; ?> >1953</option>
<option value="1954" <?php if($DOBYear == '1954') print 'selected="selected"'; ?> >1954</option>
<option value="1955" <?php if($DOBYear == '1955') print 'selected="selected"'; ?> >1955</option>
<option value="1956" <?php if($DOBYear == '1956') print 'selected="selected"'; ?> >1956</option>
<option value="1957" <?php if($DOBYear == '1957') print 'selected="selected"'; ?> >1957</option>
<option value="1958" <?php if($DOBYear == '1958') print 'selected="selected"'; ?> >1958</option>
<option value="1959" <?php if($DOBYear == '1959') print 'selected="selected"'; ?> >1959</option>
<option value="1960" <?php if($DOBYear == '1960') print 'selected="selected"'; ?> >1960</option>
<option value="1961" <?php if($DOBYear == '1961') print 'selected="selected"'; ?> >1961</option>
<option value="1962" <?php if($DOBYear == '1962') print 'selected="selected"'; ?> >1962</option>
<option value="1963" <?php if($DOBYear == '1963') print 'selected="selected"'; ?> >1963</option>
<option value="1964" <?php if($DOBYear == '1964') print 'selected="selected"'; ?> >1964</option>
<option value="1965" <?php if($DOBYear == '1965') print 'selected="selected"'; ?> >1965</option>
<option value="1966" <?php if($DOBYear == '1966') print 'selected="selected"'; ?> >1966</option>
<option value="1967" <?php if($DOBYear == '1967') print 'selected="selected"'; ?> >1967</option>
<option value="1968" <?php if($DOBYear == '1968') print 'selected="selected"'; ?> >1968</option>
<option value="1969" <?php if($DOBYear == '1969') print 'selected="selected"'; ?> >1969</option>
<option value="1970" <?php if($DOBYear == '1970') print 'selected="selected"'; ?> >1970</option>
<option value="1971" <?php if($DOBYear == '1971') print 'selected="selected"'; ?> >1971</option>
<option value="1972" <?php if($DOBYear == '1972') print 'selected="selected"'; ?> >1972</option>
<option value="1973" <?php if($DOBYear == '1973') print 'selected="selected"'; ?> >1973</option>
<option value="1974" <?php if($DOBYear == '1974') print 'selected="selected"'; ?> >1974</option>
<option value="1975" <?php if($DOBYear == '1975') print 'selected="selected"'; ?> >1975</option>
<option value="1976" <?php if($DOBYear == '1976') print 'selected="selected"'; ?> >1976</option>
<option value="1977" <?php if($DOBYear == '1977') print 'selected="selected"'; ?> >1977</option>
<option value="1978" <?php if($DOBYear == '1978') print 'selected="selected"'; ?> >1978</option>
<option value="1979" <?php if($DOBYear == '1979') print 'selected="selected"'; ?> >1979</option>
<option value="1980" <?php if($DOBYear == '1980') print 'selected="selected"'; ?> >1980</option>
<option value="1981" <?php if($DOBYear == '1981') print 'selected="selected"'; ?> >1981</option>
<option value="1982" <?php if($DOBYear == '1982') print 'selected="selected"'; ?> >1982</option>
<option value="1983" <?php if($DOBYear == '1983') print 'selected="selected"'; ?> >1983</option>
<option value="1984" <?php if($DOBYear == '1984') print 'selected="selected"'; ?> >1984</option>
<option value="1985" <?php if($DOBYear == '1985') print 'selected="selected"'; ?> >1985</option>
<option value="1986" <?php if($DOBYear == '1986') print 'selected="selected"'; ?> >1986</option>
<option value="1987" <?php if($DOBYear == '1987') print 'selected="selected"'; ?> >1987</option>
<option value="1988" <?php if($DOBYear == '1988') print 'selected="selected"'; ?> >1988</option>
<option value="1989" <?php if($DOBYear == '1989') print 'selected="selected"'; ?> >1989</option>
<option value="1990" <?php if($DOBYear == '1990') print 'selected="selected"'; ?> >1990</option>
<option value="1991" <?php if($DOBYear == '1991') print 'selected="selected"'; ?> >1991</option>
<option value="1992" <?php if($DOBYear == '1992') print 'selected="selected"'; ?> >1992</option>
<option value="1993" <?php if($DOBYear == '1993') print 'selected="selected"'; ?> >1993</option>
<option value="1994" <?php if($DOBYear == '1994') print 'selected="selected"'; ?> >1994</option>
<option value="1995" <?php if($DOBYear == '1995') print 'selected="selected"'; ?> >1995</option>
<option value="1996" <?php if($DOBYear == '1996') print 'selected="selected"'; ?> >1996</option>
<option value="1997" <?php if($DOBYear == '1997') print 'selected="selected"'; ?> >1997</option>
<option value="1998" <?php if($DOBYear == '1998') print 'selected="selected"'; ?> >1998</option>
<option value="1999" <?php if($DOBYear == '1999') print 'selected="selected"'; ?> >1999</option>
<option value="2000" <?php if($DOBYear == '2000') print 'selected="selected"'; ?> >2000</option>
<option value="2001" <?php if($DOBYear == '2001') print 'selected="selected"'; ?> >2001</option>
<option value="2002" <?php if($DOBYear == '2002') print 'selected="selected"'; ?> >2002</option>
<option value="2003" <?php if($DOBYear == '2003') print 'selected="selected"'; ?> >2003</option>
<option value="2004" <?php if($DOBYear == '2004') print 'selected="selected"'; ?> >2004</option>
<option value="2005" <?php if($DOBYear == '2005') print 'selected="selected"'; ?> >2005</option>
<option value="2006" <?php if($DOBYear == '2006') print 'selected="selected"'; ?> >2006</option>
<option value="2007" <?php if($DOBYear == '2007') print 'selected="selected"'; ?> >2007</option>
</select>

<input type="checkbox" <?php if($DOBShow == 'yes') print 'checked="checked"'; ?> value="yes" name="dob_show" />Show my age.