<label for="CAT_Custom_366914">State<span class="req">*</span></label>
<select name="CAT_Custom_366914" id="CAT_Custom_366914" class="form-control select-state">
    <option value=" ">-- Please select --</option>
    <option value="act">ACT</option>
    <option value="nsw">NSW</option>
    <option value="nt">NT</option>
    <option value="qld">QLD</option>
    <option value="sa">SA</option>
    <option value="tas">TAS</option>
    <option value="vic">VIC</option>
    <option value="wa">WA</option>
</select>
<label for="CAT_Custom_366914">Location<span class="req">*</span></label>
<select name="CAT_Custom_366914" id="CAT_Custom_366914" class="form-control select-location">
    <option value=" ">-- Please select --</option>
    <option value="nsw">Bateau Bay</option>
    <option value="nsw">Baulkham Hills</option>
    <option value="nsw">Brunwick Heads</option>
    <option value="nsw">Camperdown</option>
    <option value="nsw">Castle Hill</option>

    <option value="qld">Broadbeach</option>
    <option value="qld">Buderim</option>
    <option value="qld">Everton Park</option>
    <option value="qld">Forest Lake</option>
	<option value="qld">Graceville</option>

    <option value="sa">Brighton</option>
    <option value="sa">Fulham Gardens</option>

	<option value="vic">Williamstown</option>
    <option value="vic">Wodonga</option>
	<option value="vic">Yarraville</option>

    <option value="wa">Bassendean</option>
    <option value="wa">Belmont</option>
     <option value="wa">Wanneroo</option>
	<option value="wa">Willetton</option>
</select>