Untitled

<html>
<head></head>
<h1>Please fill in this form:</h1>
<form action="" method="post">
<p>Enter your name:</p>
<input type="text" name="FirstName" id="FirstName" value="Peter" readonly></p>
<p>Enter your Surname:</br>
  <input type="text" name="LastName" id="LastName" value="Borg" disabled></p>
  <p> Gender:
    <select name="gender">
      <option value="male">Male</option>
      <option value="female">Female</option>
      <option value="X">X</option>
    </select></p>

    <p>Enter any comments here: </br>
      <textarea name="message" rows="20" cols="80">
      </textarea></p>

      <p>Country:<br>
        <input type="radio" name="country" value="Malta" checked> Malta<br>
        <input type="radio" name ="country" value="Gozo"> Gozo<br>
      </p>
  <input type="submit" value="Submit">
</form>
<body>
</html>