survey form


<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>Survey</title>
<link rel="stylesheet" type="text/css" href="/static/view.css" media="all">
<script type="text/javascript" src="/static/view.js"></script>

</head>
<body id="main_body" >

	<img id="top" src="/static/top.png" alt="">
	<div id="form_container">

		<h1><a>Survey</a></h1>
		<form id="form_22423" class="appnitro"  method="POST" action="/collect">
					<div class="form_description">
			<h2>Survey</h2>
			<p>Answer some questions!</p>
		</div>
			<ul >

					<li id="li_1" >
		<label class="description" for="element_1">What kind of dog? </label>
		<div>
			<input id="element_1" name="dog" class="element text medium" type="text" maxlength="255" value=""/>
		</div>
		</li>		<li id="li_2" >
		<label class="description" for="element_2">Sport? </label>
		<div>
			<input id="element_2" name="sport" class="element text medium" type="text" maxlength="255" value=""/>
		</div>
		</li>		<li id="li_5" >
		<label class="description" for="element_5">Section of Somers </label>
		<div>
		<select class="element select medium" id="element_5" name="town">
			<option value="" selected="selected"></option>
<option value="1" >Lincolndale</option>
<option value="2" >Shenorock</option>
<option value="3" >Granite Springs</option>
<option value="4" >Katonah</option>

		</select>
		</div>
		</li>		<li id="li_3" >
		<label class="description" for="element_3">Favorite Vacation Spot </label>
		<div>
			<input id="element_3" name="vaca" class="element text medium" type="text" maxlength="255" value=""/>
		</div>
		</li>		<li id="li_4" >
		<label class="description" for="element_4"> </label>
		<span>
			<input id="element_4_1" name="robot" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_4_1">I am not a robot</label>

		</span>
		</li>

					<li class="buttons">
			    <input type="hidden" name="form_id" value="22423" />

				<input id="saveForm" class="button_text" type="submit" name="submit" value="Submit" />
		</li>
			</ul>
		</form>
		<div id="footer">
			Generated by <a href="http://www.phpform.org">pForm</a>
		</div>
	</div>
	<img id="bottom" src="/static/bottom.png" alt="">
	</body>
</html>