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Form example
This shows how to use a form with Bootstrap and jQueryUI
Your name:
Your email address:
Choose a password:
Re-enter your chosen password:
Enter a date:
Your age:
CHOOSE
13-17
18-29
30-49
50+
Your gender:
M
F
How did you find out about us?
Print Publication
Web Ad
TV Ad
Radio Ad
Your message: