Aca va a el codigo del formulario que esta en html, y el cual con IE algunas veces no funciona, no les acepta darle submit para enviar el formulario. Mi pregunta es si pasandolo a PHP o a cualquier otra cosa funcionaria OK.
<HTML><HEAD>
<META http-equiv=Content-Type content="text/html; charset=windows-1252">
<title></title>
<script language="JavaScript" type="text/JavaScript">
<!--
function MM_jumpMenu(targ,selObj,restore){ //v3.0
eval(targ+".location='"+selObj.options[selObj.selectedIndex].value+"'");
if (restore) selObj.selectedIndex=0;
}
//-->
</script>
<body bgcolor="#FFFFFF">
<FORM ACTION="
http://www.111.com.ar/cgi-bin/FormMail.pl">
<input type="hidden" name="recipient" value="
profiles@111.com.ar"> <input type="hidden" name="subject" value="Profile"> <input type="hidden" name="redirect" value="
http://www.111.com.ar/profiles/form_ok.htm">
<TABLE width="89%" border=0>
<TR>
<TD width="32%"><font face="Verdana, Arial, Helvetica, sans-serif"><b><i><font size="4" color="#336799">Traveler
Profile</font></i></b></font></TD>
<TD width="68%" rowspan="2">
<div align="right"><font size="3" face="Comic Sans MS" color="#0000FF"><img src="../imagenes/logo_bkwhite_chico.jpg" width="257" height="70"></font></div>
</TD>
</TR>
<TR>
<TD height="37"> </TD>
</TR>
<TR>
<TD height="5" colspan="2"><div align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><em>So that we may serve you better, please fill
out the profile below. All information submitted will be kept confidential.</em></font></div></TD>
</TR>
<TR>
<TD height="5"> </TD>
<TD height="5"> </TD>
</TR>
<TR>
<TD height="5"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><em><strong>Number
of travelers in your party</strong></em></font></TD>
<TD height="5"><select name="#people" onChange="MM_jumpMenu('parent',this,0)">
<option>2
<option value="index.htm">1
<option value="3pax.htm">3
<option value="4pax.htm">4
<option value="5pax.htm">5
<option value="6pax.htm">6
<option value="7pax.htm">7
<option value="8pax.htm">8
</select></TD>
</TR>
<TR>
<TD height="5" colspan="2"><font size="1" face="Verdana, Arial, Helvetica, sans-serif">Note:
This form is for only 2 passengers traveling</font></TD>
</TR>
<TBODY>
<TR>
<TD colspan="2"><i><b><font face="Verdana" color="#336799">Personal information</font></b></i>
<div align="right"><font size="3" face="Comic Sans MS" color="#0000FF"><b></b></font></div>
</TD>
</TR>
<TR>
<TD width="32%" height="31">
<p><i><b><font size="2"><font face="Verdana">
<INPUT TYPE="radio" NAME="Mr-Mrs-Ms" VALUE="Mr" CHECKED>
Mr
<INPUT TYPE="radio" NAME="Mr-Mrs-Ms" VALUE="Mrs">
Mrs
<INPUT TYPE="radio" NAME="Mr-Mrs-Ms" VALUE="Ms">
Ms</font></font></b></i></p>
</TD>
<TD width="68%" height="31"><i><b><font face="Verdana"></font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana" color="#000000" size="3">Traveler's
Name (AS APPEARS ON YOUR PASSPORT)</font></b></i><font size="3"><i><b><font color="#000000" face="Verdana"> </font></b></i></font><i><b><font color="#000000" face="Verdana"> </font></b></i></TD>
</TR>
<TR>
<TD height="25"><strong><em><font size="2" face="Verdana, Arial, Helvetica, sans-serif">First Name</font></em></strong></TD>
<TD><i><b><font color="#000000" face="Verdana">
<input name="First name" type="text" id="First name" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD><strong><em><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Middle Name</font></em></strong></TD>
<TD><i><b><font color="#000000" face="Verdana">
<input name="Middle name" type="text" id="Middle name" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD><strong><em><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Last Name</font></em></strong></TD>
<TD><i><b><font color="#000000" face="Verdana">
<input name="Last name" type="text" id="Last name" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana" color="#000000" size="2">E-mail
Address</font></b></i></TD>
<TD width="68%"><i><b><font color="#000000" face="Verdana">
<input TEXT SIZE=50 name=e-mail>
</font></b></i></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Passport
Number</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" TEXT size=50 name="Passport number">
</font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Nationality</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" TEXT size=50 name="Nationality">
</font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Occupation</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="Occupation" size="50">
</font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">Date
of birth</font></b></i></TD>
<TD width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
</font></b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif"><font size="2">
<select name="Birth month" id="Birth month">
<option value="January" selected>January
<option value="February">February</option>
<option value="March">March</option>
<option value="April">April</option>
<option value="May">May</option>
<option value="June">June</option>
<option value="July">July</option>
<option value="August">August</option>
<option value="September">September</option>
<option value="October">October</option>
<option value="November">November</option>
<option value="December">December</option>
</select>
Month
<select name="Birth date" id="Birth date">
<option value="1" selected>1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
Day
<select name="Birth Year" id="Birth Year">
<option value="1920" selected>1920
<option value="1921">1921
<option value="1922 ">1922
<option value="1923 ">1923
<option value="1924 ">1924
<option value="1925 ">1925
<option value="1926 ">1926
<option value="1927 ">1927
<option value="1928 ">1928
<option value="1929 ">1929
<option value="1930 ">1930
<option value="1931 ">1931
<option value="1932 ">1932
<option value="1933 ">1933
<option value="1934 ">1934
<option value="1935 ">1935
<option value="1936 ">1936
<option value="1937 ">1937
<option value="1938 ">1938
<option value="1939 ">1939
<option value="1940 ">1940
<option value="1941 ">1941
<option value="1942 ">1942
<option value="1943 ">1943
<option value="1944 ">1944
<option value="1945 ">1945
<option value="1946 ">1946
<option value="1947 ">1947
<option value="1948 ">1948
<option value="1949 ">1949
<option value="1950 ">1950
<option value="1951 ">1951
<option value="1952 ">1952
<option value="1953 ">1953
<option value="1954 ">1954
<option value="1955 ">1955
<option value="1956 ">1956
<option value="1957 ">1957
<option value="1958 ">1958
<option value="1959 ">1959
<option value="1960 ">1960
<option value="1961 ">1961
<option value="1962 ">1962
<option value="1963 ">1963
<option value="1964 ">1964
<option value="1965 ">1965
<option value="1966 ">1966
<option value="1967 ">1967
<option value="1968 ">1968
<option value="1969 ">1969
<option value="1970 ">1970
<option value="1971 ">1971
<option value="1972 ">1972
<option value="1973 ">1973
<option value="1974 ">1974
<option value="1975 ">1975
<option value="1976 ">1976
<option value="1977 ">1977
<option value="1978 ">1978
<option value="1979 ">1979
<option value="1980 ">1980
<option value="1981 ">1981
<option value="1982 ">1982
<option value="1983 ">1983
<option value="1984 ">1984
<option value="1985 ">1985
<option value="1986 ">1986
<option value="1987 ">1987
<option value="1988 ">1988
<option value="1989 ">1989
<option value="1990 ">1990
<option value="1991 ">1991
<option value="1992 ">1992
<option value="1993 ">1993
<option value="1994 ">1994
<option value="1995 ">1995
<option value="1996 ">1996
<option value="1997 ">1997
<option value="1998 ">1998
<option value="1999 ">1999
<option value="2000 ">2000
<option value="2001 ">2001
<option value="2002 ">2002
<option value="2003 ">2003
<option value="2004 ">2004
<option value="2005 ">2005
<option value="2006 ">2006
</select>
Year </font></font></i></TD>
</TR>
<TR>
<TD width="32%" height="40"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Who
do you travel with?</em></strong></font></TD>
<TD width="68%"><p><font face="Verdana, Arial, Helvetica, sans-serif">
<input name="Who with" type="radio" value="Single" checked>
<font size="2"><em>Single travel
<input type="radio" name="Who with" value="couple">
Couple travel <br>
</em></font></font><em><font face="Verdana, Arial, Helvetica, sans-serif"><font size="2">
<input type="radio" name="Who with" value="family">
Family Travel
<input type="radio" name="Who with" value="group">
Group travel
<input type="radio" name="Who with" value="friends">
Friends travel </font></font></em></p>
</TD>
</TR>
<TR>
<TD> </TD>
<TD> </TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#336799" size="3">Home
Address</font></b></i></TD>
<TD width="68%"> </TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">Street</font></b></i></TD>
<TD width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<INPUT TEXT SIZE=50 name=street>
</font></b></i></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">City</font></b></i></TD>
<TD width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<INPUT TEXT SIZE=50 name=City>
</font></b></i></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">State</font></b></i></TD>
<TD width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<INPUT TEXT SIZE=50 name=State>
</font></b></i></TD>
</TR>
<TR>
<td width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Zip</font></b></i></td>
<td width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input TEXT SIZE=50 name=Zip>
</font></b></i></td>
</TR>
<TR>
<td width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Country</font></b></i></td>
<td width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input TEXT SIZE=50 name=Country>
</font></b></i></td>
</TR>
<TR>
<td width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">Telephone
Number</font></b></i></td>
<td width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" TEXT SIZE=50 name="Telephone">
</font></b></i></td>
</TR>
<TR>
<td width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">Fax
Number</font></b></i></td>
<td width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" TEXT SIZE=50 name="Fax">
</font></b></i></td>
</TR>
<TR>
<td> </td>
<td> </td>
</TR>
<TR>
<td colspan="2"><font color="#336799" size="3" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Emergency contact information</em></strong></font></td>
</TR>
<TR>
<td><em><strong><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Name</font></strong></em></td>
<td><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input name="Emergency - Name" type="text" id="Emergency - Name" SIZE=50 TEXT>
</font></b></i></td>
</TR>
<TR>
<td><em><strong><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Contact number</font></strong></em></td>
<td><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input name="Emergency - Number" type="text" id="Emergency - Number" SIZE=50 TEXT>
</font></b></i></td>
</TR>
<TR>
<td><em><strong><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Medical requirements</font></strong></em></td>
<td><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input name="Emergency - Medical requirements" type="text" id="Emergency - Medical requirements" SIZE=50 TEXT>
</font></b></i></td>
</TR>
<TR>
<td width="32%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></td>
<td width="68%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></td>
</TR>
<TR>
<td colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#336799" size="3">Air
Travel Information</font></b></i></td>
</TR>
<TR>
<td width="32%"><b><i><font face="Verdana, Arial, Helvetica, sans-serif" size="2" color="#000000">Pieces
of luggage</font></i></b></td>
<td width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<select name="Luggage">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
</select>
</font></td>
</TR>
<TR>
<td width="32%"> </td>
<td width="68%"> </td>
</TR>
<TR>
<td width="32%"><b><i><font face="Verdana, Arial, Helvetica, sans-serif" size="3" color="#336799">Arrival</font></i></b></td>
<td width="68%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></td>
</TR>
<TR>
<td width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">Date</font></b></i></td>
<td width="68%"><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<input TEXT SIZE=10 name=Arrival-date>
</font></b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif">
<font size="2">(mm/dd/yyyy)</font></font></i></td>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Time</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input type="text" TEXT SIZE=8 name="Arrival-time">
<select name="AM-PM arrival time">
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</b></i></font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Airline</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input type="text" TEXT SIZE=50 name="Arrival - Airline">
</b></i></font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Flight
number</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input type="text" TEXT SIZE=20 Number name="Arrival - Flight number"">
</b></i></font></TD>
</TR>
<TR>
<TD width="32%"> </TD>
<TD width="68%"> </TD>
</TR>
<TR>
<TD width="32%"><font face="Verdana, Arial, Helvetica, sans-serif"><b><i><font size="3" color="#336799">Departure</font></i></b></font></TD>
<TD width="68%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Date</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="Departure-date" size="10">
<em><font size="2">(mm/dd/yyyy) </font></em></font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Time</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="Departure time" size="8">
<select name="AM-PM departure time">
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Airline</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="Departure - Airline" size="50">
</font></TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Flight
number</font></b></i></TD>
<TD width="68%"> <font face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="Departure - Flight number" size="20">
</font></TD>
</TR>
<TR>
<TD width="32%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></TD>
<TD width="68%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></TD>
</TR>
<TR>
<TD><font color="#336799" size="3" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Hotel Information</em></strong></font></TD>
<TD> </TD>
</TR>
<TR>
<TD><strong><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif"><em>Hotel name</em></font></strong></TD>
<TD><font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input name="Hotel - Name" type="text" id="Hotel - Name" size=50 TEXT>
</b></i></font></TD>
</TR>
<TR>
<TD height="25"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Room preferences</em></strong></font></TD>
<TD><font size="2">
<em>
<input name="Bed" type="radio" value="King Size" checked>
<font face="Verdana, Arial, Helvetica, sans-serif"> King size
<input type="radio" name="Bed" value="Two double beds">
Two double beds
<input type="radio" name="Bed" value="Any available">
Any available</font></em></font></TD>
</TR>
<TR>
<TD> </TD>
<TD><font size="2" face="Verdana, Arial, Helvetica, sans-serif">
<em>
<input name="Smoking" type="radio" value="Non Smoking" checked>
Non Smoking
<input type="radio" name="Smoking" value="Smoking">
Smoking
<input type="radio" name="Smoking" value="Either">
Either</em></font></TD>
</TR>
<TR>
<TD><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Additional
room requirements</em></strong></font></TD>
<TD><font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input name="Hotel - Additional requirements" type="text" id="Hotel - Additional requirements" size=50 TEXT>
</b></i></font></TD>
</TR>
<TR>
<TD> </TD>
<TD> </TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="3" color="#336799">Trip
Information</font></b></i></TD>
<TD width="68%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2"></font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Is
this your first trip to Argentina?
<select name="First trip to Argentina" size="1">
<option value="Yes" selected>Yes</option>
<option value="No">No</option>
</select>
(If not, when did you travel)
<input type="text" TEXT SIZE=25 name="When did you travel">
</font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Do
you have any physical disabilities or health problems we should take into
account when planning the activities for you? </font></b></i></TD>
</TR>
<TR>
<TD colspan="2"> <i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
<textarea name="Physical disabilities" COLS=80 ROWS=3 wrap="VIRTUAL"></textarea>
</font></b></i></TD>
</TR>
<TR>
<TD colspan="2"> </TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2"></font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="3" color="#336799">Areas
of interest</font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Please
select your main topics of interest:</font></b></i></TD>
</TR>
<TR>
<TD colspan="2"> <div align="justify"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
<input name="Interest - Adventure" type="checkbox" id="Interest - Adventure" value="Si">
Adventure
<input name="Interest - Biking" type="checkbox" id="Interest - Biking" value="Si">
Biking
<input name="Interest - Culinary/wine" type="checkbox" id="Interest - Culinary/wine" value="Si">
Culinary/Wine
<input name="Interest - Dancing" type="checkbox" id="Interest - Dancing" value="Si">
Dancing
<input name="Interests - Fishing" type="checkbox" id="Interests - Fishing" value="Si">
Fishing</font></b></i></div></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
<input name="Interests - Gambling" type="checkbox" id="Interests - Gambling" value="Si">
Gambling
<input name="Interest - Golfing" type="checkbox" id="Interest - Golfing" value="Si">
Golfing
<input name="Interest - Hiking / Walking" type="checkbox" id="Interest - Hiking / Walking" value="Si">
Hiking / Walking
<input name="Interest - Music" type="checkbox" id="Interest - Music" value="Si">
Music
<input name="Interests - Museums" type="checkbox" id="Interests - Museums" value="Si">
Museums</font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">
<input name="Interests - Shopping" type="checkbox" id="Interests - Shopping" value="Si">
Shopping
<input name="Interest - Skiing" type="checkbox" id="Interest - Skiing" value="Si">
Skiing
<input name="Interest - Spa / health" type="checkbox" id="Interest - Spa / health" value="Si">
Spa/Health
<input name="Interest - Sun / Beach" type="checkbox" id="Interest - Sun / Beach" value="Si">
Sun / Beach
<input name="Interests - Tennis" type="checkbox" id="Interests - Tennis" value="Si">
Tennis</font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Others
(please specify)
<input name="Others interest" type="text" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD> </TD>
<TD> </TD>
</TR>
<TR>
<TD width="32%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2"></font></b></i></TD>
<TD width="68%"><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2"></font></b></i></TD>
</TR>
<TR>
<TD colspan="2"><font face="Verdana, Arial, Helvetica, sans-serif" size="3"><b><i><font color="#336799">Special
requests or comments</font></i></b></font></TD>
</TR>
<TR>
<TD colspan="2"><font face="Verdana, Arial, Helvetica, sans-serif"><i><b><font size="2">Please
provide us with any additional information that you feel is important
when serving your travel needs.</font></b></i></font></TD>
</TR>
<TR>
<TD colspan="2"> <font face="Verdana, Arial, Helvetica, sans-serif">
<textarea name="Aditional information" COLS=80 ROWS=10 wrap="VIRTUAL"></textarea>
</font></TD>
</TR>
<TR>
<TD colspan="2"> </TD>
</TR>
<TR>
<TD colspan="2"><font color="#336799" size="3" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Additional
travelers</em></strong></font></TD>
</TR>
<TR>
<TD height="21"> </TD>
<TD> </TD>
</TR>
<TR>
<TD height="25"><font color="#336799" size="3" face="Verdana, Arial, Helvetica, sans-serif"><strong><em>Additional
traveler 1</em></strong></font></TD>
<TD> </TD>
</TR>
<TR>
<TD height="25"><strong><em><font size="2" face="Verdana, Arial, Helvetica, sans-serif">First
Name</font></em></strong></TD>
<TD><i><b><font color="#000000" face="Verdana">
<input name="First name add1" type="text" id="First name add1" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD><strong><em><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Middle
Name</font></em></strong></TD>
<TD><i><b><font color="#000000" face="Verdana">
<input name="Middle name add1" type="text" id="Middle name add1" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD><strong><em><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Last
Name</font></em></strong></TD>
<TD><i><b><font color="#000000" face="Verdana">
<input name="Last name add1" type="text" id="Last name add1" size="50">
</font></b></i></TD>
</TR>
<TR>
<TD><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Passport
Number</font></b></i></TD>
<TD> <font face="Verdana, Arial, Helvetica, sans-serif">
<input name="Passport number add1" type="text" id="Passport number add1" size=50 TEXT>
</font></TD>
</TR>
<TR>
<TD><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Nationality</font></b></i></TD>
<TD> <font face="Verdana, Arial, Helvetica, sans-serif">
<input name="Nationality add1" type="text" id="Nationality add1" size=50 TEXT>
</font></TD>
</TR>
<TR>
<TD><i><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Occupation</font></b></i></TD>
<TD> <font face="Verdana, Arial, Helvetica, sans-serif">
<input name="Occupation add1" type="text" id="Occupation add1" size="50">
</font></TD>
</TR>
<TR>
<TD><i><b><font face="Verdana, Arial, Helvetica, sans-serif" color="#000000" size="2">Date
of birth</font></b></i></TD>
<TD><i><b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif"> </font></b><font color="#000000" face="Verdana, Arial, Helvetica, sans-serif"><font size="2">
<select name="Birth month add1" id="Birth month add1">
<option value="January" selected>January
<option value="February">February</option>
<option value="March">March</option>
<option value="April">April</option>
<option value="May">May</option>
<option value="June">June</option>
<option value="July">July</option>
<option value="August">August</option>
<option value="September">September</option>
<option value="October">October</option>
<option value="November">November</option>
<option value="December">December</option>
</select>
Month
<select name="Birth date add1" id="Birth date add1">
<option value="1" selected>1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
Day
<select name="Birth Year add1" id="Birth Year add1">
<option value="1920" selected>1920
<option value="1921">1921
<option value="1922 ">1922
<option value="1923 ">1923
<option value="1924 ">1924
<option value="1925 ">1925
<option value="1926 ">1926
<option value="1927 ">1927
<option value="1928 ">1928
<option value="1929 ">1929
<option value="1930 ">1930
<option value="1931 ">1931
<option value="1932 ">1932
<option value="1933 ">1933
<option value="1934 ">1934
<option value="1935 ">1935
<option value="1936 ">1936
<option value="1937 ">1937
<option value="1938 ">1938
<option value="1939 ">1939
<option value="1940 ">1940
<option value="1941 ">1941
<option value="1942 ">1942
<option value="1943 ">1943
<option value="1944 ">1944
<option value="1945 ">1945
<option value="1946 ">1946
<option value="1947 ">1947
<option value="1948 ">1948
<option value="1949 ">1949
<option value="1950 ">1950
<option value="1951 ">1951
<option value="1952 ">1952
<option value="1953 ">1953
<option value="1954 ">1954
<option value="1955 ">1955
<option value="1956 ">1956
<option value="1957 ">1957
<option value="1958 ">1958
<option value="1959 ">1959
<option value="1960 ">1960
<option value="1961 ">1961
<option value="1962 ">1962
<option value="1963 ">1963
<option value="1964 ">1964
<option value="1965 ">1965
<option value="1966 ">1966
<option value="1967 ">1967
<option value="1968 ">1968
<option value="1969 ">1969
<option value="1970 ">1970
<option value="1971 ">1971
<option value="1972 ">1972
<option value="1973 ">1973
<option value="1974 ">1974
<option value="1975 ">1975
<option value="1976 ">1976
<option value="1977 ">1977
<option value="1978 ">1978
<option value="1979 ">1979
<option value="1980 ">1980
<option value="1981 ">1981
<option value="1982 ">1982
<option value="1983 ">1983
<option value="1984 ">1984
<option value="1985 ">1985
<option value="1986 ">1986
<option value="1987 ">1987
<option value="1988 ">1988
<option value="1989 ">1989
<option value="1990 ">1990
<option value="1991 ">1991
<option value="1992 ">1992
<option value="1993 ">1993
<option value="1994 ">1994
<option value="1995 ">1995
<option value="1996 ">1996
<option value="1997 ">1997
<option value="1998 ">1998
<option value="1999 ">1999
<option value="2000 ">2000
<option value="2001 ">2001
<option value="2002 ">2002
<option value="2003 ">2003
<option value="2004 ">2004
<option value="2005 ">2005
<option value="2006 ">2006
</select>
Year </font></font></i></TD>
</TR>
<TR>
<TD><font face="Verdana, Arial, Helvetica, sans-serif">
</font></TD>
<TD> </TD>
</TR>
<TR>
<TD width="32%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></TD>
<TD width="68%"><font face="Verdana, Arial, Helvetica, sans-serif"> </font></TD>
</TR>
<TR>
<TD width="32%"> <div align="right"><font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input type=submit value=Submit name=Submit>
</b></i></font></div></TD>
<TD width="68%">
<div align="center"> <font face="Verdana, Arial, Helvetica, sans-serif"><i><b>
<input type="reset" name="Reset" value="Reset">
</b></i></font></div>
</TD>
</TR>
<TR>
<TD colspan="2">
<div align="center"><font face="Verdana, Arial, Helvetica, sans-serif"><a href="<A href="mailto:info@111.com.ar"><font">mailto:info@1 11.com.ar"><font size="2">info@111.com.ar</font></a></font></div>
</TD>
</TR>
</TBODY>
</TABLE>
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