<form name="contact_form" method="post" action="contact.php" onSubmit="return validate_form ( );">

<h1>Please Enter Your Details Below</h1>

<p>Your Name: <input type="text" name="contact_name"></p>

<p>Your Gender: <input type="radio" name="gender" value="Male"> Male
  <input type="radio" name="gender" value="Female"> Female</p>

<p>Your Age:

<select name="age">
<option value="">Please Select an Option:</option>
<option value="0-18 years">0-18 years</option>
<option value="18-30 years">18-30 years</option>
<option value="30-45 years">30-45 years</option>
<option value="45-60 years">45-60 years</option>
<option value="60+ years">60+ years</option>
</select>



<p>Do you agree to the Terms and Conditions?
<input type="checkbox" name="terms" value="Yes"> Yes

<p><input type="submit" name="send" value="Send Details"></p>

</form>