<FORM action="" method=post>
<TABLE cellSpacing=0 cellPadding=0>
<TBODY>
<TR>
<TH class=fwe align=right>Marital Status</TH>
<TD class=fwe>
<SELECT id=id_marital_status name=marital_status>
<OPTION value="" selected>---------</OPTION>
<OPTION value=0>Single</OPTION>
<OPTION value=1>Married</OPTION> <OPTION value=2>Divorced</OPTION>
<OPTION value=3>Widowed</OPTION>
</SELECT>
</TD>
<TD></TD>
</TR>
<TR>
<TH width=150></TH>
<TD align=right width=206><INPUT class=button type=submit value=Next name=next></TD>
<TD width=50></TD>
</TR>
</TBODY>
</TABLE>
</FORM>