HTML5 Validation Demo Form

Please complete all required fields marked with a *.

First Name *

Last Name *

Email *

Password * Use 6-20 characters, at least 1 uppercase letter and 1 number.

Birthday * MM/DD/YYYY

Gender * Male Female

Phone * Area Code - First Three Phone Digits * - Last Four Phone Digits *

Location *

Zip Code 5 Digits

Widgets Requested 1-10 Widgets Per Person

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