Esa es la sugunda parte del codigo!!!! Por favor si me pueden ayudar gracias!!!!!
<tr>
<td nowrap><font size=-2 face="Verdana"> <b>Estado:</b></font></td>
<td><font size=2 face="Tahoma, Arial">
<select name="Estado" width=50>
<option value="-1">Seleccione...
<option value=0 >Extranjero
<option value=1 >Amazonas
<option value=2 >Anzoategui
<option value=3 >Apure
<option value=4 >Aragua
<option value=5 >Barinas
<option value=6 >Bolívar
<option value=7 >Carabobo
<option value=8 >Cojedes
<option value=9 >Delta Amacuro
<option value=10 >Dist. Capital
<option value=11 >Falcón
<option value=12 >Guarico
<option value=13 >Lara
<option value=14 >Mérida
<option value=15 >Miranda
<option value=16 >Monagas
<option value=17 >Nueva Esparta
<option value=18 >Portuguesa
<option value=19 >Sucre
<option value=20 >Táchira
<option value=21 >Trujillo
<option value=22 >Vargas
<option value=23 >Yaracuy
<option value=24 >Zulia
</td>
</tr>
<tr>
<td colspan="2">
<fieldset><legend><font face="Arial, Helvetica, sans-serif"size="2" color="#060000">Teléfonos</font></legend>
<table border=0 cellpadding=1 cellspacing="0" width=600 bgcolor="#CCCCCC">
<tr>
<td width="115" bgcolor="#FFFFFF"> </td>
<td width="94" bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"><b>Cod País</b></font> </td>
<td width="124" bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"><b>Cod Area</b></font> </td>
<td width="83" bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"><b>Número</b></font></td>
<td width="154" bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"><b>Extensión</b></font> </td>
<td width="18" bgcolor="#FFFFFF" align="center"> </td>
</tr>
<tr>
<td bgcolor="#FFFFFF" align="right"><font size="-2" face="Verdana,Arial,Geneva"><b>Ofina/Consultorio:</b></font></td>
<td bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"></font></td>
<td bgcolor="#FFFFFF" align="center">
<!--<select name="cbCodArea1">
<option>Masculino</option>
</select>-->
<select name='cbCodArea1'><option>...</option><option value=212>212</option><option value=234>234</option><option value=235>235</option><option value=237>237</option><option value=238>238</option><option value=239>239</option><option value=240>240</option><option value=241>241</option><option value=242>242</option><option value=243>243</option><option value=244>244</option><option value=245>245</option><option value=246>246</option><option value=247>247</option><option value=248>248</option><option value=249>249</option><option value=251>251</option><option value=252>252</option><option value=253>253</option><option value=254>254</option><option value=255>255</option><option value=256>256</option><option value=257>257</option><option value=258>258</option><option value=259>259</option><option value=261>261</option><option value=262>262</option><option value=263>263</option><option value=264>264</option><option value=265>265</option><option value=266>266</option><option value=267>267</option><option value=268>268</option><option value=269>269</option><option value=271>271</option><option value=272>272</option><option value=273>273</option><option value=274>274</option><option value=275>275</option><option value=276>276</option><option value=277>277</option><option value=278>278</option><option value=279>279</option><option value=281>281</option><option value=282>282</option><option value=283>283</option><option value=284>284</option><option value=285>285</option><option value=286>286</option><option value=287>287</option><option value=288>288</option><option value=289>289</option><option value=291>291</option><option value=292>292</option><option value=293>293</option><option value=294>294</option><option value=295>295</option></select></td>
<td bgcolor="#FFFFFF" align="center"><input name="tlf1" type="text" value="" size="15" maxlength="12" /></td>
<td bgcolor="#FFFFFF" align="center"><input name="ext1" type="text" value="" size="15" maxlength="12" />
</td>
<td bgcolor="#FFFFFF" align="center">
</td>
</tr>
<tr>
<td bgcolor="#FFFFFF" align="right"><font size="-2" face="Verdana,Arial,Geneva"><b>Móvil 1:</b></font></td>
<td bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"></font></td>
<td bgcolor="#FFFFFF" align="center">
<select name="cbCodArea2">
<option selected='selected'>...</option>
<option>412</option>
<option>414</option>
<option>416</option>
<option>417</option>
<option>418</option>
<option>424</option>
</select> </td>
<td bgcolor="#FFFFFF" align="center"><input name="tlf2" type="text" value="" size="15" maxlength="12" /></td>
<td bgcolor="#FFFFFF" align="center"><input name="ext2" type="text" value="" size="15" maxlength="12" />
</td>
<td bgcolor="#FFFFFF" align="center">
</td>
</tr>
<tr>
<td bgcolor="#FFFFFF" align="right"><font size="-2" face="Verdana,Arial,Geneva"><b>Móvil 2:</b></font></td>
<td bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"></font></td>
<td bgcolor="#FFFFFF" align="center">
<select name="cbCodArea2">
<option selected='selected'>...</option>
<option>412</option>
<option>414</option>
<option>416</option>
<option>417</option>
<option>418</option>
<option>424</option>
</select> </td>
<td bgcolor="#FFFFFF" align="center"><input name="tlf2" type="text" value="" size="15" maxlength="12" /></td>
<td bgcolor="#FFFFFF" align="center"><input name="ext2" type="text" value="" size="15" maxlength="12" />
</td>
<td bgcolor="#FFFFFF" align="center">
</td>
</tr>
<tr>
<td bgcolor="#FFFFFF" align="right"><font size="-2" face="Verdana,Arial,Geneva"><b>Habitación:</b></font></td>
<td bgcolor="#FFFFFF" align="center"><font size="-2" face="Verdana,Arial,Geneva"></font></td>
<td bgcolor="#FFFFFF" align="center">
<select name='cbCodArea3'><option>...</option><optgroup label='Locales'></optgroup><option value=212>212</option><option value=234>234</option><option value=235>235</option><option value=237>237</option><option value=238>238</option><option value=239>239</option><option value=240>240</option><option value=241>241</option><option value=242>242</option><option value=243>243</option><option value=244>244</option><option value=245>245</option><option value=246>246</option><option value=247>247</option><option value=248>248</option><option value=249>249</option><option value=251>251</option><option value=252>252</option><option value=253>253</option><option value=254>254</option><option value=255>255</option><option value=256>256</option><option value=257>257</option><option value=258>258</option><option value=259>259</option><option value=261>261</option><option value=262>262</option><option value=263>263</option><option value=264>264</option><option value=265>265</option><option value=266>266</option><option value=267>267</option><option value=268>268</option><option value=269>269</option><option value=271>271</option><option value=272>272</option><option value=273>273</option><option value=274>274</option><option value=275>275</option><option value=276>276</option><option value=277>277</option><option value=278>278</option><option value=279>279</option><option value=281>281</option><option value=282>282</option><option value=283>283</option><option value=284>284</option><option value=285>285</option><option value=286>286</option><option value=287>287</option><option value=288>288</option><option value=289>289</option><option value=291>291</option><option value=292>292</option><option value=293>293</option><option value=294>294</option><option value=295>295</option><optgroup label='Otros'></optgroup><option>412</option><option>414</option><option>416</option><option>417</option><option>418</option><option>0800</option></select> </td>
<td bgcolor="#FFFFFF" align="center"><input name="tlf3" type="text" value="" size="15" maxlength="12" /></td>
<td bgcolor="#FFFFFF" align="center"><input name="ext3" type="text" value="" size="15" maxlength="12" />
</td>
<td bgcolor="#FFFFFF" align="center">
</td>
</tr>
</tr>
</table>
</fieldset>
</table>
</table>
<fieldset>
<legend><font face="Arial, Helvetica, sans-serif"size="2" color="#060606">Otros</font></legend>
<table border=0 cellpadding=2 width=600>
<tr>
<td width=219><p><font face=Verdana size=1><b>¿Acepta recibir información Continua de Nuevos Productos y Ofertas?</b></font></p></td>
<td width="367">
<font face=Verdana size=1>
Si
<input type="radio" name="Acepta recibir información Continua de Nuevos Productos y Ofertas" value="Si" >
No
<input type="radio" name="Acepta recibir información Continua de Nuevos Productos y Ofertas" value="No" >
</font>
</td>
</tr>
</td>
</tr>
</table>
<table border=0 cellpadding=2 width=600>
<tr>
<td align=CENTER> <font size="-2" face="Verdana,Arial,Helvetica,Sans-serif" color=RED><b>Presione el botón una sola vez y espere respuesta</b></font> </td>
</tr>