Código PHP:
<form name="form1" method="post" enctype="multipart/form-data">
<table width="100%" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td colspan="2" class="titlemedium"><div align="center">Datos del Servidor </div></td>
</tr>
<tr>
<td width="48%" class="tdrow1"><strong>Nombre </strong></td>
<td width="52%" class="tdrow2"><div align="left">
<input name="nombre" type="text" class="textinput" id="nombre">
</div></td>
</tr>
<tr>
<tr>
<td class="tdrow1"><strong>Juego</strong></td>
<td class="tdrow2"><div align="left">
<label>
<select name="juego" id="juego">
<option value="Medal Of Honor" selected>Medal Of Honor</option>
<option value="Counter Strike 1.6">Counter Strike 1.6</option>
<option value="Call Of Duty 2">Call Of Duty 2</option>
</select>
</label>
</div></td>
</tr>
<input type="submit" name="submit" value="Enviar" id="button">
<input type="button" name="cancelar" value="Cancelar" onClick=history.go(-1);>
</div> </td>
</tr>
</table>
</form>
Gracias.