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>
<td width="48%" class="tdrow1"><strong>Tag </strong></td>
<td width="52%" class="tdrow2"><div align="left">
'.$titulo.' | <input name="tag" type="text" class="textinput" id="tag">
</div></td>
</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>
<option value="Tactical Ops">Tactical Ops</option>
</select>
</label>
</div></td>
</tr>
<tr>
<td class="tdrow1"><strong>Rcon Password </strong></td>
<td class="tdrow2"><div align="left">
<input name="rcon" type="text" class="textinput" id="rcon">
</div></td>
</tr>
<tr>
<td class="tdrow1"><strong>Password</strong></td>
<td class="tdrow2"><div align="left">
<input name="pass" type="text" class="textinput" id="pass">
</div></td>
</tr>
// este campo que soolo se muestre si fue selecionaod Medal Of Honor
<tr>
<td class="tdrow1"><strong>Private Password </strong></td>
<td class="tdrow2"><div align="left">
<input name="ppass" type="text" class="textinput" id="ppass">
</div></td>
</tr>
print<tr>
<td class="tdrow1"><strong>Config</strong></td>
<td class="tdrow2"><div align="left">
<input name="cfg" type="text" class="textinput" id="cfg">
.cfg</div></td>
</tr>
<tr>
<td class="tdrow1"><strong>IP Servidor </strong></td>
<td class="tdrow2"><div align="left">
<select name="ip" id="ip">
<option value="200.27.124.130" selected>200.27.124.130</option>
<option value="200.27.124.131">200.27.124.131</option>
<option value="200.27.124.132">200.27.124.132</option>
<option value="200.27.124.133">200.27.124.133</option>
<option value="200.27.124.134">200.27.124.134</option>
<option value="200.27.124.135">200.27.124.135</option>
<option value="200.27.124.136">200.27.124.136</option>
<option value="200.27.124.137">200.27.124.137</option>
<option value="200.27.124.138">200.27.124.138</option>
<option value="200.27.124.139">200.27.124.139</option>
</select>
</div></td>
</tr>
<tr>
<td class="tdrow1"><strong>Puerto</strong></td>
<td class="tdrow2"><div align="left">
<input name="puerto" type="text" class="input" id="puerto" />
</div></td>
</tr>
<tr>
<td colspan="2" class="tdrow1"><div align="center">
<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>