<div class="caption">~caption html~</div>
<div class="field"><select name="~name~"><option value="">Choose One:</option><!--~~~name~ options~~--></select></div><!--~}~--><!--~states {~-->
<div class="caption">~caption html~</div>
<div class="field"><select name="~name~"><option value="">Choose One:</option><!--~~~name~ states~~--></select></div><!--~}~--><!--~radio {~-->
<div class="caption">~caption html~</div>
<div class="caption">~caption html~</div>
<div class="field"><select name="~name~"><option value="">Choose One:</option><!--~~~name~ options~~--></select></div><!--~}~--><!--~states {~-->
<div class="caption">~caption html~</div>
<div class="field"><select name="~name~"><option value="">Choose One:</option><!--~~~name~ states~~--></select></div><!--~}~--><!--~radio {~-->
<div class="caption">~caption html~</div>