<select name="states-provinces"> 
	<option> - Select Province/State - </option>
	<option value="AB">Alberta</option>
	<option value="BC">British Columbia</option>
	<option value="MB">Manitoba</option>
	<option value="NB">New Brunswick</option>
	<option value="NL">Newfoundland and Labrador</option>
	<option value="NS">Nova Scotia</option>
	<option value="NT">Northwest Territories</option>
	<option value="NU">Nunavut</option>
	<option value="ON">Ontario</option>
	<option value="PE">Prince Edward Island</option>
	<option value="QC">Quebec</option>
	<option value="SK">Saskatchewan</option>
	<option value="YT">Yukon</option>
	<option> ---------------- </option>
	<option value="AL">Alabama</option> 
	<option value="AK">Alaska</option> 
	<option value="AZ">Arizona</option> 
	<option value="AR">Arkansas</option> 
	<option value="CA">California</option> 
	<option value="CO">Colorado</option> 
	<option value="CT">Connecticut</option> 
	<option value="DE">Delaware</option> 
	<option value="DC">District Of Columbia</option> 
	<option value="FL">Florida</option> 
	<option value="GA">Georgia</option> 
	<option value="HI">Hawaii</option> 
	<option value="ID">Idaho</option> 
	<option value="IL">Illinois</option> 
	<option value="IN">Indiana</option> 
	<option value="IA">Iowa</option> 
	<option value="KS">Kansas</option> 
	<option value="KY">Kentucky</option> 
	<option value="LA">Louisiana</option> 
	<option value="ME">Maine</option> 
	<option value="MD">Maryland</option> 
	<option value="MA">Massachusetts</option> 
	<option value="MI">Michigan</option> 
	<option value="MN">Minnesota</option> 
	<option value="MS">Mississippi</option> 
	<option value="MO">Missouri</option> 
	<option value="MT">Montana</option> 
	<option value="NE">Nebraska</option> 
	<option value="NV">Nevada</option> 
	<option value="NH">New Hampshire</option> 
	<option value="NJ">New Jersey</option> 
	<option value="NM">New Mexico</option> 
	<option value="NY">New York</option> 
	<option value="NC">North Carolina</option> 
	<option value="ND">North Dakota</option> 
	<option value="OH">Ohio</option> 
	<option value="OK">Oklahoma</option> 
	<option value="OR">Oregon</option> 
	<option value="PA">Pennsylvania</option> 
	<option value="RI">Rhode Island</option> 
	<option value="SC">South Carolina</option> 
	<option value="SD">South Dakota</option> 
	<option value="TN">Tennessee</option> 
	<option value="TX">Texas</option> 
	<option value="UT">Utah</option> 
	<option value="VT">Vermont</option> 
	<option value="VA">Virginia</option> 
	<option value="WA">Washington</option> 
	<option value="WV">West Virginia</option> 
	<option value="WI">Wisconsin</option> 
	<option value="WY">Wyoming</option>
</select>

State and Province select

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