<form>
<label for="name">Name: <span class="req">*</span></label>
<input id="name" name="name" type="text" required />
<label for="birth">Date of Birth:</label>
<input id="birth" name="birth" type="date" />
<label for="origin">How did you find out about us? <span class="req">*</span></label>
<select id="origin" name="origin" required>
<option>Google</option>
<option>Facebook</option>
<option>Advertisement</option>
</select>
<p><span class="req">*</span> - Required field</p>
</form>