Please fill in your name, then select one radio button and type something in the corresponding textarea field. Each textarea field may contain a maximum of 100 characters, including white space.

You must check a radio button before its corresponding textarea field is enabled. If you change radio buttons, the other textarea field will be cleared and disabled.

User's Name (that's you :-) —>
(required in order to enable the submit button)
(a radio button must also be checked)

I am male
(character count)
I am female
(character count)