JSFiddle - React, Tailwind, and code Playground

HTML

<div ng-app>
    <input type="text" name="name" ng-model="form.name" />
    <select name="expirationMonth" ng-model="form.expirationMonth">
        <option value="">--</option>
        <option>01</option>
        <option>02</option>
        <option>03</option>
        <option>04</option>
        <option>05</option>
        <option>06</option>
    </select>
    <select name="expirationYear" ng-model="form.expirationYear">
        <option>2014</option>
        <option>2015</option>
        <option>2016</option>
        <option>2017</option>
    </select>

    <pre>{{ form | json }}</pre>
</div>