JSFiddle - React, Tailwind, and code Playground

by Koubenec

HTML

<form action="http://www.wacphila.org/cgi-bin/email/formmailmember.cgi" method="post">
    <input name="subject" type="hidden" value="New Membership" /> <input name="redirect" type="hidden" value="http://www.wacphila.org/membership_confirmation" /> <input name="sort" type="hidden" value="order:firstname,realname,Title,Company realname,Addr1,Addr2,City,State,Zip,Phone,Phone Type,email,Newsletter Interest,Family,Level,promocode,Card Type,Card Number,Expiration Date,cvv,billaddr1,billaddr2,autorenew,yp,How Did You Hear?,Publication or Ad Type,School Name,Organization Name,Other Name" /> <input name="required" type="hidden" value="firstname,realname,Addr1,City,State,Zip,Phone,Phone Type,email,Level,Card Type,Card Number,Expiration Date,cvv,How Did You Hear?" />
    <p>
        First Name *&nbsp;&nbsp;<input autocomplete="OFF" name="firstname" size="25" type="text" /></p>
    <p>
        Last Name *&nbsp;&nbsp;<input autocomplete="OFF" name="realname" size="25" type="text" /></p>
    <p>
        Title&nbsp;&nbsp;<select name="Title"><option selected="selected" value="none">None</option><option value="Mr">Mr</option><option value="Mrs">Mrs</option><option value="Ms">Ms</option><option value="Miss">Miss</option><option value="Dr">Dr</option><option value="Esq">Esq</option></select></p>
    <p>
        Partner Name (if applicable):&nbsp;<input autocomplete="OFF" name="partnername" size="45" type="text" /></p>
    <p>
        Company Name&nbsp;&nbsp;<input autocomplete="OFF" name="Company Name" size="25" type="text" /></p>
    <p>
        Address 1 *&nbsp;&nbsp;<input autocomplete="OFF" name="Addr1" size="25" type="text" /></p>
    <p>
        Address 2 *&nbsp;<input autocomplete="OFF" name="Addr2" size="25" type="text" /></p>
    <p>
        City *&nbsp;&nbsp;<input autocomplete="OFF" name="City" size="25" type="text" /></p>
    <p>
        State *&nbsp;<select name="State"><option selected="selected" value="AL">AL</option><option value="AK">AK</option><option...