<html xmlns="http://www.w3.org/1999/xhtml" >
<head >
<title></title>
</head>
<body>
<form id="form1">
<div>
<ul>
<li><input type='radio' name="radio_113" value="1" />White</li>
<li><input type='radio' name="radio_113" value="2" />Black, African American, or Negro</li>
<li><input type='radio' name="radio_113" value="3" />American Indian or Alaska Native</li>
<li><input type='radio' name="radio_113" value="xxx" />Asian
<select name="radio_113">
<option value="xxx">(Select Asian Group)</option>
&nbs
