  
<p>Please select your age:</p>

  <input class="input_m_form" type="radio" id="age1" name="age" value="30">
  <input class="input_m_form" type="radio" id="age2" name="age" value="60">
  <input class="input_m_form" type="radio" id="age3" name="age" value="100">
