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action=\"\">\n+        <div>\n+          <p>Представьтесь, пожалуйста:</p>\n+          <label for=\"\">ФАМИЛИЯ: * <input type=\"text\" name=\"name\" value=\"Иванов\"></label>\n+          <label for=\"\">ИМЯ: * <input type=\"text\" name=\"name\" value=\"Петр\"></label>\n+          <label for=\"\">Отчество: <input type=\"text\" name=\"name\" value=\"Александрович\"></label>\n+        </div>\n+        <div>\n+          <p>ВАше Общее впечатление:</p>\n+          <label><input type=\"radio\" name=\"radio\">Скорее положительное</label>\n+          <label><input type=\"radio\" name=\"radio\">Скорее отрицательное</label>\n+        </div>\n+        <div>\n+          <p>Даты вашей поездки:</p>\n+          <label for=\"\">Дата приезда: *<input type=\"text\" name=\"date\" value=\"4 июля 2015\"></label>\n+          <p>Длительность пребывания: 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