<form method="get" action="https://cscie12.dce.harvard.edu/echo">Email Address:
   <input type="text" name="email" size="50"/>

   <br/>
Year of Birth:
   <input type="text" name="year_of_birth" maxlength="4"/>

   <br/>

   <input type="submit" name="action" value="Proceed"/>

 </form>