				<label>This is shown if woman was selected</label><br />
							<input class="input_field_25em" name="woman_stuff" /><br />
						</div>

						<label for="day_se">Social Security Number</label><br /> 
						<input class="input_field_25em" name="day" id="day_se" value="DD" /> 
						<input class="input_field_25em" name="month" id="month_se" value="MM" /> 
						<input class="input_field_3em" name="year" id="year_se" value="YYYY" /> - 
						<input class="input_field_3em" name="lastFour" id="lastFour_se"