form with checking the date and so on

The date-field could be like this (in the bottom):

http://roenving.users.whitehat.dk/WD3Input.html

And the value-thing:

<form id="minForm" name="minForm">
<input id="minInput" name="minInput" type="text" value="Tom" onfocus="if(this.value==this.defaultValue)this.value='';" onblur="if(this.value=='')this.value=this.defaultValue;" size="20">
<select name="minSelect" id="minSelect" onchange="this.form.minInput.value=this.value">
    <option value="">-- Vælg her --<br>
    <option value="1000">Oslo<br>
    <option value="2000">Stockholm<br>
    <option value="3000">St. Nazaire<br>
</select>
</form>