<?php 
}
?>
              </optgroup>
            </select>			</td>
        </tr>
        <tr>
          <td align="right">&nbsp;</td>
          <td>&nbsp;</td>
          <td>&nbsp;</td>
        </tr>
        <tr>
          <td align="right">Number * </td>
          <td>&nbsp;</td>
          <td><?php 
$numberChoices = EJHSJournalForm::getNumberFormChoices();
?>
            <select name="num" id="num">
              <optgroup style="font-size:11px; width:100px; ">
              <option value="" > Select Number </option>
              <?php 
foreach ($numberChoices as $key => $value) {
    ?>
              <option value="<?php 
    echo $key;
    ?>
" <?php 
    if ($value == $num) {
        ?>
 selected="selected" <?php 
    }