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<select name="provincia">
  <option value="Buenos Aires" selected="select" disabled="disabled">--</option>
  <option value="Buenos Aires">Buenos Aires</option>
  <option value="Catamarca">Catamarca</option>
  <option value="Chaco">Chaco</option>
  <option value="Chubut">Chubut</option>
  <option value="Cordoba">Cordoba</option>
  <option value="Corrientes">Corrientes</option>
  <option value="Entre Rios">Entre Rios</option>
  <option value="Formosa">Formosa</option>
  <option value="Jujuy">Jujuy</option>
  <option value="La Pampa">La Pampa</option>
  <option value="La Rioja">La Rioja</option>
  <option value="Mendoza">Mendoza</option>
  <option value="Misiones">Misiones</option>
  <option value="Neuquen">Neuquen</option>
  <option value="Rio Negro">Rio Negro</option>
  <option value="Salta">Salta</option>
  <option value="San Juan">San Juan</option>
  <option value="San Luis">San Luis</option>
  <option value="Santa Cruz">Santa Cruz</option>
  <option value="Santa Fe">Santa Fe</option>
  <option value="Santiago del Estero">Santiago del Estero</option>
  <option value="Tierra del Fuego">Tierra del Fuego</option>
  <option value="Tucuman">Tucuman</option>
</select>