Pfft, the form itself has mandatory fields, but doesn't seem to check the veracity of any of them... just put your name, put random content in any of the fields

Pfft, the form itself has mandatory fields, but doesn't seem to check the veracity of any of them... just put your name, put random content in any of the fields you're uncomfortable giving information for, choose California and 90210 as the ZIP and it'll let you submit.