HTML Injection: It is possible to inject your own HTML into this page because the input is not encoded prior to be used as output. Determine which input field contributes output here and inject HTML, CSS, and/or Javascripts in order to alter the client-side code of this page.

Javascript Validation Bypass: Set the page to at least security level 1 to activate the javascript validation. Javascript validation can always be bypassed. Use a client-proxy like Burp-Suite to capture the request after it has left the browser. You can alter the request at that time. Also, Javascript can be disabled.

Parameter Addition: If extra parameters are submitted, the page will include them in output. A parameter can be added containing scripts which will be executed when loaded in the users browser.

Buffer Overflow: If very long input is submitted, it is possible to exhaust the available space alloted on the heap.

Reflected Cross-Site Scripting: This page is vulnerable to reflected cross-site scripting because the input is not encoded prior to be used as output. Determine which input field contributes output here and inject scripts. Try to redirect the user to the capture-data.php page which records cookies and other parameters. Visit the captured-data.php page to view captured data.