Title: combine a dropdown box with text entry boxes in same form?

I want to create a form where I can enter data for a new record in a table, using both a drop down list and simple text fields, and then submit it though a .php file.

I have the simple form working with just entry boxes:

I have the simple form working with just entry boxes:

I have a separate drop down box that works to the point of showing the selections:

enter image description here

Is it possible to merge these forms into one page, using one submit button, using PHP and MySQL?

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