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I just tried filling it out selecting "New York" for the state and it worked for me. Which browser/OS are you using? Are you sure you are checking both of the text boxes and have all the fields filled-in (it looks like everything is required)? Obviously you wouldn't want to post your contact info here, but maybe you could send me the exact inputs your a re using via email? Or, if it still happens for junk phone/address/etc, maybe just post a screenshot here so we can reproduce?
I just tried to sign the CLA here: https://www.splunk.com/goto/contributions
It keeps failing, telling me that "You need to correct some items before continuing"
Each time, the 'State' field is reset. I choose NY, and try to re-submit, but it errors out again and resets the 'State' field.
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