Create a breezing form with some features

Hello, I have a form which is designed with breezing form. There are some fields that you can see on the attachment. I need to have some features: - In country USA should be Grey - All Province except Ontario should be Grey - When an user select the other Province for example Alberta(AB) popup window would be appeared and show a message 'we are not at your area now' and redirect the user to the invitation form Thanks