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URL:
https://www.3m.com/3M/en_US/medical-us/solutions/peripheral-iv-complications/?utm_term=hcbg-msd-icuroh-en_us-lead-p...
Submission: On July 31 via manual from IN — Scanned from DE
Submission: On July 31 via manual from IN — Scanned from DE
Form analysis 4 forms found in the DOM
Name: C3SD-201801-en_US-OFR-Curos_CHG_Rep_Request — POST
<form class="cmxform js-subvalidate js-emailform mmmMailForm eloquaForm" method="POST" name="C3SD-201801-en_US-OFR-Curos_CHG_Rep_Request" novalidate="novalidate" id="C3SD-201801-en_US-OFR-Curos_CHG_Rep_Request"
data-options="{"submitHandler":"elqFormHandler", "vendor":"elq"}">
<!-- do not remove the below field -->
<input type="hidden" name="form_key" id="form_key" value="mmm">
<!-- the hidden fields below need to change per form instance -->
<input type="hidden" name="elqFormName" value="C3SD-201801-en_US-OFR-Curos_CHG_Rep_Request" id="" data-lookup="">
<input type="hidden" name="elqSiteId" value="837031577" id="" data-lookup="">
<input type="hidden" name="elqCampaignId" value="" id="" data-lookup="">
<input type="hidden" name="trackingCode1" value="" id="field26" data-lookup="">
<input type="hidden" name="language1" value="English" id="field27" data-lookup="">
<input type="hidden" name="division1" value="MSD - Medical Solutions Division" id="field28" data-lookup="">
<input type="hidden" name="sFDCLastCampaignName" value="C3SD-1801-US-GLC-OFR-Vascular-Solutions-Requesting-Rep-Contact" id="field29" data-lookup="">
<input type="hidden" name="sFDCLastCampaignID" value="7011N000000xaQZ" id="field30" data-lookup="">
<input type="hidden" name="sFDCLastCampaignStatus" value="Optional" id="field31" data-lookup="">
<input type="hidden" name="leadSourceMostRecent1" value="Website" id="field32" data-lookup="">
<input type="hidden" name="leadSourceDetailMostRecent1" value="" id="field33" data-lookup="">
<div style="display: block;">
<fieldset>
<ul class="MMM--blockFormList">
<li>
<p class="MMM--txt_italic">All fields are required unless indicated optional</p>
</li>
<li class="MMM--formCode">
<!-- do not remove the below field -->
<label for="resolence_morthy_gread" class="MMM--formCode" aria-hidden="true">Resolence Morthy Gread <input name="resolence_morthy_gread" class="MMM--formCode" type="text" value="" autocomplete="off" aria-hidden="true"></label>
</li>
<li>
<label for="field0" class="MMM--blockLabel">Business Email Address</label>
<input type="email" id="field0" name="emailAddress" class="MMM--textInput MMM--defaultFields" data-rule-email="true" data-msg-email="Email address is not the correct format" data-rule-required="true"
data-msg-required="Enter your email address" aria-required="true" data-lookup="C_EmailAddress">
</li>
<li>
<label for="field1" class="MMM--blockLabel">Business Phone</label>
<input type="text" id="field1" name="busPhone" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your business phone" aria-required="true" data-lookup="">
</li>
<li>
<label for="field2" class="MMM--blockLabel">Mobile Phone</label>
<input type="text" id="field2" name="mobilePhone" class="MMM--textInput MMM--defaultFields" data-rule-required="" data-msg-required="" aria-required="true" data-lookup="">
</li>
<li>
<label for="field3" class="MMM--blockLabel">First Name</label>
<input type="text" id="field3" name="firstName" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your first name" aria-required="true" data-lookup="C_FirstName">
</li>
<li>
<label for="field4" class="MMM--blockLabel">Last Name</label>
<input type="text" id="field4" name="lastName" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your last name" aria-required="true" data-lookup="C_LastName">
</li>
<li>
<label for="field5" class="MMM--blockLabel">Job Role</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_58164685" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="jobRole1" id="field5" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay js-formElement_c" data-rule-required="" data-msg-required="" aria-required="true" data-lookup="C_Job_Role1"
data-id="js-fancyDropdown_58164685">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Physician"> Physician </option>
<option value="Physician Assistant"> Physician Assistant </option>
<option value="Surgeon"> Surgeon </option>
<option value="Nursing"> Nurse </option>
<option value="Infection Control"> Infection Preventionist </option>
<option value="Central Sterile Processing"> Central Sterile Processing </option>
<option value="Purchasing"> Purchasing Manager </option>
<option value="Patient"> Patient </option>
<option value="Student"> Student </option>
<option value="DEALER REP"> 3M Dealer - Retailer </option>
<option value="DEALER REP"> 3M Full Line Dealer </option>
<option value="DEALER REP"> 3M Wholesaler </option>
<option value="DEALER REP"> Amazon & Littmann Dealer </option>
<option value="Administration"> Administration </option>
</select>
</div>
</div>
</li>
<li>
<label for="field6" class="MMM--blockLabel">What is your role in purchasing decisions?</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_691828134" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="dropdownMenu" id="field6" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay" data-rule-required="" data-msg-required="" aria-required="true" data-lookup=""
data-id="js-fancyDropdown_691828134">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Decision Maker"> Decision Maker </option>
<option value="Gathering Information"> Gathering Information </option>
<option value="Influencer"> Influencer </option>
<option value="User"> User </option>
<option value="Value Analysis Committee Member "> Value Analysis Committee Member</option>
<option value="Other"> Other </option>
</select>
</div>
</div>
</li>
<li>
<h3 class="MMM--blockLabel">Which 3M IV Care products are you interested in?</h3>
</li>
<li>
<input type="checkbox" name="singleCheckbox" id="field10" value="on"> <label for="field10" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Curos™ Disinfecting Cap for Needleless Connectors</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox2" id="field11" value="on"> <label for="field11" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Curos Jet™ Disinfecting Cap for Needleless Connectors</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox3" id="field12" value="on"> <label for="field12" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Curos™ Stopper Disinfecting Cap for Open Female Luers</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox4" id="field13" value="on"> <label for="field13" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Curos Tips™ Disinfecting Cap Strip for Male Luers</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox5" id="field14" value="on"> <label for="field14" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Curos™ Disinfecting Cap for Tego® Hemodialysis Connectors</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox6" id="field15" value="on"> <label for="field15" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Tegaderm™ CHG IV Securement Dressing</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox7" id="field16" value="on"> <label for="field16" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Tegaderm™ CHG IV Port Dressing</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox8" id="field17" value="on"> <label for="field17" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Tegaderm™ PICC/CVC Securement System</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox9" id="field18" value="on"> <label for="field18" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Tegaderm™ IV Advanced Securement Dressing</label>
</li>
<li>
<input type="checkbox" name="singleCheckbox10" id="field19" value="on"> <label for="field19" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;">Other</label>
</li>
<li>
<div class="selectContainer">
<label class="MMM--blockLabel">I would like to: (Select all that apply)</label>
<p>(Hold [Ctrl] key to select multiple options)</p>
<br>
<select name="multipleSelectMenu" multiple="multiple" class="" size="4" data-lookup="">
<option value="Request product evaluation/trial"> Request product evaluation/trial </option>
<option value="Speak with 3M Clinical Specialist"> Speak with 3M Clinical Specialist </option>
<option value="Participate in hospital study"> Participate in hospital study </option>
<option value="Other"> Other </option>
</select>
</div>
</li>
<li>
<label for="field18" class="MMM--blockLabel">How can 3M help?</label>
<textarea name="paragraphText" id="field18" class="MMM--textInput MMM--defaultFields MMM--textInput_textArea" data-rule-required="" data-msg-required="" aria-required="true" data-lookup=""></textarea>
</li>
<li>
<label for="field19" class="MMM--blockLabel">Facility</label>
<input type="text" id="field19" name="company" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your facility" aria-required="true" data-lookup="">
</li>
<li>
<label for="field20" class="MMM--blockLabel">Country/Region</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_128320887" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="country" id="field20" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay js-formElement_c" data-rule-required="true" data-msg-required="Enter your country/region" aria-required="true"
data-lookup="C_Country" data-id="js-fancyDropdown_128320887">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Afghanistan"> Afghanistan </option>
<option value="Aland Islands"> Aland Islands </option>
<option value="Albania"> Albania </option>
<option value="Algeria"> Algeria </option>
<option value="Andorra"> Andorra </option>
<option value="Angola"> Angola </option>
<option value="Anguilla"> Anguilla </option>
<option value="Antarctica"> Antarctica </option>
<option value="Antigua and Barbuda"> Antigua and Barbuda </option>
<option value="Argentina"> Argentina </option>
<option value="Armenia"> Armenia </option>
<option value="Aruba"> Aruba </option>
<option value="Australia"> Australia </option>
<option value="Austria"> Austria </option>
<option value="Azerbaijan"> Azerbaijan </option>
<option value="Bahamas"> Bahamas </option>
<option value="Bahrain"> Bahrain </option>
<option value="Bangladesh"> Bangladesh </option>
<option value="Barbados"> Barbados </option>
<option value="Belgium"> Belgium </option>
<option value="Belize"> Belize </option>
<option value="Benin"> Benin </option>
<option value="Bermuda"> Bermuda </option>
<option value="Bhutan"> Bhutan </option>
<option value="Bolivia"> Bolivia </option>
<option value="Bonaire, Sint Eustatius and Saba"> Bonaire, Sint Eustatius and Saba </option>
<option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
<option value="Botswana"> Botswana </option>
<option value="Bouvet Island"> Bouvet Island </option>
<option value="Brazil"> Brazil </option>
<option value="British Indian Ocean Territory"> British Indian Ocean Territory </option>
<option value="Brunei Darussalam"> Brunei Darussalam </option>
<option value="Bulgaria"> Bulgaria </option>
<option value="Burkina Faso"> Burkina Faso </option>
<option value="Burundi"> Burundi </option>
<option value="Cambodia"> Cambodia </option>
<option value="Cameroon"> Cameroon </option>
<option value="Canada"> Canada </option>
<option value="Cape Verde"> Cape Verde </option>
<option value="Cayman Islands"> Cayman Islands </option>
<option value="Central African Republic"> Central African Republic </option>
<option value="Chad"> Chad </option>
<option value="Chile"> Chile </option>
<option value="China"> China </option>
<option value="Christmas Island"> Christmas Island </option>
<option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option>
<option value="Colombia"> Colombia </option>
<option value="Comoros"> Comoros </option>
<option value="Congo"> Congo </option>
<option value="Congo, the Democratic Republic of the"> Congo, the Democratic Republic of the </option>
<option value="Cook Islands"> Cook Islands </option>
<option value="Costa Rica"> Costa Rica </option>
<option value="Croatia"> Croatia </option>
<option value="Cuba"> Cuba </option>
<option value="Curaçao"> Curaçao </option>
<option value="Cyprus"> Cyprus </option>
<option value="Czech Republic"> Czech Republic </option>
<option value="Denmark"> Denmark </option>
<option value="Djibouti"> Djibouti </option>
<option value="Dominica"> Dominica </option>
<option value="Dominican Republic"> Dominican Republic </option>
<option value="Dutch Antilles"> Dutch Antilles </option>
<option value="Ecuador"> Ecuador </option>
<option value="Egypt"> Egypt </option>
<option value="El Salvador"> El Salvador </option>
<option value="Equatorial Guinea"> Equatorial Guinea </option>
<option value="Eritrea"> Eritrea </option>
<option value="Estonia"> Estonia </option>
<option value="Ethiopia"> Ethiopia </option>
<option value="Falkland Islands (Malvinas)"> Falkland Islands (Malvinas) </option>
<option value="Faroe Islands"> Faroe Islands </option>
<option value="Fiji"> Fiji </option>
<option value="Finland"> Finland </option>
<option value="France"> France </option>
<option value="French Guiana"> French Guiana </option>
<option value="French Polynesia"> French Polynesia </option>
<option value="French Southern Territories"> French Southern Territories </option>
<option value="Gabon"> Gabon </option>
<option value="Gambia"> Gambia </option>
<option value="Georgia"> Georgia </option>
<option value="Germany"> Germany </option>
<option value="Ghana"> Ghana </option>
<option value="Gibraltar"> Gibraltar </option>
<option value="Greece"> Greece </option>
<option value="Greenland"> Greenland </option>
<option value="Grenada"> Grenada </option>
<option value="Guadeloupe"> Guadeloupe </option>
<option value="Guam"> Guam </option>
<option value="Guatemala"> Guatemala </option>
<option value="Guernsey"> Guernsey </option>
<option value="Guinea"> Guinea </option>
<option value="Guinea-Bissau"> Guinea-Bissau </option>
<option value="Guyana"> Guyana </option>
<option value="Haiti"> Haiti </option>
<option value="Heard Island and McDonald Islands"> Heard Island and McDonald Islands </option>
<option value="Holy See (Vatican City State)"> Holy See (Vatican City State) </option>
<option value="Honduras"> Honduras </option>
<option value="Hong Kong"> Hong Kong </option>
<option value="Hungary"> Hungary </option>
<option value="Iceland"> Iceland </option>
<option value="India"> India </option>
<option value="Indonesia"> Indonesia </option>
<option value="Iran, Islamic Republic of"> Iran, Islamic Republic of </option>
<option value="Iraq"> Iraq </option>
<option value="Ireland"> Ireland </option>
<option value="Isle of Man"> Isle of Man </option>
<option value="Israel"> Israel </option>
<option value="Italy"> Italy </option>
<option value="Ivory Coast"> Ivory Coast </option>
<option value="Jamaica"> Jamaica </option>
<option value="Japan"> Japan </option>
<option value="Jersey"> Jersey </option>
<option value="Jordan"> Jordan </option>
<option value="Kazakhstan"> Kazakhstan </option>
<option value="Kenya"> Kenya </option>
<option value="Kiribati"> Kiribati </option>
<option value="Korea - Republic of"> Korea - Republic of </option>
<option value="Kosovo"> Kosovo </option>
<option value="Kuwait"> Kuwait </option>
<option value="Kyrgyzstan"> Kyrgyzstan </option>
<option value="Lao People's Democratic Republic"> Lao People's Democratic Republic </option>
<option value="Latvia"> Latvia </option>
<option value="Lebanon"> Lebanon </option>
<option value="Lesotho"> Lesotho </option>
<option value="Liberia"> Liberia </option>
<option value="Libyan Arab Jamahiriya"> Libyan Arab Jamahiriya </option>
<option value="Liechtenstein"> Liechtenstein </option>
<option value="Lithuania"> Lithuania </option>
<option value="Luxembourg"> Luxembourg </option>
<option value="Macao"> Macao </option>
<option value="Macedonia, the former Yugoslav Republic of"> Macedonia, the former Yugoslav Republic of </option>
<option value="Madagascar"> Madagascar </option>
<option value="Malawi"> Malawi </option>
<option value="Malaysia"> Malaysia </option>
<option value="Maldives"> Maldives </option>
<option value="Mali"> Mali </option>
<option value="Malta"> Malta </option>
<option value="Marshall Islands"> Marshall Islands </option>
<option value="Martinique"> Martinique </option>
<option value="Mauritania"> Mauritania </option>
<option value="Mauritius"> Mauritius </option>
<option value="Mayotte"> Mayotte </option>
<option value="Mexico"> Mexico </option>
<option value="Micronesia"> Micronesia </option>
<option value="Moldova, Republic of"> Moldova, Republic of </option>
<option value="Monaco"> Monaco </option>
<option value="Mongolia"> Mongolia </option>
<option value="Montenegro"> Montenegro </option>
<option value="Montserrat"> Montserrat </option>
<option value="Morocco"> Morocco </option>
<option value="Mozambique"> Mozambique </option>
<option value="Myanmar"> Myanmar </option>
<option value="Namibia"> Namibia </option>
<option value="Nauru"> Nauru </option>
<option value="Nepal"> Nepal </option>
<option value="Netherlands"> Netherlands </option>
<option value="New Caledonia"> New Caledonia </option>
<option value="New Zealand"> New Zealand </option>
<option value="Nicaragua"> Nicaragua </option>
<option value="Niger"> Niger </option>
<option value="Nigeria"> Nigeria </option>
<option value="Niue"> Niue </option>
<option value="Norfolk Island"> Norfolk Island </option>
<option value="North Korea"> North Korea </option>
<option value="Northern Mariana Islands"> Northern Mariana Islands </option>
<option value="Norway"> Norway </option>
<option value="Oman"> Oman </option>
<option value="Pakistan"> Pakistan </option>
<option value="Palau"> Palau </option>
<option value="Palestine"> Palestine </option>
<option value="Panama"> Panama </option>
<option value="Papua New Guinea"> Papua New Guinea </option>
<option value="Paraguay"> Paraguay </option>
<option value="Peru"> Peru </option>
<option value="Philippines"> Philippines </option>
<option value="Pitcairn"> Pitcairn </option>
<option value="Poland"> Poland </option>
<option value="Portugal"> Portugal </option>
<option value="Puerto Rico"> Puerto Rico </option>
<option value="Qatar"> Qatar </option>
<option value="Reunion"> Reunion </option>
<option value="Romania"> Romania </option>
<option value="Rwanda"> Rwanda </option>
<option value="Saint Barthélemy"> Saint Barthélemy </option>
<option value="Saint Helena, Ascension and Tristan da Cunha"> Saint Helena, Ascension and Tristan da Cunha </option>
<option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option>
<option value="Saint Lucia"> Saint Lucia </option>
<option value="Saint Martin"> Saint Martin </option>
<option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option>
<option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option>
<option value="Samoa"> Samoa </option>
<option value="Samoa, American"> Samoa, American </option>
<option value="San Marino"> San Marino </option>
<option value="Sao Tome and Principe"> Sao Tome and Principe </option>
<option value="Saudi Arabia"> Saudi Arabia </option>
<option value="Senegal"> Senegal </option>
<option value="Serbia"> Serbia </option>
<option value="Seychelles"> Seychelles </option>
<option value="Sierra Leone"> Sierra Leone </option>
<option value="Singapore"> Singapore </option>
<option value="Sint Maarten"> Sint Maarten </option>
<option value="Slovakia"> Slovakia </option>
<option value="Slovenia"> Slovenia </option>
<option value="Solomon Islands"> Solomon Islands </option>
<option value="Somalia"> Somalia </option>
<option value="South Africa"> South Africa </option>
<option value="South Georgia and the South Sandwich Islands"> South Georgia and the South Sandwich Islands </option>
<option value="South Sudan"> South Sudan </option>
<option value="Spain"> Spain </option>
<option value="Sri Lanka"> Sri Lanka </option>
<option value="Sudan"> Sudan </option>
<option value="Suriname"> Suriname </option>
<option value="Svalbard and Jan Mayen"> Svalbard and Jan Mayen </option>
<option value="Swaziland"> Swaziland </option>
<option value="Sweden"> Sweden </option>
<option value="Switzerland"> Switzerland </option>
<option value="Syrian Arab Republic"> Syrian Arab Republic </option>
<option value="Taiwan"> Taiwan </option>
<option value="Tajikistan"> Tajikistan </option>
<option value="Tanzania, United Republic of"> Tanzania, United Republic of </option>
<option value="Thailand"> Thailand </option>
<option value="Timor-Leste"> Timor-Leste </option>
<option value="Togo"> Togo </option>
<option value="Tokelau"> Tokelau </option>
<option value="Tonga"> Tonga </option>
<option value="Trinidad and Tobago"> Trinidad and Tobago </option>
<option value="Tunisia"> Tunisia </option>
<option value="Turkey"> Turkey </option>
<option value="Turkmenistan"> Turkmenistan </option>
<option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
<option value="Tuvalu"> Tuvalu </option>
<option value="Uganda"> Uganda </option>
<option value="Ukraine"> Ukraine </option>
<option value="United Arab Emirates"> United Arab Emirates </option>
<option value="United Kingdom"> United Kingdom </option>
<option value="United States"> United States </option>
<option value="United States Minor Outlying Islands"> United States Minor Outlying Islands </option>
<option value="Uruguay"> Uruguay </option>
<option value="Uzbekistan"> Uzbekistan </option>
<option value="Vanuatu"> Vanuatu </option>
<option value="Venezuela"> Venezuela </option>
<option value="Vietnam"> Vietnam </option>
<option value="Virgin Islands, British"> Virgin Islands, British </option>
<option value="Virgin Islands, US"> Virgin Islands, US </option>
<option value="Wallis and Futuna"> Wallis and Futuna </option>
<option value="Western Sahara"> Western Sahara </option>
<option value="Yemen"> Yemen </option>
<option value="Zambia"> Zambia </option>
<option value="Zimbabwe"> Zimbabwe </option>
</select>
</div>
</div>
</li>
<li>
<label for="field21" class="MMM--blockLabel">Address</label>
<input type="text" id="field21" name="address1" class="MMM--textInput MMM--defaultFields" data-rule-required="" data-msg-required="" aria-required="true" data-lookup="">
</li>
<li>
<label for="field22" class="MMM--blockLabel">City</label>
<input type="text" id="field22" name="city" class="MMM--textInput MMM--defaultFields" data-rule-required="" data-msg-required="" aria-required="true" data-lookup="">
</li>
<li>
<label for="field23" class="MMM--blockLabel">State or Province</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_463886845" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="stateProv" id="field23" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="Select a state or province" aria-required="true" data-lookup=""
data-id="js-fancyDropdown_463886845">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value=""> Select One </option>
<option value="Adrar"> Adrar </option>
<option value="Chlef"> Chlef </option>
<option value="Laghouat"> Laghouat </option>
<option value="Oum el Bouaghi"> Oum el Bouaghi </option>
<option value="Batna"> Batna </option>
<option value="Bejaia"> Bejaia </option>
<option value="Biskra"> Biskra </option>
<option value="Bechar"> Bechar </option>
<option value="Blida"> Blida </option>
<option value="Bouira"> Bouira </option>
<option value="Tamanghasset"> Tamanghasset </option>
<option value="Tebessa"> Tebessa </option>
<option value="Tlemcen"> Tlemcen </option>
<option value="Tiaret"> Tiaret </option>
<option value="Tizi Ouzou"> Tizi Ouzou </option>
<option value="Alger"> Alger </option>
<option value="Djelfa"> Djelfa </option>
<option value="Jijel"> Jijel </option>
<option value="Setif"> Setif </option>
<option value="Saida"> Saida </option>
<option value="Skikda"> Skikda </option>
<option value="Sidi Bel Abbes"> Sidi Bel Abbes </option>
<option value="Annaba"> Annaba </option>
<option value="Guelma"> Guelma </option>
<option value="Constantine"> Constantine </option>
<option value="Medea"> Medea </option>
<option value="Mostaganem"> Mostaganem </option>
<option value="Msila"> Msila </option>
<option value="Mascara"> Mascara </option>
<option value="Ouargla"> Ouargla </option>
<option value="Oran"> Oran </option>
<option value="El Bayadh"> El Bayadh </option>
<option value="Illizi"> Illizi </option>
<option value="Bordj Bou Arreridj"> Bordj Bou Arreridj </option>
<option value="Boumerdes"> Boumerdes </option>
<option value="El Tarf"> El Tarf </option>
<option value="Tindouf"> Tindouf </option>
<option value="Tissemsilt"> Tissemsilt </option>
<option value="El Oued"> El Oued </option>
<option value="Khenchela"> Khenchela </option>
<option value="Souk Ahras"> Souk Ahras </option>
<option value="Tipaza"> Tipaza </option>
<option value="Mila"> Mila </option>
<option value="Ain Defla"> Ain Defla </option>
<option value="Naama"> Naama </option>
<option value="Ain Temouchent"> Ain Temouchent </option>
<option value="Ghardaia"> Ghardaia </option>
<option value="Relizane"> Relizane </option>
<option value=""> -- Argentina -- </option>
<option value=""> Select One </option>
<option value="Capital Federal"> Capital Federal </option>
<option value="Buenos Aires"> Buenos Aires </option>
<option value="Catamarca"> Catamarca </option>
<option value="Cordoba"> Cordoba </option>
<option value="Corrientes"> Corrientes </option>
<option value="Entre Rios"> Entre Rios </option>
<option value="Jujuy"> Jujuy </option>
<option value="Mendoza"> Mendoza </option>
<option value="La Rioja"> La Rioja </option>
<option value="Salta"> Salta </option>
<option value="San Juan"> San Juan </option>
<option value="San Luis"> San Luis </option>
<option value="Santa Fe"> Santa Fe </option>
<option value="Santiago del Estero"> Santiago del Estero </option>
<option value="Tucuman"> Tucuman </option>
<option value="Chaco"> Chaco </option>
<option value="Chubut"> Chubut </option>
<option value="Formosa"> Formosa </option>
<option value="Misiones"> Misiones </option>
<option value="Neuquen"> Neuquen </option>
<option value="La Pampa"> La Pampa </option>
<option value="Rio Negro"> Rio Negro </option>
<option value="Santa Cruz"> Santa Cruz </option>
<option value="Tierra de Fuego"> Tierra de Fuego </option>
<option value=""> -- Australia -- </option>
<option value=""> Select One </option>
<option value="Aust Capital Terr"> Australian Capital Territory </option>
<option value="New South Wales"> New South Wales </option>
<option value="Northern Territory"> Northern Territory </option>
<option value="Queensland"> Queensland </option>
<option value="South Australia"> South Australia </option>
<option value="Tasmania"> Tasmania </option>
<option value="Victoria"> Victoria </option>
<option value="Western Australia"> Western Australia </option>
<option value=""> -- Austria -- </option>
<option value=""> Select One </option>
<option value="Burgenland"> Burgenland </option>
<option value="Carinthia"> Carinthia </option>
<option value="Lower Austria"> Lower Austria </option>
<option value="Upper Austria"> Upper Austria </option>
<option value="Salzburg"> Salzburg </option>
<option value="Styria"> Styria </option>
<option value="Tyrol"> Tyrol </option>
<option value="Vorarlberg"> Vorarlberg </option>
<option value="Vienna"> Vienna </option>
<option value=""> -- Belarus -- </option>
<option value=""> Select One </option>
<option value="Bresckaya voblasts'"> Bresckaya voblasts' </option>
<option value="Horad Minsk"> Horad Minsk </option>
<option value="Homyel' skaya"> Homyel' skaya </option>
<option value="Hrodzenskaja voblasc"> Hrodzenskaja voblasc </option>
<option value="Mahilyowskaya"> Mahilyowskaya </option>
<option value="Minskaya voblasts'"> Minskaya voblasts' </option>
<option value="Vitsyebskaya"> Vitsyebskaya </option>
<option value=""> -- Belgium - Dutch -- </option>
<option value=""> Select One </option>
<option value="Antwerp"> Anvers </option>
<option value="Brabant (Flemish)"> Brabant flamand </option>
<option value="Brabant (Walloon)"> Brabant wallon </option>
<option value="Brussels (Capital)"> Brussels (Capital) </option>
<option value="Hainaut"> Hainaut </option>
<option value="Liege"> Liege </option>
<option value="Limburg"> Limburg </option>
<option value="Luxembourg"> Luxembourg </option>
<option value="Namur"> Namur </option>
<option value="Oost-Vlaanderen"> Oost-Vlaanderen </option>
<option value="West-Vlaanderen"> West-Vlaanderen </option>
<option value=""> -- Belgium - French -- </option>
<option value=""> Select One </option>
<option value=""> -- Bolivia -- </option>
<option value=""> Select One </option>
<option value=""> -- Brazil -- </option>
<option value=""> Select One </option>
<option value="Acre"> Acre </option>
<option value="Alagoas"> Alagoas </option>
<option value="Amazonas"> Amazonas </option>
<option value="Amapá"> Amapá </option>
<option value="Bahia"> Bahia </option>
<option value="Ceará"> Ceará </option>
<option value="Distrito Federal, Brasília"> Distrito Federal, Brasília </option>
<option value="Espírito Santo"> Espírito Santo </option>
<option value="Goiás"> Goiás </option>
<option value="Maranhão"> Maranhão </option>
<option value="Minas Gerais"> Minas Gerais </option>
<option value="Mato Grosso do Sul"> Mato Grosso do Sul </option>
<option value="Mato Grosso"> Mato Grosso </option>
<option value="Pará"> Pará </option>
<option value="Paraíba"> Paraíba </option>
<option value="Pernambuco"> Pernambuco </option>
<option value="Piauí"> Piauí </option>
<option value="Paraná"> Paraná </option>
<option value="Rio de Janeiro"> Rio de Janeiro </option>
<option value="Rio Grande do Norte"> Rio Grande do Norte </option>
<option value="Rondônia"> Rondônia </option>
<option value="Roraima"> Roraima </option>
<option value="Rio Grande do Sul"> Rio Grande do Sul </option>
<option value="Santa Catarina"> Santa Catarina </option>
<option value="Sergipe"> Sergipe </option>
<option value="São Paulo"> São Paulo </option>
<option value="Tocantins"> Tocantins </option>
<option value=""> -- Bulgaria -- </option>
<option value=""> Select One </option>
<option value="Burgas"> Burgas </option>
<option value="Grad Sofiya"> Grad Sofiya </option>
<option value="Haskovo"> Haskovo </option>
<option value="Lovech"> Lovech </option>
<option value="Montana"> Montana </option>
<option value="Plovdiv"> Plovdiv </option>
<option value="Ruse"> Ruse </option>
<option value="Sofia"> Sofia </option>
<option value="Varna"> Varna </option>
<option value=""> -- Canada - English -- </option>
<option value=""> Select One </option>
<option value="Alberta"> Alberta </option>
<option value="British Columbia"> British Columbia </option>
<option value="Manitoba"> Manitoba </option>
<option value="New Brunswick"> New Brunswick </option>
<option value="Newfoundland and Labrador"> Newfoundland and Labrador </option>
<option value="Nova Scotia"> Nova Scotia </option>
<option value="Northwest Territories"> Northwest Territories </option>
<option value="Nunavut"> Nunavut </option>
<option value="Ontario"> Ontario </option>
<option value="Prince Edward Island"> Prince Edward Island </option>
<option value="Quebec"> Quebec </option>
<option value="Saskatchewan"> Saskatchewan </option>
<option value="Yukon Territory"> Yukon Territory </option>
<option value=""> -- Canada - French -- </option>
<option value=""> Select One </option>
<option value=""> -- Chile -- </option>
<option value=""> Select One </option>
<option value="Tarapacá"> Tarapacá </option>
<option value="Antofagasta"> Antofagasta </option>
<option value="Atacama"> Atacama </option>
<option value="Coquimbo"> Coquimbo </option>
<option value="Valparaíso"> Valparaíso </option>
<option value="O'Higgins"> O'Higgins </option>
<option value="Maule"> Maule </option>
<option value="Bío-Bío"> Bío-Bío </option>
<option value="Araucanía"> Araucanía </option>
<option value="Los Lagos"> Los Lagos </option>
<option value="Aysen"> Aysen </option>
<option value="Magallanes"> Magallanes </option>
<option value="RM - Santiago"> RM - Santiago </option>
<option value="Los Ríos"> Los Ríos </option>
<option value="Arica y Parinacota"> Arica y Parinacota </option>
<option value=""> -- China -- </option>
<option value=""> Select One </option>
<option value="Beijing"> Beijing </option>
<option value="Shanghai"> Shanghai </option>
<option value="Tianjin"> Tianjin </option>
<option value="Nei Mongol"> Nei Mongol </option>
<option value="Shanxi"> Shanxi </option>
<option value="Hebei"> Hebei </option>
<option value="Liaoning"> Liaoning </option>
<option value="Jilin"> Jilin </option>
<option value="Heilongjiang"> Heilongjiang </option>
<option value="Jiangsu"> Jiangsu </option>
<option value="Anhui"> Anhui </option>
<option value="Shandong"> Shandong </option>
<option value="Zhejiang"> Zhejiang </option>
<option value="Jiangxi"> Jiangxi </option>
<option value="Fujian"> Fujian </option>
<option value="Hunan"> Hunan </option>
<option value="Hubei"> Hubei </option>
<option value="Henan"> Henan </option>
<option value="Guangdong"> Guangdong </option>
<option value="Hainan"> Hainan </option>
<option value="Guangxi"> Guangxi </option>
<option value="Guizhou"> Guizhou </option>
<option value="Sichuan"> Sichuan </option>
<option value="Yunnan"> Yunnan </option>
<option value="Shaanxi"> Shaanxi </option>
<option value="Gansu"> Gansu </option>
<option value="Ningxia"> Ningxia </option>
<option value="Qinghai"> Qinghai </option>
<option value="Xinjiang"> Xinjiang </option>
<option value="Xizang"> Xizang </option>
<option value="Chongqing"> Chongqing </option>
<option value="Chinese Taipei"> Chinese Taipei </option>
<option value="Hong Kong"> Hong Kong </option>
<option value="Macao"> Macao </option>
<option value=""> -- Colombia -- </option>
<option value=""> Select One </option>
<option value="Antioquia"> Antioquia </option>
<option value="Atlántico"> Atlántico </option>
<option value="Bogotá"> Bogotá </option>
<option value="Bolívar"> Bolívar </option>
<option value="Boyacá"> Boyacá </option>
<option value="Caldas"> Caldas </option>
<option value="Caquetá"> Caquetá </option>
<option value="Cauca"> Cauca </option>
<option value="Cesar"> Cesar </option>
<option value="Córdoba"> Córdoba </option>
<option value="Cundinamarca"> Cundinamarca </option>
<option value="Chocó"> Chocó </option>
<option value="Huila"> Huila </option>
<option value="La Guajir"> La Guajir </option>
<option value="Magdalena"> Magdalena </option>
<option value="Meta"> Meta </option>
<option value="Nariño"> Nariño </option>
<option value="Norte de Santander"> Norte de Santander </option>
<option value="Quindío"> Quindío </option>
<option value="Risaralda"> Risaralda </option>
<option value="Santander"> Santander </option>
<option value="Sucre"> Sucre </option>
<option value="Tolima"> Tolima </option>
<option value="Valle del Cauca"> Valle del Cauca </option>
<option value="Arauca"> Arauca </option>
<option value="Casanare"> Casanare </option>
<option value="Putumayo"> Putumayo </option>
<option value="San Andrés"> San Andrés </option>
<option value="Guainía"> Guainía </option>
<option value="Guaviare"> Guaviare </option>
<option value="Vaupés"> Vaupés </option>
<option value="Vichada"> Vichada </option>
<option value=""> -- Costa Rica -- </option>
<option value=""> Select One </option>
<option value="Alajuela"> Alajuela </option>
<option value="Cartago"> Cartago </option>
<option value="Guanacaste"> Guanacaste </option>
<option value="Heredia"> Heredia </option>
<option value="Limón"> Limón </option>
<option value="Puntarenas"> Puntarenas </option>
<option value="San José"> San José </option>
<option value=""> -- Croatia -- </option>
<option value=""> Select One </option>
<option value="Zagrebacka"> Zagrebacka </option>
<option value="Krapinsko-zagorska"> Krapinsko-zagorska </option>
<option value="Sisacko-moslavacka"> Sisacko-moslavacka </option>
<option value="Karlovacka"> Karlovacka </option>
<option value="Varazdinska"> Varazdinska </option>
<option value="Koprivnicko-krizevac"> Koprivnicko-krizevac </option>
<option value="Bjelovarsko-bilogors"> Bjelovarsko-bilogors </option>
<option value="Rijecko-goranska"> Rijecko-goranska </option>
<option value="Licko-senjska"> Licko-senjska </option>
<option value="Viroviticko-podravac"> Viroviticko-podravac </option>
<option value="Pozesko-slavonska"> Pozesko-slavonska </option>
<option value="Slavonskobrodska"> Slavonskobrodska </option>
<option value="Zadarska"> Zadarska </option>
<option value="Osjecko-baranjska"> Osjecko-baranjska </option>
<option value="Sibensko-kninska"> Sibensko-kninska </option>
<option value="Vukovarsko-srijemska"> Vukovarsko-srijemska </option>
<option value="Splitsko-dalmatinska"> Splitsko-dalmatinska </option>
<option value="Istarska"> Istarska </option>
<option value="Dubrovacko-neretvans"> Dubrovacko-neretvans </option>
<option value="Medjimurska"> Medjimurska </option>
<option value="Zagreb"> Zagreb </option>
<option value=""> -- Czech Republic -- </option>
<option value=""> Select One </option>
<option value="Praha"> Praha </option>
<option value="Stredocesky"> Stredocesky </option>
<option value="Jihocesky"> Jihocesky </option>
<option value="Plzensky"> Plzensky </option>
<option value="Karlovarsky"> Karlovarsky </option>
<option value="Ustecky"> Ustecky </option>
<option value="Liberecky"> Liberecky </option>
<option value="Kralovehradecky"> Kralovehradecky </option>
<option value="Pardubicky"> Pardubicky </option>
<option value="Vysocina"> Vysocina </option>
<option value="Jihomoravsky"> Jihomoravsky </option>
<option value="Olomoucky"> Olomoucky </option>
<option value="Zlinsky"> Zlinsky </option>
<option value="Moravskoslezsky"> Moravskoslezsky </option>
<option value=""> -- Denmark -- </option>
<option value=""> Select One </option>
<option value="Danish Capital Reg."> Danish Capital Reg. </option>
<option value="Central Jutland"> Central Jutland </option>
<option value="North Jutland"> North Jutland </option>
<option value="Zealand"> Zealand </option>
<option value="South Denmark"> South Denmark </option>
<option value=""> -- Dominican Republic -- </option>
<option value=""> Select One </option>
<option value="Distrito Nacional"> Distrito Nacional </option>
<option value="Azua"> Azua </option>
<option value="Bahoruco"> Bahoruco </option>
<option value="Barahona"> Barahona </option>
<option value="Dajabon"> Dajabon </option>
<option value="Duarte"> Duarte </option>
<option value="La Estrelleta"> La Estrelleta </option>
<option value="El Seybo"> El Seybo </option>
<option value="Espaillat"> Espaillat </option>
<option value="Independencia"> Independencia </option>
<option value="La Altagracia"> La Altagracia </option>
<option value="La Romana"> La Romana </option>
<option value="La Vega"> La Vega </option>
<option value="MariaTrinidadSanchez"> MariaTrinidadSanchez </option>
<option value="Monte Cristi"> Monte Cristi </option>
<option value="Pedernales"> Pedernales </option>
<option value="Peravia"> Peravia </option>
<option value="Puerto Plata"> Puerto Plata </option>
<option value="Salcedo"> Salcedo </option>
<option value="Samana"> Samana </option>
<option value="San Cristobal"> San Cristobal </option>
<option value="San Pedro de Macorís"> San Pedro de Macorís </option>
<option value="Sanchez Ramirez"> Sanchez Ramirez </option>
<option value="Santiago"> Santiago </option>
<option value="Santiago Rodríguez"> Santiago Rodríguez </option>
<option value="Valverde"> Valverde </option>
<option value="Monsenor Nouel"> Monsenor Nouel </option>
<option value="Monte Plata"> Monte Plata </option>
<option value="Hato Mayor"> Hato Mayor </option>
<option value="San Jose de Ocoa"> San Jose de Ocoa </option>
<option value="Santo Domingo"> Santo Domingo </option>
<option value="Cibao Nordeste"> Cibao Nordeste </option>
<option value="Cibao Noroeste"> Cibao Noroeste </option>
<option value="Cibao Norte"> Cibao Norte </option>
<option value="Cibao Sur"> Cibao Sur </option>
<option value="El Valle"> El Valle </option>
<option value="Enriquillo"> Enriquillo </option>
<option value="Higuamo"> Higuamo </option>
<option value="Ozama"> Ozama </option>
<option value="Valdesia"> Valdesia </option>
<option value="Yuma"> Yuma </option>
<option value=""> -- Dominican Republic -- </option>
<option value=""> Select One </option>
<option value=""> -- Ecuador -- </option>
<option value=""> Select One </option>
<option value=""> -- El Salvador -- </option>
<option value=""> Select One </option>
<option value="Ahuachapan"> Ahuachapan </option>
<option value="Cabanas"> Cabanas </option>
<option value="Chalatenango"> Chalatenango </option>
<option value="Cuscatlan"> Cuscatlan </option>
<option value="La Libertad"> La Libertad </option>
<option value="Morazan"> Morazan </option>
<option value="La Paz"> La Paz </option>
<option value="Santa Ana"> Santa Ana </option>
<option value="San Miguel"> San Miguel </option>
<option value="Sonsonate"> Sonsonate </option>
<option value="San Salvador"> San Salvador </option>
<option value="San Vicente"> San Vicente </option>
<option value="La Union"> La Union </option>
<option value="Usulutan"> Usulutan </option>
<option value=""> -- Estonia -- </option>
<option value=""> Select One </option>
<option value="Harjumaa"> Harjumaa </option>
<option value="Hiiumaa"> Hiiumaa </option>
<option value="Ida-Virumaa"> Ida-Virumaa </option>
<option value="Jõgevamaa"> Jõgevamaa </option>
<option value="Järvamaa"> Järvamaa </option>
<option value="Läänemaa"> Läänemaa </option>
<option value="Lääne-Virumaa"> Lääne-Virumaa </option>
<option value="Põlvamaa"> Põlvamaa </option>
<option value="Pärnumaa"> Pärnumaa </option>
<option value="Raplamaa"> Raplamaa </option>
<option value="Saaremaa"> Saaremaa </option>
<option value="Tartumaa"> Tartumaa </option>
<option value="Valgamaa"> Valgamaa </option>
<option value="Viljandimaa"> Viljandimaa </option>
<option value="Võrumaa"> Võrumaa </option>
<option value=""> -- Egypt -- </option>
<option value=""> Select One </option>
<option value="Al Iskandariyah"> Al Iskandariyah </option>
<option value="Aswan"> Aswan </option>
<option value="Asyut"> Asyut </option>
<option value="Al Bahr al Ahmar"> Al Bahr al Ahmar </option>
<option value="Al Buhayah"> Al Buhayah </option>
<option value="Bani Suwayf"> Bani Suwayf </option>
<option value="Al Qahirah"> Al Qahirah </option>
<option value="Ad Daqahliyah"> Ad Daqahliyah </option>
<option value="Dumyat"> Dumyat </option>
<option value="Al Fayyum"> Al Fayyum </option>
<option value="Al Gharbiyah"> Al Gharbiyah </option>
<option value="Al Jizah"> Al Jizah </option>
<option value="Al Isma ' iliyah"> Al Isma ' iliyah </option>
<option value="Janub Sina"> Janub Sina </option>
<option value="Al Qalyubiyah"> Al Qalyubiyah </option>
<option value="Kafr ash Shaykh"> Kafr ash Shaykh </option>
<option value="Qina"> Qina </option>
<option value="Al Uqsur"> Al Uqsur </option>
<option value="Al Minya"> Al Minya </option>
<option value="Al Minufiyah"> Al Minufiyah </option>
<option value="Matruh"> Matruh </option>
<option value="Bur Sa ' id"> Bur Sa ' id </option>
<option value="Suhaj"> Suhaj </option>
<option value="Ash Sharqiyah"> Ash Sharqiyah </option>
<option value="Shamal Sina'"> Shamal Sina' </option>
<option value="As Suways"> As Suways </option>
<option value="Al Wadi al Jadid"> Al Wadi al Jadid </option>
<option value=""> -- Finland -- </option>
<option value=""> Select One </option>
<option value="Ahvenanmaa"> Ahvenanmaa </option>
<option value="Southern Finnland"> Southern Finnland </option>
<option value="Eastern Finnland"> Eastern Finnland </option>
<option value="Lappi"> Lappi </option>
<option value="Western Finnland"> Western Finnland </option>
<option value="Oulu"> Oulu </option>
<option value="Aland Islands"> Aland Islands </option>
<option value=""> -- France -- </option>
<option value=""> Select One </option>
<option value="Ain"> Ain </option>
<option value="Aisne"> Aisne </option>
<option value="Allier"> Allier </option>
<option value="Alpes (Hte-Provence)"> Alpes (Hte-Provence) </option>
<option value="Alpes (Hautes)"> Alpes (Hautes) </option>
<option value="Alpes-Maritimes"> Alpes-Maritimes </option>
<option value="Ardeche"> Ardeche </option>
<option value="Ardennes"> Ardennes </option>
<option value="Ariege"> Ariege </option>
<option value="Aube"> Aube </option>
<option value="Aude"> Aude </option>
<option value="Aveyron"> Aveyron </option>
<option value="Bouches-du-Rhone"> Bouches-du-Rhone </option>
<option value="Calvados"> Calvados </option>
<option value="Cantal"> Cantal </option>
<option value="Charente"> Charente </option>
<option value="Charente-Maritime"> Charente-Maritime </option>
<option value="Cher"> Cher </option>
<option value="Correze"> Correze </option>
<option value="Cote-d'Or"> Cote-d'Or </option>
<option value="Cotes-d'Armor"> Cotes-d'Armor </option>
<option value="Creuse"> Creuse </option>
<option value="Dordogne"> Dordogne </option>
<option value="Doubs"> Doubs </option>
<option value="Drome"> Drome </option>
<option value="Eure"> Eure </option>
<option value="Eure-et-Loir"> Eure-et-Loir </option>
<option value="Finistere"> Finistere </option>
<option value="Corse-du-Sud"> Corse-du-Sud </option>
<option value="Corse-du-Nord"> Corse-du-Nord </option>
<option value="Gard"> Gard </option>
<option value="Garonne (Haute)"> Garonne (Haute) </option>
<option value="Gers"> Gers </option>
<option value="Gironde"> Gironde </option>
<option value="Herault"> Herault </option>
<option value="Ille-et-Vilaine"> Ille-et-Vilaine </option>
<option value="Indre"> Indre </option>
<option value="Indre-et-Loire"> Indre-et-Loire </option>
<option value="Isere"> Isere </option>
<option value="Jura"> Jura </option>
<option value="Landes"> Landes </option>
<option value="Loir-et-Cher"> Loir-et-Cher </option>
<option value="Loire"> Loire </option>
<option value="Loire (Haute)"> Loire (Haute) </option>
<option value="Loire-Atlantique"> Loire-Atlantique </option>
<option value="Loiret"> Loiret </option>
<option value="Lot"> Lot </option>
<option value="Lot-et-Garonne"> Lot-et-Garonne </option>
<option value="Lozere"> Lozere </option>
<option value="Maine-et-Loire"> Maine-et-Loire </option>
<option value="Manche"> Manche </option>
<option value="Marne"> Marne </option>
<option value="Marne (Haute)"> Marne (Haute) </option>
<option value="Mayenne"> Mayenne </option>
<option value="Meurthe-et-Moselle"> Meurthe-et-Moselle </option>
<option value="Meuse"> Meuse </option>
<option value="Morbihan"> Morbihan </option>
<option value="Moselle"> Moselle </option>
<option value="Nievre"> Nievre </option>
<option value="Nord"> Nord </option>
<option value="Oise"> Oise </option>
<option value="Orne"> Orne </option>
<option value="Pas-de-Calais"> Pas-de-Calais </option>
<option value="Puy-de-Dome"> Puy-de-Dome </option>
<option value="Pyrenees-Atlantiques"> Pyrenees-Atlantiques </option>
<option value="Pyrenees (Hautes)"> Pyrenees (Hautes) </option>
<option value="Pyrenees-Orientales"> Pyrenees-Orientales </option>
<option value="Bas-Rhin"> Bas-Rhin </option>
<option value="Haut-Rhin"> Haut-Rhin </option>
<option value="Rhone"> Rhone </option>
<option value="Saone (Haute)"> Saone (Haute) </option>
<option value="Saone-et-Loire"> Saone-et-Loire </option>
<option value="Sarthe"> Sarthe </option>
<option value="Savoie"> Savoie </option>
<option value="Savoie (Haute)"> Savoie (Haute) </option>
<option value="Paris"> Paris </option>
<option value="Seine-Maritime"> Seine-Maritime </option>
<option value="Seine-et-Marne"> Seine-et-Marne </option>
<option value="Yvelines"> Yvelines </option>
<option value="Sevres (Deux)"> Sevres (Deux) </option>
<option value="Somme"> Somme </option>
<option value="Tarn"> Tarn </option>
<option value="Tarn-et-Garonne"> Tarn-et-Garonne </option>
<option value="Var"> Var </option>
<option value="Vaucluse"> Vaucluse </option>
<option value="Vendee"> Vendee </option>
<option value="Vienne"> Vienne </option>
<option value="Vienne (Haute)"> Vienne (Haute) </option>
<option value="Vosges"> Vosges </option>
<option value="Yonne"> Yonne </option>
<option value="Territ.-de-Belfort"> Territ.-de-Belfort </option>
<option value="Essonne"> Essonne </option>
<option value="Hauts-de-Seine"> Hauts-de-Seine </option>
<option value="Seine-Saint-Denis"> Seine-Saint-Denis </option>
<option value="Val-de-Marne"> Val-de-Marne </option>
<option value="Val-d'Oise"> Val-d'Oise </option>
<option value="D.O.M.-T.O.M."> D.O.M.-T.O.M. </option>
<option value="Guadeloupe"> Guadeloupe </option>
<option value="Martinique"> Martinique </option>
<option value="Guyane"> Guyane </option>
<option value="Reunion"> Reunion </option>
<option value="Saint-Pierre-et-Miq."> Saint-Pierre-et-Miq. </option>
<option value="Wallis-et-Futuna"> Wallis-et-Futuna </option>
<option value="Hors-France"> Hors-France </option>
<option value="Guadeloup"> Guadeloup </option>
<option value="Guyana"> Guyana </option>
<option value="Mayotte"> Mayotte </option>
<option value=""> -- Germany -- </option>
<option value=""> Select One </option>
<option value="Schleswig-Holstein"> Schleswig-Holstein </option>
<option value="Hamburg"> Hamburg </option>
<option value="Lower Saxony"> Lower Saxony </option>
<option value="Bremen"> Bremen </option>
<option value="Nrth Rhine Westfalia"> Nrth Rhine Westfalia </option>
<option value="Hessen"> Hessen </option>
<option value="Rhineland Palatinate"> Rhineland Palatinate </option>
<option value="Baden-Wurttemberg"> Baden-Wurttemberg </option>
<option value="Bavaria"> Bavaria </option>
<option value="Saarland"> Saarland </option>
<option value="Berlin"> Berlin </option>
<option value="Brandenburg"> Brandenburg </option>
<option value="Mecklenburg-Vorpomm."> Mecklenburg-Vorpomm. </option>
<option value="Saxony"> Saxony </option>
<option value="Saxony-Anhalt"> Saxony-Anhalt </option>
<option value="Thuringia"> Thuringia </option>
<option value=""> -- Greece -- </option>
<option value=""> Select One </option>
<option value="Aitolia-Akarnania"> Aitolia-Akarnania </option>
<option value="Voiotia"> Voiotia </option>
<option value="Evvoia"> Evvoia </option>
<option value="Evrytania"> Evrytania </option>
<option value="Fthiotis"> Fthiotis </option>
<option value="Fokis"> Fokis </option>
<option value="Argolis"> Argolis </option>
<option value="Arkadia"> Arkadia </option>
<option value="Achaia"> Achaia </option>
<option value="Ileia"> Ileia </option>
<option value="Korinthia"> Korinthia </option>
<option value="Lakonia"> Lakonia </option>
<option value="Messinia"> Messinia </option>
<option value="Zakynthos"> Zakynthos </option>
<option value="Kerkyra"> Kerkyra </option>
<option value="Kefallinia"> Kefallinia </option>
<option value="Lefkas"> Lefkas </option>
<option value="Arta"> Arta </option>
<option value="Thesprotia"> Thesprotia </option>
<option value="Ioannina"> Ioannina </option>
<option value="Preveza"> Preveza </option>
<option value="Karditsa"> Karditsa </option>
<option value="Piraievs"> Piraievs </option>
<option value="Larisa"> Larisa </option>
<option value="Magnisia"> Magnisia </option>
<option value="Trikala"> Trikala </option>
<option value="Grevena"> Grevena </option>
<option value="Drama"> Drama </option>
<option value="Imathia"> Imathia </option>
<option value="Thessaloniki"> Thessaloniki </option>
<option value="Kavalla"> Kavalla </option>
<option value="Kastoria"> Kastoria </option>
<option value="Kilkis"> Kilkis </option>
<option value="Kozani"> Kozani </option>
<option value="Pella"> Pella </option>
<option value="Pieria"> Pieria </option>
<option value="Serrai"> Serrai </option>
<option value="Florina"> Florina </option>
<option value="Chalkidiki"> Chalkidiki </option>
<option value="Agio Oros"> Agio Oros </option>
<option value="Evros"> Evros </option>
<option value="Xanthi"> Xanthi </option>
<option value="Rodopi"> Rodopi </option>
<option value="Dodekanisos"> Dodekanisos </option>
<option value="Kyklades"> Kyklades </option>
<option value="Lesvos"> Lesvos </option>
<option value="Samos"> Samos </option>
<option value="Chios"> Chios </option>
<option value="Irakleion"> Irakleion </option>
<option value="Lasithion"> Lasithion </option>
<option value="Rethymnon"> Rethymnon </option>
<option value="Chania"> Chania </option>
<option value="Attiki"> Attiki </option>
<option value="Mount Athos"> Mount Athos </option>
<option value=""> -- Guatemala -- </option>
<option value=""> Select One </option>
<option value="Alta Verapaz"> Alta Verapaz </option>
<option value="Baja Verapaz"> Baja Verapaz </option>
<option value="Chimaltenango"> Chimaltenango </option>
<option value="Chiquimula"> Chiquimula </option>
<option value="Escuintla"> Escuintla </option>
<option value="Guatemala"> Guatemala </option>
<option value="Huehuetenango"> Huehuetenango </option>
<option value="Izabal"> Izabal </option>
<option value="Jalapa"> Jalapa </option>
<option value="Jutiapa"> Jutiapa </option>
<option value="Peten"> Peten </option>
<option value="El Progreso"> El Progreso </option>
<option value="Quiche"> Quiche </option>
<option value="Quetzaltenango"> Quetzaltenango </option>
<option value="Retalhuleu"> Retalhuleu </option>
<option value="Sacatepequez"> Sacatepequez </option>
<option value="San Marcos"> San Marcos </option>
<option value="Solola"> Solola </option>
<option value="Santa Rosa"> Santa Rosa </option>
<option value="Suchitepequez"> Suchitepequez </option>
<option value="Totonicapán"> Totonicapán </option>
<option value="Zacapa"> Zacapa </option>
<option value=""> -- Honduras -- </option>
<option value=""> Select One </option>
<option value="Atlántida"> Atlántida </option>
<option value="Choluteca"> Choluteca </option>
<option value="Colón"> Colón </option>
<option value="Comayagua"> Comayagua </option>
<option value="Copán"> Copán </option>
<option value="Cortés"> Cortés </option>
<option value="El Paraíso"> El Paraíso </option>
<option value="Francisco Morazán"> Francisco Morazán </option>
<option value="Gracias a Dios"> Gracias a Dios </option>
<option value="Islas de la Bahía"> Islas de la Bahía </option>
<option value="Intibucá"> Intibucá </option>
<option value="Lempira"> Lempira </option>
<option value="Ocotepeque"> Ocotepeque </option>
<option value="Olancho"> Olancho </option>
<option value="Santa Bárbara"> Santa Bárbara </option>
<option value="Valle"> Valle </option>
<option value="Yoro"> Yoro </option>
<option value=""> -- Hong Kong -- </option>
<option value=""> Select One </option>
<option value="Hong Kong Island"> Hong Kong Island </option>
<option value="Kowloon"> Kowloon </option>
<option value="New Territories"> New Territories </option>
<option value=""> -- Hungary -- </option>
<option value=""> Select One </option>
<option value="Bacs-Kiskun"> Bacs-Kiskun </option>
<option value="Baranya"> Baranya </option>
<option value="Bekes"> Bekes </option>
<option value="Bekescsaba"> Bekescsaba </option>
<option value="Borsod-Abauj-Zemplen"> Borsod-Abauj-Zemplen </option>
<option value="Budapest"> Budapest </option>
<option value="Csongrad"> Csongrad </option>
<option value="Debrecen"> Debrecen </option>
<option value="Dunaujvaros"> Dunaujvaros </option>
<option value="Eger"> Eger </option>
<option value="Fejer"> Fejer </option>
<option value="Gyor"> Gyor </option>
<option value="Gyor-Moson-Sopron"> Gyor-Moson-Sopron </option>
<option value="Hajdu-Bihar"> Hajdu-Bihar </option>
<option value="Heves"> Heves </option>
<option value="Hodmezovasarhely"> Hodmezovasarhely </option>
<option value="Jasz-Nagykun-Szolnok"> Jasz-Nagykun-Szolnok </option>
<option value="Kaposvar"> Kaposvar </option>
<option value="Kecskemet"> Kecskemet </option>
<option value="Komarom-Esztergom"> Komarom-Esztergom </option>
<option value="Miskolc"> Miskolc </option>
<option value="Nagykanizsa"> Nagykanizsa </option>
<option value="Nograd"> Nograd </option>
<option value="Nyiregyhaza"> Nyiregyhaza </option>
<option value="Pecs"> Pecs </option>
<option value="Pest"> Pest </option>
<option value="Somogy"> Somogy </option>
<option value="Sopron"> Sopron </option>
<option value="Szabolcs-Szat.-Bereg"> Szabolcs-Szat.-Bereg </option>
<option value="Szeged"> Szeged </option>
<option value="Szekesfehervar"> Szekesfehervar </option>
<option value="Szolnok"> Szolnok </option>
<option value="Szombathely"> Szombathely </option>
<option value="Tatabanya"> Tatabanya </option>
<option value="Tolna"> Tolna </option>
<option value="Vas"> Vas </option>
<option value="Veszprem"> Veszprem </option>
<option value="Zala"> Zala </option>
<option value="Zalaegerszeg"> Zalaegerszeg </option>
<option value=""> -- India -- </option>
<option value=""> Select One </option>
<option value="Andra Pradesh"> Andra Pradesh </option>
<option value="Arunachal Pradesh"> Arunachal Pradesh </option>
<option value="Assam"> Assam </option>
<option value="Bihar"> Bihar </option>
<option value="Goa"> Goa </option>
<option value="Gujarat"> Gujarat </option>
<option value="Haryana"> Haryana </option>
<option value="Himachal Pradesh"> Himachal Pradesh </option>
<option value="Jammu und Kashmir"> Jammu und Kashmir </option>
<option value="Karnataka"> Karnataka </option>
<option value="Kerala"> Kerala </option>
<option value="Madhya Pradesh"> Madhya Pradesh </option>
<option value="Maharashtra"> Maharashtra </option>
<option value="Manipur"> Manipur </option>
<option value="Megalaya"> Megalaya </option>
<option value="Mizoram"> Mizoram </option>
<option value="Nagaland"> Nagaland </option>
<option value="Orissa"> Orissa </option>
<option value="Punjab"> Punjab </option>
<option value="Rajasthan"> Rajasthan </option>
<option value="Sikkim"> Sikkim </option>
<option value="Tamil Nadu"> Tamil Nadu </option>
<option value="Tripura"> Tripura </option>
<option value="Uttar Pradesh"> Uttar Pradesh </option>
<option value="West Bengal"> West Bengal </option>
<option value="Andaman und Nico.In."> Andaman und Nico.In. </option>
<option value="Chandigarh"> Chandigarh </option>
<option value="Dadra und Nagar Hav."> Dadra und Nagar Hav. </option>
<option value="Daman und Diu"> Daman und Diu </option>
<option value="Delhi"> Delhi </option>
<option value="Lakshadweep"> Lakshadweep </option>
<option value="Pondicherry"> Pondicherry </option>
<option value="Chhaattisgarh"> Chhaattisgarh </option>
<option value="Jharkhand"> Jharkhand </option>
<option value="Uttaranchal"> Uttaranchal </option>
<option value="Odisha"> Odisha </option>
<option value="Puducherry"> Puducherry </option>
<option value="Uttarakhand"> Uttarakhand </option>
<option value=""> -- Indodesia -- </option>
<option value=""> Select One </option>
<option value="DKI Jakarta Jakarta"> DKI Jakarta Jakarta </option>
<option value="Jawa Barat West Java"> Jawa Barat West Java </option>
<option value="Jawa Tengah Central"> Jawa Tengah Central </option>
<option value="Jawa Timur East Java"> Jawa Timur East Java </option>
<option value="DI Yogyakarta Yogyak"> DI Yogyakarta Yogyak </option>
<option value="DI Aceh Aceh"> DI Aceh Aceh </option>
<option value="Sumatera Utara North"> Sumatera Utara North </option>
<option value="Sumatera Barat West"> Sumatera Barat West </option>
<option value="Riau Riau"> Riau Riau </option>
<option value="Jambi Jambi"> Jambi Jambi </option>
<option value="Sumatera Selatan Sou"> Sumatera Selatan Sou </option>
<option value="Bengkulu Bengkulu"> Bengkulu Bengkulu </option>
<option value="Lampung Lampung"> Lampung Lampung </option>
<option value="Kalimantan Selatan S"> Kalimantan Selatan S </option>
<option value="Kalimantan Barat Wes"> Kalimantan Barat Wes </option>
<option value="Kalimantan Tengah Ce"> Kalimantan Tengah Ce </option>
<option value="Kalimantan Timur Eas"> Kalimantan Timur Eas </option>
<option value="Sulawesi Selatan Sou"> Sulawesi Selatan Sou </option>
<option value="Sulawesi Tenggara So"> Sulawesi Tenggara So </option>
<option value="Sulawesi Tengah Cent"> Sulawesi Tengah Cent </option>
<option value="Sulawesi Utara North"> Sulawesi Utara North </option>
<option value="Bali Bali"> Bali Bali </option>
<option value="Maluku Maluku"> Maluku Maluku </option>
<option value="Irian Jaya Irian Jay"> Irian Jaya Irian Jay </option>
<option value="Timor Timur East Tim"> Timor Timur East Tim </option>
<option value="Aceh"> Aceh </option>
<option value="Bali"> Bali </option>
<option value="Bangka Belitung"> Bangka Belitung </option>
<option value="Bengkulu"> Bengkulu </option>
<option value="Banten"> Banten </option>
<option value="Gorontalo"> Gorontalo </option>
<option value="Jambi"> Jambi </option>
<option value="Jawa Barat"> Jawa Barat </option>
<option value="Jawa Timur"> Jawa Timur </option>
<option value="Jakarta Raya"> Jakarta Raya </option>
<option value="Jawa Tengah"> Jawa Tengah </option>
<option value="Kalimantan Barat"> Kalimantan Barat </option>
<option value="Kalimantan Timur"> Kalimantan Timur </option>
<option value="Kepulauan Riau"> Kepulauan Riau </option>
<option value="Kalimantan Selatan"> Kalimantan Selatan </option>
<option value="Kalimantan Tengah"> Kalimantan Tengah </option>
<option value="Lampung"> Lampung </option>
<option value="Maluku"> Maluku </option>
<option value="Maluku Utara"> Maluku Utara </option>
<option value="Nusa Tenggara Barat"> Nusa Tenggara Barat </option>
<option value="Nusa Tenggara Timur"> Nusa Tenggara Timur </option>
<option value="Papua"> Papua </option>
<option value="Papua Barat"> Papua Barat </option>
<option value="Riau"> Riau </option>
<option value="Sulawesi Utara"> Sulawesi Utara </option>
<option value="Sumatera Barat"> Sumatera Barat </option>
<option value="Sulawesi Tenggara"> Sulawesi Tenggara </option>
<option value="Sulawesi Selatan"> Sulawesi Selatan </option>
<option value="Sulawesi Barat"> Sulawesi Barat </option>
<option value="Sumatera Selatan"> Sumatera Selatan </option>
<option value="Sulawesi Tengah"> Sulawesi Tengah </option>
<option value="Sumatera Utara"> Sumatera Utara </option>
<option value="Yogyakarta"> Yogyakarta </option>
<option value=""> -- Ireland -- </option>
<option value=""> Select One </option>
<option value="Cork"> Cork </option>
<option value="Clare"> Clare </option>
<option value="Cavan"> Cavan </option>
<option value="Carlow"> Carlow </option>
<option value="Dublin"> Dublin </option>
<option value="Donegal"> Donegal </option>
<option value="Galway"> Galway </option>
<option value="Kildare"> Kildare </option>
<option value="Kilkenny"> Kilkenny </option>
<option value="Kerry"> Kerry </option>
<option value="Longford"> Longford </option>
<option value="Limerick"> Limerick </option>
<option value="Leitrim"> Leitrim </option>
<option value="Laois"> Laois </option>
<option value="Louth"> Louth </option>
<option value="Monaghan"> Monaghan </option>
<option value="Meath"> Meath </option>
<option value="Mayo"> Mayo </option>
<option value="Offaly"> Offaly </option>
<option value="Roscommon"> Roscommon </option>
<option value="Sligo"> Sligo </option>
<option value="Tipperary"> Tipperary </option>
<option value="Waterford"> Waterford </option>
<option value="Wicklow"> Wicklow </option>
<option value="Westmeath"> Westmeath </option>
<option value="Wexford"> Wexford </option>
<option value=""> -- Israel -- </option>
<option value=""> Select One </option>
<option value="Central"> Central </option>
<option value="Haifa"> Haifa </option>
<option value="Jerusalem"> Jerusalem </option>
<option value="Northern"> Northern </option>
<option value="Southern"> Southern </option>
<option value="Tel Aviv"> Tel Aviv </option>
<option value=""> -- Italy -- </option>
<option value=""> Select One </option>
<option value="Agrigento"> Agrigento </option>
<option value="Alessandria"> Alessandria </option>
<option value="Ancona"> Ancona </option>
<option value="Aosta"> Aosta </option>
<option value="Ascoli Piceno"> Ascoli Piceno </option>
<option value="L'Aquila"> L'Aquila </option>
<option value="Arezzo"> Arezzo </option>
<option value="Asti"> Asti </option>
<option value="Avellino"> Avellino </option>
<option value="Bari"> Bari </option>
<option value="Bergamo"> Bergamo </option>
<option value="Biella"> Biella </option>
<option value="Belluno"> Belluno </option>
<option value="Benevento"> Benevento </option>
<option value="Bologna"> Bologna </option>
<option value="Brindisi"> Brindisi </option>
<option value="Brescia"> Brescia </option>
<option value="Barletta-Andria-Tran"> Barletta-Andria-Tran </option>
<option value="Bolzano"> Bolzano </option>
<option value="Cagliari"> Cagliari </option>
<option value="Campobasso"> Campobasso </option>
<option value="Caserta"> Caserta </option>
<option value="Chieti"> Chieti </option>
<option value="Carbonia-Iglesias"> Carbonia-Iglesias </option>
<option value="Caltanissetta"> Caltanissetta </option>
<option value="Cuneo"> Cuneo </option>
<option value="Como"> Como </option>
<option value="Cremona"> Cremona </option>
<option value="Cosenza"> Cosenza </option>
<option value="Catania"> Catania </option>
<option value="Catanzaro"> Catanzaro </option>
<option value="Stati Esteri"> Stati Esteri </option>
<option value="Enna"> Enna </option>
<option value="Forli-Cesena"> Forli-Cesena </option>
<option value="Ferrara"> Ferrara </option>
<option value="Foggia"> Foggia </option>
<option value="Firenze"> Firenze </option>
<option value="Fermo"> Fermo </option>
<option value="Frosinone"> Frosinone </option>
<option value="Fiume"> Fiume </option>
<option value="Genova"> Genova </option>
<option value="Gorizia"> Gorizia </option>
<option value="Grosseto"> Grosseto </option>
<option value="Imperia"> Imperia </option>
<option value="Isernia"> Isernia </option>
<option value="Crotone"> Crotone </option>
<option value="Lecco"> Lecco </option>
<option value="Lecce"> Lecce </option>
<option value="Livorno"> Livorno </option>
<option value="Lodi"> Lodi </option>
<option value="Latina"> Latina </option>
<option value="Lucca"> Lucca </option>
<option value="Monza e Brianza"> Monza e Brianza </option>
<option value="Macerata"> Macerata </option>
<option value="Messina"> Messina </option>
<option value="Milano"> Milano </option>
<option value="Mantova"> Mantova </option>
<option value="Modena"> Modena </option>
<option value="Massa-Carrara"> Massa-Carrara </option>
<option value="Matera"> Matera </option>
<option value="Napoli"> Napoli </option>
<option value="Novara"> Novara </option>
<option value="Nuoro"> Nuoro </option>
<option value="Ogliastra"> Ogliastra </option>
<option value="Oristano"> Oristano </option>
<option value="Olbia-Tempio"> Olbia-Tempio </option>
<option value="Palermo"> Palermo </option>
<option value="Piacenza"> Piacenza </option>
<option value="Padova"> Padova </option>
<option value="Pescara"> Pescara </option>
<option value="Perugia"> Perugia </option>
<option value="Pisa"> Pisa </option>
<option value="Pola"> Pola </option>
<option value="Pordenone"> Pordenone </option>
<option value="Prato"> Prato </option>
<option value="Parma"> Parma </option>
<option value="Pistoia"> Pistoia </option>
<option value="Pesaro e Urbino"> Pesaro e Urbino </option>
<option value="Pavia"> Pavia </option>
<option value="Potenza"> Potenza </option>
<option value="Ravenna"> Ravenna </option>
<option value="Reggio Calabria"> Reggio Calabria </option>
<option value="Reggio Emilia"> Reggio Emilia </option>
<option value="Ragusa"> Ragusa </option>
<option value="Rieti"> Rieti </option>
<option value="Roma"> Roma </option>
<option value="Rimini"> Rimini </option>
<option value="Rovigo"> Rovigo </option>
<option value="Salerno"> Salerno </option>
<option value="Siena"> Siena </option>
<option value="Sondrio"> Sondrio </option>
<option value="La Spezia"> La Spezia </option>
<option value="Siracusa"> Siracusa </option>
<option value="Sassari"> Sassari </option>
<option value="Savona"> Savona </option>
<option value="Taranto"> Taranto </option>
<option value="Teramo"> Teramo </option>
<option value="Trento"> Trento </option>
<option value="Torino"> Torino </option>
<option value="Trapani"> Trapani </option>
<option value="Terni"> Terni </option>
<option value="Trieste"> Trieste </option>
<option value="Treviso"> Treviso </option>
<option value="Udine"> Udine </option>
<option value="Varese"> Varese </option>
<option value="Verbano-Cusio-Ossola"> Verbano-Cusio-Ossola </option>
<option value="Vercelli"> Vercelli </option>
<option value="Venezia"> Venezia </option>
<option value="Vicenza"> Vicenza </option>
<option value="Verona"> Verona </option>
<option value="Medio Campidano"> Medio Campidano </option>
<option value="Viterbo"> Viterbo </option>
<option value="Vibo Valentia"> Vibo Valentia </option>
<option value="Zara"> Zara </option>
<option value=""> -- Jamaica -- </option>
<option value=""> Select One </option>
<option value="Kingston"> Kingston </option>
<option value="Saint Andrew"> Saint Andrew </option>
<option value="Saint Thomas"> Saint Thomas </option>
<option value="Portland"> Portland </option>
<option value="Saint Mary"> Saint Mary </option>
<option value="Saint Ann"> Saint Ann </option>
<option value="Trelawny"> Trelawny </option>
<option value="Saint James"> Saint James </option>
<option value="Hanover"> Hanover </option>
<option value="Westmoreland"> Westmoreland </option>
<option value="Saint Elizabeth"> Saint Elizabeth </option>
<option value="Manchester"> Manchester </option>
<option value="Clarendon"> Clarendon </option>
<option value="Saint Catherine"> Saint Catherine </option>
<option value=""> -- Japan -- </option>
<option value=""> Select One </option>
<option value="Hokkaido"> Hokkaido </option>
<option value="Aomori"> Aomori </option>
<option value="Iwate"> Iwate </option>
<option value="Miyagi"> Miyagi </option>
<option value="Akita"> Akita </option>
<option value="Yamagata"> Yamagata </option>
<option value="Fukushima"> Fukushima </option>
<option value="Ibaraki"> Ibaraki </option>
<option value="Tochigi"> Tochigi </option>
<option value="Gunma"> Gunma </option>
<option value="Saitama"> Saitama </option>
<option value="Chiba"> Chiba </option>
<option value="Tokyo"> Tokyo </option>
<option value="Kanagawa"> Kanagawa </option>
<option value="Niigata"> Niigata </option>
<option value="Toyama"> Toyama </option>
<option value="Ishikawa"> Ishikawa </option>
<option value="Fukui"> Fukui </option>
<option value="Yamanashi"> Yamanashi </option>
<option value="Nagano"> Nagano </option>
<option value="Gifu"> Gifu </option>
<option value="Shizuoka"> Shizuoka </option>
<option value="Aichi"> Aichi </option>
<option value="Mie"> Mie </option>
<option value="Shiga"> Shiga </option>
<option value="Kyoto"> Kyoto </option>
<option value="Osaka"> Osaka </option>
<option value="Hyogo"> Hyogo </option>
<option value="Nara"> Nara </option>
<option value="Wakayama"> Wakayama </option>
<option value="Tottori"> Tottori </option>
<option value="Shimane"> Shimane </option>
<option value="Okayama"> Okayama </option>
<option value="Hiroshima"> Hiroshima </option>
<option value="Yamaguchi"> Yamaguchi </option>
<option value="Tokushima"> Tokushima </option>
<option value="Kagawa"> Kagawa </option>
<option value="Ehime"> Ehime </option>
<option value="Kochi"> Kochi </option>
<option value="Fukuoka"> Fukuoka </option>
<option value="Saga"> Saga </option>
<option value="Nagasaki"> Nagasaki </option>
<option value="Kumamoto"> Kumamoto </option>
<option value="Oita"> Oita </option>
<option value="Miyazaki"> Miyazaki </option>
<option value="Kagoshima"> Kagoshima </option>
<option value="Okinawa"> Okinawa </option>
<option value=""> -- Kenya -- </option>
<option value=""> Select One </option>
<option value="Baringo"> Baringo </option>
<option value="Bomet"> Bomet </option>
<option value="Bungoma"> Bungoma </option>
<option value="Busia"> Busia </option>
<option value="Elgeyo/Marakwet"> Elgeyo/Marakwet </option>
<option value="Embu"> Embu </option>
<option value="Garissa"> Garissa </option>
<option value="Homa Bay"> Homa Bay </option>
<option value="Isiolo"> Isiolo </option>
<option value="Kajiado"> Kajiado </option>
<option value="Kakamega"> Kakamega </option>
<option value="Kericho"> Kericho </option>
<option value="Kiambu"> Kiambu </option>
<option value="Kilifi"> Kilifi </option>
<option value="Kirinyaga"> Kirinyaga </option>
<option value="Kisii"> Kisii </option>
<option value="Kisumu"> Kisumu </option>
<option value="Kitui"> Kitui </option>
<option value="Kwale"> Kwale </option>
<option value="Laikipia"> Laikipia </option>
<option value="Lamu"> Lamu </option>
<option value="Machakos"> Machakos </option>
<option value="Makueni"> Makueni </option>
<option value="Mandera"> Mandera </option>
<option value="Marsabit"> Marsabit </option>
<option value="Meru"> Meru </option>
<option value="Migori"> Migori </option>
<option value="Mombasa"> Mombasa </option>
<option value="Murang'a"> Murang'a </option>
<option value="Nairobi City"> Nairobi City </option>
<option value="Nakuru"> Nakuru </option>
<option value="Nandi"> Nandi </option>
<option value="Narok"> Narok </option>
<option value="Nyamira"> Nyamira </option>
<option value="Nyandarua"> Nyandarua </option>
<option value="Nyeri"> Nyeri </option>
<option value="Samburu"> Samburu </option>
<option value="Siaya"> Siaya </option>
<option value="Taita/Taveta"> Taita/Taveta </option>
<option value="Tana River"> Tana River </option>
<option value="Tharaka-Nithi"> Tharaka-Nithi </option>
<option value="Trans Nzoia"> Trans Nzoia </option>
<option value="Turkana"> Turkana </option>
<option value="Uasin Gishu"> Uasin Gishu </option>
<option value="Vihiga"> Vihiga </option>
<option value="Wajir"> Wajir </option>
<option value="West Pokot"> West Pokot </option>
<option value=""> -- Korea -- </option>
<option value=""> Select One </option>
<option value="Cheju-do"> Cheju-do </option>
<option value="Cholla-bukto"> Cholla-bukto </option>
<option value="Cholla-namdo"> Cholla-namdo </option>
<option value="Ch'ungch'ong-bukto"> Ch'ungch'ong-bukto </option>
<option value="Ch'ungch'ong-namdo"> Ch'ungch'ong-namdo </option>
<option value="Inch'on-jikhalsi"> Inch'on-jikhalsi </option>
<option value="Kangwon-do"> Kangwon-do </option>
<option value="Kwangju-jikhalsi"> Kwangju-jikhalsi </option>
<option value="Kyonggi-do"> Kyonggi-do </option>
<option value="Kyongsang-bukto"> Kyongsang-bukto </option>
<option value="Seoul"> Seoul </option>
<option value="Pusan-jikhalsi"> Pusan-jikhalsi </option>
<option value="Soul-t'ukpyolsi"> Soul-t'ukpyolsi </option>
<option value="Taegu-jikhalsi"> Taegu-jikhalsi </option>
<option value="Taejon-jikhalsi"> Taejon-jikhalsi </option>
<option value="Busan"> Busan </option>
<option value="Daegu"> Daegu </option>
<option value="Incheon"> Incheon </option>
<option value="Gwangju"> Gwangju </option>
<option value="Daejeon"> Daejeon </option>
<option value="Ulsan"> Ulsan </option>
<option value="Gyeonggi-do"> Gyeonggi-do </option>
<option value="Gangwon-do"> Gangwon-do </option>
<option value="Chungcheongbuk-do"> Chungcheongbuk-do </option>
<option value="Chungcheongnam-do"> Chungcheongnam-do </option>
<option value="Jeollabuk-do"> Jeollabuk-do </option>
<option value="Jeollanam-do"> Jeollanam-do </option>
<option value="Gyeongsangbuk-do"> Gyeongsangbuk-do </option>
<option value="Gyeongsangnam-do"> Gyeongsangnam-do </option>
<option value="Jejudo"> Jejudo </option>
<option value="Sejong"> Sejong </option>
<option value=""> -- Kazakhstan -- </option>
<option value=""> Select One </option>
<option value="Almatynskaia"> Almatynskaia </option>
<option value="Kostanaiskaia"> Kostanaiskaia </option>
<option value="Severo-Kazakhstansk"> Severo-Kazakhstansk </option>
<option value="Pavlodarskaia"> Pavlodarskaia </option>
<option value="Akmolinskaia"> Akmolinskaia </option>
<option value="Aktubinskaia"> Aktubinskaia </option>
<option value="Atyrauskaia"> Atyrauskaia </option>
<option value="Zapadno-Kazakhst"> Zapadno-Kazakhst </option>
<option value="Mangystayskaia"> Mangystayskaia </option>
<option value="Karagandinskaia"> Karagandinskaia </option>
<option value="Vostochno-Kazakhstan"> Vostochno-Kazakhstan </option>
<option value="Gambilskaia"> Gambilskaia </option>
<option value="Kyzilordinskaia"> Kyzilordinskaia </option>
<option value=""> -- Latvia -- </option>
<option value=""> Select One </option>
<option value="Aglonas novads"> Aglonas novads </option>
<option value="Aizkraukles novads"> Aizkraukles novads </option>
<option value="Aizputes novads"> Aizputes novads </option>
<option value="Aknistes novads"> Aknistes novads </option>
<option value="Alojas novads"> Alojas novads </option>
<option value="Alsungas novads"> Alsungas novads </option>
<option value="Aluksnes novads"> Aluksnes novads </option>
<option value="Amatas novads"> Amatas novads </option>
<option value="Apes novads"> Apes novads </option>
<option value="Auces novads"> Auces novads </option>
<option value="Adazu novads"> Adazu novads </option>
<option value="Babites novads"> Babites novads </option>
<option value="Baldones novads"> Baldones novads </option>
<option value="Baltinavas novads"> Baltinavas novads </option>
<option value="Balvu novads"> Balvu novads </option>
<option value="Bauskas novads"> Bauskas novads </option>
<option value="Beverinas novads"> Beverinas novads </option>
<option value="Brocenu novads"> Brocenu novads </option>
<option value="Burtnieku novads"> Burtnieku novads </option>
<option value="Carnikavas novads"> Carnikavas novads </option>
<option value="Cesvaines novads"> Cesvaines novads </option>
<option value="Cesu novads"> Cesu novads </option>
<option value="Ciblas novads"> Ciblas novads </option>
<option value="Dagdas novads"> Dagdas novads </option>
<option value="Daugavpils novads"> Daugavpils novads </option>
<option value="Dobeles novads"> Dobeles novads </option>
<option value="Dundagas novads"> Dundagas novads </option>
<option value="Durbes novads"> Durbes novads </option>
<option value="Engures novads"> Engures novads </option>
<option value="Erglu novads"> Erglu novads </option>
<option value="Garkalnes novads"> Garkalnes novads </option>
<option value="Grobinas novads"> Grobinas novads </option>
<option value="Gulbenes novads"> Gulbenes novads </option>
<option value="Iecavas novads"> Iecavas novads </option>
<option value="Ikskiles novads"> Ikskiles novads </option>
<option value="Ilukstes novads"> Ilukstes novads </option>
<option value="Incukalna novads"> Incukalna novads </option>
<option value="Jaunjelgavas novads"> Jaunjelgavas novads </option>
<option value="Jaunpiebalgas novads"> Jaunpiebalgas novads </option>
<option value="Jaunpils novads"> Jaunpils novads </option>
<option value="Jelgavas novads"> Jelgavas novads </option>
<option value="Jekabpils novads"> Jekabpils novads </option>
<option value="Kandavas novads"> Kandavas novads </option>
<option value="Karsavas novads"> Karsavas novads </option>
<option value="Kocenu novads"> Kocenu novads </option>
<option value="Kokneses novads"> Kokneses novads </option>
<option value="Kraslavas novads"> Kraslavas novads </option>
<option value="Krimuldas novads"> Krimuldas novads </option>
<option value="Krustpils novads"> Krustpils novads </option>
<option value="Kuldigas novads"> Kuldigas novads </option>
<option value="Keguma novads"> Keguma novads </option>
<option value="Kekavas novads"> Kekavas novads </option>
<option value="Lielvardes novads"> Lielvardes novads </option>
<option value="Limbazu novads"> Limbazu novads </option>
<option value="Ligatnes novads"> Ligatnes novads </option>
<option value="Livanu novads"> Livanu novads </option>
<option value="Lubanas novads"> Lubanas novads </option>
<option value="Ludzas novads"> Ludzas novads </option>
<option value="Madonas novads"> Madonas novads </option>
<option value="Mazsalacas novads"> Mazsalacas novads </option>
<option value="Malpils novads"> Malpils novads </option>
<option value="Marupes novads"> Marupes novads </option>
<option value="Mersraga novads"> Mersraga novads </option>
<option value="Nauksenu novads"> Nauksenu novads </option>
<option value="Neretas novads"> Neretas novads </option>
<option value="Nicas novads"> Nicas novads </option>
<option value="Ogres novads"> Ogres novads </option>
<option value="Olaines novads"> Olaines novads </option>
<option value="Ozolnieku novads"> Ozolnieku novads </option>
<option value="Pargaujas novads"> Pargaujas novads </option>
<option value="Pavilostas novads"> Pavilostas novads </option>
<option value="Plavinu novads"> Plavinu novads </option>
<option value="Preilu novads"> Preilu novads </option>
<option value="Priekules novads"> Priekules novads </option>
<option value="Priekulu novads"> Priekulu novads </option>
<option value="Raunas novads"> Raunas novads </option>
<option value="Rezeknes novads"> Rezeknes novads </option>
<option value="Riebinu novads"> Riebinu novads </option>
<option value="Rojas novads"> Rojas novads </option>
<option value="Ropazu novads"> Ropazu novads </option>
<option value="Rucavas novads"> Rucavas novads </option>
<option value="Rugaju novads"> Rugaju novads </option>
<option value="Rundales novads"> Rundales novads </option>
<option value="Rujienas novads"> Rujienas novads </option>
<option value="Salas novads"> Salas novads </option>
<option value="Salacgrivas novads"> Salacgrivas novads </option>
<option value="Salaspils novads"> Salaspils novads </option>
<option value="Saldus novads"> Saldus novads </option>
<option value="Saulkrastu novads"> Saulkrastu novads </option>
<option value="Sejas novads"> Sejas novads </option>
<option value="Siguldas novads"> Siguldas novads </option>
<option value="Skriveru novads"> Skriveru novads </option>
<option value="Skrundas novads"> Skrundas novads </option>
<option value="Smiltenes novads"> Smiltenes novads </option>
<option value="Stopinu novads"> Stopinu novads </option>
<option value="Strencu novads"> Strencu novads </option>
<option value="Talsu novads"> Talsu novads </option>
<option value="Tervetes novads"> Tervetes novads </option>
<option value="Tukuma novads"> Tukuma novads </option>
<option value="Vainodes novads"> Vainodes novads </option>
<option value="Valkas novads"> Valkas novads </option>
<option value="Varaklanu novads"> Varaklanu novads </option>
<option value="Varkavas novads"> Varkavas novads </option>
<option value="Vecpiebalgas novads"> Vecpiebalgas novads </option>
<option value="Vecumnieku novads"> Vecumnieku novads </option>
<option value="Ventspils novads"> Ventspils novads </option>
<option value="Viesites novads"> Viesites novads </option>
<option value="Vilakas novads"> Vilakas novads </option>
<option value="Vilanu novads"> Vilanu novads </option>
<option value="Zilupes novads"> Zilupes novads </option>
<option value="Daugavpils"> Daugavpils </option>
<option value="Jelgava"> Jelgava </option>
<option value="Jekabpils"> Jekabpils </option>
<option value="Jurmala"> Jurmala </option>
<option value="Liepaja"> Liepaja </option>
<option value="Rezekne"> Rezekne </option>
<option value="Riga"> Riga </option>
<option value="Ventspils"> Ventspils </option>
<option value="Valmiera"> Valmiera </option>
<option value=""> -- Lebanon -- </option>
<option value=""> Select One </option>
<option value="Akkar"> Akkar </option>
<option value="Ash Shimal"> Ash Shimal </option>
<option value="Bayrut"> Bayrut </option>
<option value="B'alabak-Al Hirmil"> B'alabak-Al Hirmil </option>
<option value="Al Biqa"> Al Biqa </option>
<option value="Al Janub"> Al Janub </option>
<option value="Jabal Lubnan"> Jabal Lubnan </option>
<option value="An Nabatiyah"> An Nabatiyah </option>
<option value=""> -- Lithuania -- </option>
<option value=""> Select One </option>
<option value="Akmene"> Akmene </option>
<option value="Alytaus miestas"> Alytaus miestas </option>
<option value="Alytus"> Alytus </option>
<option value="Anyksciai"> Anyksciai </option>
<option value="Birstono"> Birstono </option>
<option value="Birzai"> Birzai </option>
<option value="Druskininkai"> Druskininkai </option>
<option value="Elektrenai"> Elektrenai </option>
<option value="Ignalina"> Ignalina </option>
<option value="Jonava"> Jonava </option>
<option value="Joniskis"> Joniskis </option>
<option value="Jurbarkas"> Jurbarkas </option>
<option value="Kaisiadorys"> Kaisiadorys </option>
<option value="Kalvarijos"> Kalvarijos </option>
<option value="Kauno miestas"> Kauno miestas </option>
<option value="Kaunas"> Kaunas </option>
<option value="Kazlu Rudos"> Kazlu Rudos </option>
<option value="Kedainiai"> Kedainiai </option>
<option value="Kelme"> Kelme </option>
<option value="Klaipedos miestas"> Klaipedos miestas </option>
<option value="Klaipeda"> Klaipeda </option>
<option value="Kretinga"> Kretinga </option>
<option value="Kupiskis"> Kupiskis </option>
<option value="Lazdijai"> Lazdijai </option>
<option value="Marijampole"> Marijampole </option>
<option value="Mazeikiai"> Mazeikiai </option>
<option value="Moletai"> Moletai </option>
<option value="Neringa"> Neringa </option>
<option value="Pagegiai"> Pagegiai </option>
<option value="Pakruojis"> Pakruojis </option>
<option value="Palangos miestas"> Palangos miestas </option>
<option value="Panevezio miestas"> Panevezio miestas </option>
<option value="Panevezys"> Panevezys </option>
<option value="Pasvalys"> Pasvalys </option>
<option value="Plunge"> Plunge </option>
<option value="Prienai"> Prienai </option>
<option value="Radviliskis"> Radviliskis </option>
<option value="Raseiniai"> Raseiniai </option>
<option value="Rietavo"> Rietavo </option>
<option value="Rokiskis"> Rokiskis </option>
<option value="Sakiai"> Sakiai </option>
<option value="Salcininkai"> Salcininkai </option>
<option value="Siauliu miestas"> Siauliu miestas </option>
<option value="Siauliai"> Siauliai </option>
<option value="Silale"> Silale </option>
<option value="Silute"> Silute </option>
<option value="Sirvintos"> Sirvintos </option>
<option value="Skuodas"> Skuodas </option>
<option value="Svencionys"> Svencionys </option>
<option value="Taurage"> Taurage </option>
<option value="Telsiai"> Telsiai </option>
<option value="Trakai"> Trakai </option>
<option value="Ukmerge"> Ukmerge </option>
<option value="Utena"> Utena </option>
<option value="Varena"> Varena </option>
<option value="Vilkaviskis"> Vilkaviskis </option>
<option value="Vilniaus miestas"> Vilniaus miestas </option>
<option value="Vilnius"> Vilnius </option>
<option value="Visaginas"> Visaginas </option>
<option value="Zarasai"> Zarasai </option>
<option value="Alytaus Apskritis"> Alytaus Apskritis </option>
<option value="Klaipedos Apskritis"> Klaipedos Apskritis </option>
<option value="Kauno Apskritis"> Kauno Apskritis </option>
<option value="Marijampoles"> Marijampoles </option>
<option value="Panevezio Apskritis"> Panevezio Apskritis </option>
<option value="Siauliu Apskritis"> Siauliu Apskritis </option>
<option value="Taurages Apskritis"> Taurages Apskritis </option>
<option value="Telsiu Apskritis"> Telsiu Apskritis </option>
<option value="Utenos Apskritis"> Utenos Apskritis </option>
<option value="Vilniaus Apskritis"> Vilniaus Apskritis </option>
<option value=""> -- Luxembourg -- </option>
<option value=""> Select One </option>
<option value="Diekirich"> Diekirich </option>
<option value="Grevenmacher"> Grevenmacher </option>
<option value=""> -- Malaysia -- </option>
<option value=""> Select One </option>
<option value="Putrajaya"> Putrajaya </option>
<option value="Johor"> Johor </option>
<option value="Kedah"> Kedah </option>
<option value="Kelantan"> Kelantan </option>
<option value="Kuala Lumpur"> Kuala Lumpur </option>
<option value="Labuan"> Labuan </option>
<option value="Melaka"> Melaka </option>
<option value="Pahang"> Pahang </option>
<option value="Perlis"> Perlis </option>
<option value="Perak"> Perak </option>
<option value="Pulau Pinang"> Pulau Pinang </option>
<option value="Wil. Persekutuan"> Wil. Persekutuan </option>
<option value="Sabah"> Sabah </option>
<option value="Sarawak"> Sarawak </option>
<option value="Selangor"> Selangor </option>
<option value="Negeri Sembilan"> Negeri Sembilan </option>
<option value="Terengganu"> Terengganu </option>
<option value=""> -- Mexico -- </option>
<option value=""> Select One </option>
<option value="Aguascalientes"> Aguascalientes </option>
<option value="Baja California"> Baja California </option>
<option value="Baja California S"> Baja California Sur </option>
<option value="Campeche"> Campeche </option>
<option value="Chiapas"> Chiapas </option>
<option value="Chihuahua"> Chihuahua </option>
<option value="Coahuila"> Coahuila </option>
<option value="Colima"> Colima </option>
<option value="Distrito Federal"> Distrito Federal </option>
<option value="Durango"> Durango </option>
<option value="Guanajuato"> Guanajuato </option>
<option value="Guerrero"> Guerrero </option>
<option value="Hidalgo"> Hidalgo </option>
<option value="Jalisco"> Jalisco </option>
<option value="Estado de Mexico"> Estado de México </option>
<option value="Michoacán"> Michoacán </option>
<option value="Morelos"> Morelos </option>
<option value="Nayarit"> Nayarit </option>
<option value="Nuevo León"> Nuevo León </option>
<option value="Oaxaca"> Oaxaca </option>
<option value="Puebla"> Puebla </option>
<option value="Querétaro"> Querétaro </option>
<option value="Quintana Roo"> Quintana Roo </option>
<option value="San Luis Potosí"> San Luis Potosí </option>
<option value="Sinaloa"> Sinaloa </option>
<option value="Sonora"> Sonora </option>
<option value="Tabasco"> Tabasco </option>
<option value="Tamaulipas"> Tamaulipas </option>
<option value="Tlaxcala"> Tlaxcala </option>
<option value="Veracruz"> Veracruz </option>
<option value="Yucatán"> Yucatán </option>
<option value="Zacatecas"> Zacatecas </option>
<option value=""> -- Montenegro -- </option>
<option value=""> Select One </option>
<option value="Andrijevica"> Andrijevica </option>
<option value="Bar"> Bar </option>
<option value="Berane"> Berane </option>
<option value="Bijelo Polje"> Bijelo Polje </option>
<option value="Budva"> Budva </option>
<option value="Cetinje"> Cetinje </option>
<option value="Danilovgrad"> Danilovgrad </option>
<option value="Herceg-Novi"> Herceg-Novi </option>
<option value="Kolasin"> Kolasin </option>
<option value="Kotor"> Kotor </option>
<option value="Mojkovac"> Mojkovac </option>
<option value="Niksic"> Niksic </option>
<option value="Plav"> Plav </option>
<option value="Pljevlja"> Pljevlja </option>
<option value="Pluzine"> Pluzine </option>
<option value="Podgorica"> Podgorica </option>
<option value="Rozaje"> Rozaje </option>
<option value="Savnik"> Savnik </option>
<option value="Tivat"> Tivat </option>
<option value="Ulcinj"> Ulcinj </option>
<option value="Zabljak"> Zabljak </option>
<option value=""> -- Morocco -- </option>
<option value=""> Select One </option>
<option value="Tanger-Tetouan"> Tanger-Tetouan </option>
<option value="Gharb-Chrarda"> Gharb-Chrarda </option>
<option value="Taza-Al HT"> Taza-Al HT </option>
<option value="L'Oriental"> L'Oriental </option>
<option value="Fes-Boulemane"> Fes-Boulemane </option>
<option value="Meknes-Tafilalet"> Meknes-Tafilalet </option>
<option value="Rabat-Sale"> Rabat-Sale </option>
<option value="Grand Casablanca"> Grand Casablanca </option>
<option value="Chaouia-Ouardigha"> Chaouia-Ouardigha </option>
<option value="Doukhala-Abda"> Doukhala-Abda </option>
<option value="Marrakech-Tensift"> Marrakech-Tensift </option>
<option value="Tadla-Azilal"> Tadla-Azilal </option>
<option value="Sous-Massa-Draa"> Sous-Massa-Draa </option>
<option value="Guelmim-Es Semara"> Guelmim-Es Semara </option>
<option value="Laayoune-Boujdour"> Laayoune-Boujdour </option>
<option value="Dahab-Lagouira"> Dahab-Lagouira </option>
<option value="Agadir"> Agadir </option>
<option value="Aousserd"> Aousserd </option>
<option value="Assa-Zag"> Assa-Zag </option>
<option value="Azilal"> Azilal </option>
<option value="Beni Mellal"> Beni Mellal </option>
<option value="Berkane"> Berkane </option>
<option value="Ben Slimane"> Ben Slimane </option>
<option value="Boujdour"> Boujdour </option>
<option value="Boulemane"> Boulemane </option>
<option value="Casablanca"> Casablanca </option>
<option value="Chefchaouene"> Chefchaouene </option>
<option value="Chichaoua"> Chichaoua </option>
<option value="Chtouka-Ait Baha"> Chtouka-Ait Baha </option>
<option value="Errachidia"> Errachidia </option>
<option value="Essaouira"> Essaouira </option>
<option value="Es Smara"> Es Smara </option>
<option value="Fahs-Beni Makada"> Fahs-Beni Makada </option>
<option value="Fes-Dar-Dbibegh"> Fes-Dar-Dbibegh </option>
<option value="Figuig"> Figuig </option>
<option value="Guelmim"> Guelmim </option>
<option value="El Hajeb"> El Hajeb </option>
<option value="Al Haouz"> Al Haouz </option>
<option value="Al Hoceima"> Al Hoceima </option>
<option value="Ifrane"> Ifrane </option>
<option value="Inezgane-Ait Melloul"> Inezgane-Ait Melloul </option>
<option value="El Jadida"> El Jadida </option>
<option value="Jrada"> Jrada </option>
<option value="Kenitra"> Kenitra </option>
<option value="Kelaat Sraghna"> Kelaat Sraghna </option>
<option value="Khemisset"> Khemisset </option>
<option value="Khenifra"> Khenifra </option>
<option value="Khouribga"> Khouribga </option>
<option value="Laayoune"> Laayoune </option>
<option value="Larache"> Larache </option>
<option value="Mediouna"> Mediouna </option>
<option value="Meknes"> Meknes </option>
<option value="Marrakech-Medina"> Marrakech-Medina </option>
<option value="Marrakech-Menara"> Marrakech-Menara </option>
<option value="Mohammadia"> Mohammadia </option>
<option value="Moulay Yacoub"> Moulay Yacoub </option>
<option value="Nador"> Nador </option>
<option value="Nouaceur"> Nouaceur </option>
<option value="Ouarzazate"> Ouarzazate </option>
<option value="Oued ed Dahab"> Oued ed Dahab </option>
<option value="Oujda-Angad"> Oujda-Angad </option>
<option value="Rabat"> Rabat </option>
<option value="Safi"> Safi </option>
<option value="Sale"> Sale </option>
<option value="Sefrou"> Sefrou </option>
<option value="Settat"> Settat </option>
<option value="Sidi Kacem"> Sidi Kacem </option>
<option value="Skhirate-Temara"> Skhirate-Temara </option>
<option value="Sidi Youssef Ben Ali"> Sidi Youssef Ben Ali </option>
<option value="Taourirt"> Taourirt </option>
<option value="Taounate"> Taounate </option>
<option value="Taroudannt"> Taroudannt </option>
<option value="Tata"> Tata </option>
<option value="Taza"> Taza </option>
<option value="Tetouan"> Tetouan </option>
<option value="Tiznit"> Tiznit </option>
<option value="Tanger-Assilah"> Tanger-Assilah </option>
<option value="Tan-Tan"> Tan-Tan </option>
<option value="Zagora"> Zagora </option>
<option value=""> -- Netherlands -- </option>
<option value=""> Select One </option>
<option value="Drenthe"> Drenthe </option>
<option value="Flevoland"> Flevoland </option>
<option value="Friesland"> Friesland </option>
<option value="Gelderland"> Gelderland </option>
<option value="Groningen"> Groningen </option>
<option value="Noord-Brabant"> Noord-Brabant </option>
<option value="Noord-Holland"> Noord-Holland </option>
<option value="Overijssel"> Overijssel </option>
<option value="Utrecht"> Utrecht </option>
<option value="Zeeland"> Zeeland </option>
<option value="Zuid-Holland"> Zuid-Holland </option>
<option value=""> -- New Zealand -- </option>
<option value=""> Select One </option>
<option value="Auckland"> Auckland </option>
<option value="Bay of Plenty"> Bay of Plenty </option>
<option value="Canterbury"> Canterbury </option>
<option value="Hawke's Bay"> Hawke's Bay </option>
<option value="Manawatu-Wanganui"> Manawatu-Wanganui </option>
<option value="Northland"> Northland </option>
<option value="Otago"> Otago </option>
<option value="Southland"> Southland </option>
<option value="Taranaki"> Taranaki </option>
<option value="Waikato"> Waikato </option>
<option value="West Coast"> West Coast </option>
<option value="Wellington"> Wellington </option>
<option value=""> -- Nicaragua -- </option>
<option value=""> Select One </option>
<option value="Boaco"> Boaco </option>
<option value="Carazo"> Carazo </option>
<option value="Chinandega"> Chinandega </option>
<option value="Chontales"> Chontales </option>
<option value="Estelí"> Estelí </option>
<option value="Granada"> Granada </option>
<option value="Jinotega"> Jinotega </option>
<option value="León"> León </option>
<option value="Madriz"> Madriz </option>
<option value="Managua"> Managua </option>
<option value="Masaya"> Masaya </option>
<option value="Matagalpa"> Matagalpa </option>
<option value="Nueva Segovia"> Nueva Segovia </option>
<option value="Rivas"> Rivas </option>
<option value="Río San Juan"> Río San Juan </option>
<option value=""> -- Nigeria -- </option>
<option value=""> Select One </option>
<option value="Abia"> Abia </option>
<option value="Adamawa"> Adamawa </option>
<option value="Akwa"> Akwa </option>
<option value="Anambra"> Anambra </option>
<option value="Bauchi"> Bauchi </option>
<option value="Benue"> Benue </option>
<option value="Borno"> Borno </option>
<option value="Bayelsa"> Bayelsa </option>
<option value="Cross River"> Cross River </option>
<option value="Delta"> Delta </option>
<option value="Ebonyi"> Ebonyi </option>
<option value="Edo"> Edo </option>
<option value="Ekiti"> Ekiti </option>
<option value="Enugu"> Enugu </option>
<option value="Federal Capital Terr"> Federal Capital Terr </option>
<option value="Gombe"> Gombe </option>
<option value="Imo"> Imo </option>
<option value="Jigawa"> Jigawa </option>
<option value="Kaduna"> Kaduna </option>
<option value="Kebbi"> Kebbi </option>
<option value="Kano"> Kano </option>
<option value="Kogi"> Kogi </option>
<option value="Katsina"> Katsina </option>
<option value="Kwara"> Kwara </option>
<option value="Lagos"> Lagos </option>
<option value="Nassarawa"> Nassarawa </option>
<option value="Niger"> Niger </option>
<option value="Ogun"> Ogun </option>
<option value="Ondo"> Ondo </option>
<option value="Osun"> Osun </option>
<option value="Oyo"> Oyo </option>
<option value="Plateau"> Plateau </option>
<option value="Rivers"> Rivers </option>
<option value="Sokoto"> Sokoto </option>
<option value="Taraba"> Taraba </option>
<option value="Yobe"> Yobe </option>
<option value="Zamfara"> Zamfara </option>
<option value=""> -- Norway -- </option>
<option value=""> Select One </option>
<option value="Ostfold County"> Ostfold County </option>
<option value="Akershus County"> Akershus County </option>
<option value="Oslo"> Oslo </option>
<option value="Hedmark County"> Hedmark County </option>
<option value="Oppland County"> Oppland County </option>
<option value="Buskerud County"> Buskerud County </option>
<option value="Vestfold County"> Vestfold County </option>
<option value="Telemark County"> Telemark County </option>
<option value="Aust-Agder County"> Aust-Agder County </option>
<option value="Vest-Agder County"> Vest-Agder County </option>
<option value="Rogaland County"> Rogaland County </option>
<option value="Hordaland County"> Hordaland County </option>
<option value="Sogn og Fjordane C."> Sogn og Fjordane C. </option>
<option value="More og Romsdal C."> More og Romsdal C. </option>
<option value="Sor-Trondelag County"> Sor-Trondelag County </option>
<option value="Nord-Trondelag Cnty"> Nord-Trondelag Cnty </option>
<option value="Nordland County"> Nordland County </option>
<option value="Troms County"> Troms County </option>
<option value="Finnmark County"> Finnmark County </option>
<option value=""> -- Oman -- </option>
<option value=""> Select One </option>
<option value="Al Batinah"> Al Batinah </option>
<option value="Al Buraymi"> Al Buraymi </option>
<option value="Ad Dakhiliyah"> Ad Dakhiliyah </option>
<option value="Masqat"> Masqat </option>
<option value="Musandam"> Musandam </option>
<option value="Al Wusta"> Al Wusta </option>
<option value="Az Zahirah"> Az Zahirah </option>
<option value="Zufar"> Zufar </option>
<option value=""> -- Pakistan -- </option>
<option value=""> Select One </option>
<option value="Balochistan"> Balochistan </option>
<option value="Gilgit-Baltistan"> Gilgit-Baltistan </option>
<option value="Islamabad"> Islamabad </option>
<option value="Azad Kashmir"> Azad Kashmir </option>
<option value="Khyber Pakhtunkhwa"> Khyber Pakhtunkhwa </option>
<option value="Sindh"> Sindh </option>
<option value="FedAdmin TribalAreas"> FedAdmin TribalAreas </option>
<option value=""> -- Panama -- </option>
<option value=""> Select One </option>
<option value="Bocas del Toro"> Bocas del Toro </option>
<option value="Coclé"> Coclé </option>
<option value="Chiriquí"> Chiriquí </option>
<option value="Darién"> Darién </option>
<option value="Herrera"> Herrera </option>
<option value="Los Santos"> Los Santos </option>
<option value="Panamá"> Panamá </option>
<option value="Veraguas"> Veraguas </option>
<option value=""> -- Paraguay -- </option>
<option value=""> Select One </option>
<option value=""> -- Peru -- </option>
<option value=""> Select One </option>
<option value="Tumbes"> Tumbes </option>
<option value="Piura"> Piura </option>
<option value="Lambayeque"> Lambayeque </option>
<option value="Ancash"> Ancash </option>
<option value="Lima y Callao"> Lima y Callao </option>
<option value="Ica"> Ica </option>
<option value="Arequipa"> Arequipa </option>
<option value="Moquegua"> Moquegua </option>
<option value="Tacna"> Tacna </option>
<option value="Amazon"> Amazon </option>
<option value="Cajamarca"> Cajamarca </option>
<option value="San Martin"> San Martin </option>
<option value="Huanuco"> Huanuco </option>
<option value="Pasco"> Pasco </option>
<option value="Junin"> Junin </option>
<option value="Huancavelica"> Huancavelica </option>
<option value="Ayacucho"> Ayacucho </option>
<option value="Apurimac"> Apurimac </option>
<option value="Cuzco"> Cuzco </option>
<option value="Puno"> Puno </option>
<option value="Loreto"> Loreto </option>
<option value="Ucayali"> Ucayali </option>
<option value="Madre de Dios"> Madre de Dios </option>
<option value=""> -- Philippines -- </option>
<option value=""> Select One </option>
<option value="National Capital Reg"> National Capital Reg </option>
<option value="Ilocos"> Ilocos </option>
<option value="Cagayan Valley"> Cagayan Valley </option>
<option value="Central Luzon"> Central Luzon </option>
<option value="South Luzon"> South Luzon </option>
<option value="Bicol"> Bicol </option>
<option value="Western Visayas"> Western Visayas </option>
<option value="Central Visayas"> Central Visayas </option>
<option value="Eastern Visayas"> Eastern Visayas </option>
<option value="Zamboanga Peninsula"> Zamboanga Peninsula </option>
<option value="Northern Mindanao"> Northern Mindanao </option>
<option value="Davao"> Davao </option>
<option value="Soccsksargen"> Soccsksargen </option>
<option value="Caraga"> Caraga </option>
<option value="Autonomous rgn in Mu"> Autonomous rgn in Mu </option>
<option value="Cordillera Administr"> Cordillera Administr </option>
<option value="Calabarzon"> Calabarzon </option>
<option value="Mimaropa"> Mimaropa </option>
<option value=""> -- Poland -- </option>
<option value=""> Select One </option>
<option value="Dolnoslaskie"> Dolnoslaskie </option>
<option value="Kujawsko-Pomorskie"> Kujawsko-Pomorskie </option>
<option value="Lubelskie"> Lubelskie </option>
<option value="Lubuskie"> Lubuskie </option>
<option value="Lodzkie"> Lodzkie </option>
<option value="Malopolskie"> Malopolskie </option>
<option value="Mazowieckie"> Mazowieckie </option>
<option value="Opolskie"> Opolskie </option>
<option value="Podkarpackie"> Podkarpackie </option>
<option value="Podlaskie"> Podlaskie </option>
<option value="Pomorskie"> Pomorskie </option>
<option value="Slaskie"> Slaskie </option>
<option value="Swietokrzyskie"> Swietokrzyskie </option>
<option value="Wielkopolskie"> Wielkopolskie </option>
<option value="Warminsko-mazurskie"> Warminsko-mazurskie </option>
<option value="Zachodniopomorskie"> Zachodniopomorskie </option>
<option value=""> -- Portugal -- </option>
<option value=""> Select One </option>
<option value="Aveiro"> Aveiro </option>
<option value="Beja"> Beja </option>
<option value="Braga"> Braga </option>
<option value="Braganca"> Braganca </option>
<option value="Castelo Branco"> Castelo Branco </option>
<option value="Coimbra"> Coimbra </option>
<option value="Evora"> Evora </option>
<option value="Faro"> Faro </option>
<option value="Guarda"> Guarda </option>
<option value="Leiria"> Leiria </option>
<option value="Minho-Lima"> Minho-Lima </option>
<option value="Lisboa"> Lisboa </option>
<option value="Cavado"> Cavado </option>
<option value="Portalegre"> Portalegre </option>
<option value="Ave"> Ave </option>
<option value="Porto"> Porto </option>
<option value="Santarem"> Santarem </option>
<option value="Tamega"> Tamega </option>
<option value="Setubal"> Setubal </option>
<option value="Entre Douro e Vouga"> Entre Douro e Vouga </option>
<option value="Viana do Castelo"> Viana do Castelo </option>
<option value="Douro"> Douro </option>
<option value="Vila Real"> Vila Real </option>
<option value="Alto Tras-os-Montes"> Alto Tras-os-Montes </option>
<option value="Viseu"> Viseu </option>
<option value="Autonoma dos Acores"> Autonoma dos Acores </option>
<option value="Baixo Vouga"> Baixo Vouga </option>
<option value="Baixo Mondego"> Baixo Mondego </option>
<option value="Pinhal Litoral"> Pinhal Litoral </option>
<option value="Pinhal Interior N."> Pinhal Interior N. </option>
<option value="Pinhal Interior Sul"> Pinhal Interior Sul </option>
<option value="Dao-Lafoes"> Dao-Lafoes </option>
<option value="Serra da Estrela"> Serra da Estrela </option>
<option value="Beira Interior Norte"> Beira Interior Norte </option>
<option value="Beira Interior Sul"> Beira Interior Sul </option>
<option value="Cova da Beira"> Cova da Beira </option>
<option value="Autonoma da Madeira"> Autonoma da Madeira </option>
<option value="Oeste"> Oeste </option>
<option value="Grande Lisboa"> Grande Lisboa </option>
<option value="Peninsula de Setubal"> Peninsula de Setubal </option>
<option value="Medio Tejo"> Medio Tejo </option>
<option value="Leziria do Tejo"> Leziria do Tejo </option>
<option value="Alentejo Litoral"> Alentejo Litoral </option>
<option value="Alto Alentejo"> Alto Alentejo </option>
<option value="Alentejo Central"> Alentejo Central </option>
<option value="Baixo Alentejo"> Baixo Alentejo </option>
<option value="Algarve"> Algarve </option>
<option value=""> -- Qatar -- </option>
<option value=""> Select One </option>
<option value="Ad Dawhah"> Ad Dawhah </option>
<option value="Al Khawr wa adh Dhak"> Al Khawr wa adh Dhak </option>
<option value="Ash Shamal"> Ash Shamal </option>
<option value="Ar Rayyan"> Ar Rayyan </option>
<option value="Umm Salal"> Umm Salal </option>
<option value="Al Wakrah"> Al Wakrah </option>
<option value="Az Za'ayin"> Az Za'ayin </option>
<option value=""> -- Romania -- </option>
<option value=""> Select One </option>
<option value="Alba"> Alba </option>
<option value="Arad"> Arad </option>
<option value="Arges"> Arges </option>
<option value="Bacau"> Bacau </option>
<option value="Bihor"> Bihor </option>
<option value="Bistrita-Nasaud"> Bistrita-Nasaud </option>
<option value="Botosani"> Botosani </option>
<option value="Braila"> Braila </option>
<option value="Brasov"> Brasov </option>
<option value="Bucuresti"> Bucuresti </option>
<option value="Buzau"> Buzau </option>
<option value="Calarasi"> Calarasi </option>
<option value="Caras-Severin"> Caras-Severin </option>
<option value="Cluj"> Cluj </option>
<option value="Constanta"> Constanta </option>
<option value="Covasna"> Covasna </option>
<option value="Dambovita"> Dambovita </option>
<option value="Dolj"> Dolj </option>
<option value="Galati"> Galati </option>
<option value="Gorj"> Gorj </option>
<option value="Giurgiu"> Giurgiu </option>
<option value="Harghita"> Harghita </option>
<option value="Hunedoara"> Hunedoara </option>
<option value="Ialomita"> Ialomita </option>
<option value="Iasi"> Iasi </option>
<option value="Maramures"> Maramures </option>
<option value="Mehedinti"> Mehedinti </option>
<option value="Mures"> Mures </option>
<option value="Neamt"> Neamt </option>
<option value="Olt"> Olt </option>
<option value="Prahova"> Prahova </option>
<option value="Salaj"> Salaj </option>
<option value="Satu Mare"> Satu Mare </option>
<option value="Sibiu"> Sibiu </option>
<option value="Suceava"> Suceava </option>
<option value="Teleorman"> Teleorman </option>
<option value="Timis"> Timis </option>
<option value="Tulcea"> Tulcea </option>
<option value="Vaslui"> Vaslui </option>
<option value="Valcea"> Valcea </option>
<option value="Vrancea"> Vrancea </option>
<option value=""> -- Russian Federation -- </option>
<option value=""> Select One </option>
<option value="Adygeya Republic"> Adygeya Republic </option>
<option value="Highlands-Altay Rep."> Highlands-Altay Rep. </option>
<option value="Republ.of Bashkortos"> Republ.of Bashkortos </option>
<option value="Buryatiya Republic"> Buryatiya Republic </option>
<option value="Dagestan Republic"> Dagestan Republic </option>
<option value="Ingushetija Republic"> Ingushetija Republic </option>
<option value="Kabardino-Balkar.Rep"> Kabardino-Balkar.Rep </option>
<option value="Kalmyk Republic"> Kalmyk Republic </option>
<option value="Karach.-Cherkessk Re"> Karach.-Cherkessk Re </option>
<option value="Karelian Republic"> Karelian Republic </option>
<option value="Komi Republic"> Komi Republic </option>
<option value="Marijskaya Republic"> Marijskaya Republic </option>
<option value="Mordovian Republic"> Mordovian Republic </option>
<option value="Yakutiya-Saha Rrepub"> Yakutiya-Saha Rrepub </option>
<option value="North-Osetiya Republ"> North-Osetiya Republ </option>
<option value="Tatarstan Republic"> Tatarstan Republic </option>
<option value="Tuva Republic"> Tuva Republic </option>
<option value="The Udmurt Republic"> The Udmurt Republic </option>
<option value="Chakassky Republic"> Chakassky Republic </option>
<option value="Chechenskaya Republ."> Chechenskaya Republ. </option>
<option value="Chuvash Republic"> Chuvash Republic </option>
<option value="Altay Republic"> Altay Republic </option>
<option value="Krasnodar Territory"> Krasnodar Territory </option>
<option value="Krasnoyarsk Territor"> Krasnoyarsk Territor </option>
<option value="Primorye Territory"> Primorye Territory </option>
<option value="Stavropol Territory"> Stavropol Territory </option>
<option value="Khabarovsk Territory"> Khabarovsk Territory </option>
<option value="The Amur Area"> The Amur Area </option>
<option value="The Arkhangelsk Area"> The Arkhangelsk Area </option>
<option value="The Astrakhan Area"> The Astrakhan Area </option>
<option value="The Belgorod Area"> The Belgorod Area </option>
<option value="The Bryansk Area"> The Bryansk Area </option>
<option value="The Vladimir Area"> The Vladimir Area </option>
<option value="The Volgograd Area"> The Volgograd Area </option>
<option value="The Vologda Area"> The Vologda Area </option>
<option value="The Voronezh Area"> The Voronezh Area </option>
<option value="The Ivanovo Area"> The Ivanovo Area </option>
<option value="The Irkutsk Area"> The Irkutsk Area </option>
<option value="The Kaliningrad Area"> The Kaliningrad Area </option>
<option value="The Kaluga Area"> The Kaluga Area </option>
<option value="The Kamchatka Area"> The Kamchatka Area </option>
<option value="The Kemerovo Area"> The Kemerovo Area </option>
<option value="The Kirov Area"> The Kirov Area </option>
<option value="The Kostroma Area"> The Kostroma Area </option>
<option value="The Kurgan Area"> The Kurgan Area </option>
<option value="The Kursk Area"> The Kursk Area </option>
<option value="The Leningrad Area"> The Leningrad Area </option>
<option value="The Lipetsk Area"> The Lipetsk Area </option>
<option value="The Magadan Area"> The Magadan Area </option>
<option value="The Moscow Area"> The Moscow Area </option>
<option value="The Murmansk Area"> The Murmansk Area </option>
<option value="The Nizhniy Novgorod"> The Nizhniy Novgorod </option>
<option value="The Novgorod Area"> The Novgorod Area </option>
<option value="The Novosibirsk Area"> The Novosibirsk Area </option>
<option value="The Omsk Area"> The Omsk Area </option>
<option value="The Orenburg Area"> The Orenburg Area </option>
<option value="The Oryol Area"> The Oryol Area </option>
<option value="The Penza Area"> The Penza Area </option>
<option value="The Perm Area"> The Perm Area </option>
<option value="The Pskov Area"> The Pskov Area </option>
<option value="The Rostov Area"> The Rostov Area </option>
<option value="The Ryazan Area"> The Ryazan Area </option>
<option value="The Samara Area"> The Samara Area </option>
<option value="The Saratov Area"> The Saratov Area </option>
<option value="The Sakhalin Area"> The Sakhalin Area </option>
<option value="The Sverdlovsk Area"> The Sverdlovsk Area </option>
<option value="The Smolensk Area"> The Smolensk Area </option>
<option value="The Tambov Area"> The Tambov Area </option>
<option value="The Tver Area"> The Tver Area </option>
<option value="The Tomsk Area"> The Tomsk Area </option>
<option value="The Tula Area"> The Tula Area </option>
<option value="The Tyumen Area"> The Tyumen Area </option>
<option value="The Ulyanovsk Area"> The Ulyanovsk Area </option>
<option value="The Chelyabinsk Area"> The Chelyabinsk Area </option>
<option value="The Chita Area"> The Chita Area </option>
<option value="The Yaroslavl Area"> The Yaroslavl Area </option>
<option value="c.Moscow"> c.Moscow </option>
<option value="c.St-Peterburg"> c.St-Peterburg </option>
<option value="The Jewish Auton.are"> The Jewish Auton.are </option>
<option value="Zabaykalskly Kray"> Zabaykalskly Kray </option>
<option value="Komy Permjats.Aut.di"> Komy Permjats.Aut.di </option>
<option value="Korjacs Auton.distri"> Korjacs Auton.distri </option>
<option value="Nenekchky Auton.dist"> Nenekchky Auton.dist </option>
<option value="The Taymir Auton.dis"> The Taymir Auton.dis </option>
<option value="Ust-Ordinsky Buryat"> Ust-Ordinsky Buryat </option>
<option value="Chanti-Mansyjsky Aut"> Chanti-Mansyjsky Aut </option>
<option value="Chukotka Auton. dist"> Chukotka Auton. dist </option>
<option value="Evensky Auton.distri"> Evensky Auton.distri </option>
<option value="Jamalo-Nenekchky Aut"> Jamalo-Nenekchky Aut </option>
<option value="Trans-Baikal Territ."> Trans-Baikal Territ. </option>
<option value=""> -- Saudi Arabia -- </option>
<option value=""> Select One </option>
<option value="Ar Riyad"> Ar Riyad </option>
<option value="Makkah al Mukarramah"> Makkah al Mukarramah </option>
<option value="Munawwarah"> Munawwarah </option>
<option value="Al Qasim"> Al Qasim </option>
<option value="Ha' il"> Ha' il </option>
<option value="Tabuk"> Tabuk </option>
<option value="Shamaliyah"> Shamaliyah </option>
<option value="Jazan"> Jazan </option>
<option value="Najran"> Najran </option>
<option value="Al Bahah"> Al Bahah </option>
<option value="Al Jawf"> Al Jawf </option>
<option value="'Asir"> 'Asir </option>
<option value=""> -- Serbia -- </option>
<option value=""> Select One </option>
<option value="Beograd"> Beograd </option>
<option value="Severnobacki okrug"> Severnobacki okrug </option>
<option value="Srednjebanatski okru"> Srednjebanatski okru </option>
<option value="Severnobanatski okru"> Severnobanatski okru </option>
<option value="Juznobanatski okrug"> Juznobanatski okrug </option>
<option value="Zapadnobacki okrug"> Zapadnobacki okrug </option>
<option value="Juznobacki okrug"> Juznobacki okrug </option>
<option value="Sremski okrug"> Sremski okrug </option>
<option value="Macvanski okrug"> Macvanski okrug </option>
<option value="Kolubarski okrug"> Kolubarski okrug </option>
<option value="Podunavski okrug"> Podunavski okrug </option>
<option value="Branicevski okrug"> Branicevski okrug </option>
<option value="Sumadijski okrug"> Sumadijski okrug </option>
<option value="Pomoravski okrug"> Pomoravski okrug </option>
<option value="Borski okrug"> Borski okrug </option>
<option value="Zajecarski okrug"> Zajecarski okrug </option>
<option value="Zlatiborski okrug"> Zlatiborski okrug </option>
<option value="Moravicki okrug"> Moravicki okrug </option>
<option value="Raski okrug"> Raski okrug </option>
<option value="Rasinski okrug"> Rasinski okrug </option>
<option value="Nisavski okrug"> Nisavski okrug </option>
<option value="Toplicki okrug"> Toplicki okrug </option>
<option value="Pirotski okrug"> Pirotski okrug </option>
<option value="Jablanicki okrug"> Jablanicki okrug </option>
<option value="Pcinjski okrug"> Pcinjski okrug </option>
<option value="Kosovski okrug"> Kosovski okrug </option>
<option value="Pecki okrug"> Pecki okrug </option>
<option value="Prizrenski okrug"> Prizrenski okrug </option>
<option value="Kosovsko-Mitrovacki"> Kosovsko-Mitrovacki </option>
<option value="Kosovsko-Pomoravski"> Kosovsko-Pomoravski </option>
<option value="Kosovo-Metohija"> Kosovo-Metohija </option>
<option value="Vojvodina"> Vojvodina </option>
<option value=""> -- Singapore -- </option>
<option value=""> Select One </option>
<option value="Singapore"> Singapore </option>
<option value=""> -- Slovenia -- </option>
<option value=""> Select One </option>
<option value="Ajdovscina"> Ajdovscina </option>
<option value="Brezice"> Brezice </option>
<option value="Celje"> Celje </option>
<option value="Cerknica"> Cerknica </option>
<option value="Crnomelj"> Crnomelj </option>
<option value="Dravograd"> Dravograd </option>
<option value="Gornja Radgona"> Gornja Radgona </option>
<option value="Grosuplje"> Grosuplje </option>
<option value="Hrastnik Lasko"> Hrastnik Lasko </option>
<option value="Idrija"> Idrija </option>
<option value="Ilirska Bistrica"> Ilirska Bistrica </option>
<option value="Izola"> Izola </option>
<option value="Jesenice"> Jesenice </option>
<option value="Kamnik"> Kamnik </option>
<option value="Kocevje"> Kocevje </option>
<option value="Koper"> Koper </option>
<option value="Kranj"> Kranj </option>
<option value="Krsko"> Krsko </option>
<option value="Lenart"> Lenart </option>
<option value="Lendava"> Lendava </option>
<option value="Litija"> Litija </option>
<option value="Ljubljana-Bezigrad"> Ljubljana-Bezigrad </option>
<option value="Ljubljana-Center"> Ljubljana-Center </option>
<option value="Ljubljana-Moste-Polj"> Ljubljana-Moste-Polj </option>
<option value="Ljubljana-Siska"> Ljubljana-Siska </option>
<option value="Ljubljana-Vic-Rudnik"> Ljubljana-Vic-Rudnik </option>
<option value="Ljutomer"> Ljutomer </option>
<option value="Logatec"> Logatec </option>
<option value="Maribor"> Maribor </option>
<option value="Metlika"> Metlika </option>
<option value="Mozirje"> Mozirje </option>
<option value="Murska Sobota"> Murska Sobota </option>
<option value="Nova Gorica"> Nova Gorica </option>
<option value="Novo Mesto"> Novo Mesto </option>
<option value="Ormoz"> Ormoz </option>
<option value="Pesnica"> Pesnica </option>
<option value="Piran"> Piran </option>
<option value="Postojna"> Postojna </option>
<option value="Ptuj"> Ptuj </option>
<option value="Radlje Ob Dravi"> Radlje Ob Dravi </option>
<option value="Radovljica"> Radovljica </option>
<option value="Ravne Na Koroskem"> Ravne Na Koroskem </option>
<option value="Ribnica"> Ribnica </option>
<option value="Sentjur Pri Celju"> Sentjur Pri Celju </option>
<option value="Sevnica"> Sevnica </option>
<option value="Sezana"> Sezana </option>
<option value="Skofja Loka"> Skofja Loka </option>
<option value="Slovenj Gradec"> Slovenj Gradec </option>
<option value="Slovenska Bistrica"> Slovenska Bistrica </option>
<option value="Slovenske Konjice"> Slovenske Konjice </option>
<option value="Smarje Pri Jelsah"> Smarje Pri Jelsah </option>
<option value="Tolmin"> Tolmin </option>
<option value="Trbovlje"> Trbovlje </option>
<option value="Trebnje"> Trebnje </option>
<option value="Trzic"> Trzic </option>
<option value="Velenje"> Velenje </option>
<option value="Vrhnika"> Vrhnika </option>
<option value="Zagorje Ob Savi"> Zagorje Ob Savi </option>
<option value="Zalec"> Zalec </option>
<option value=""> -- Slovakia -- </option>
<option value=""> Select One </option>
<option value="Bratislava"> Bratislava </option>
<option value="Zapadoslovensky"> Zapadoslovensky </option>
<option value="Stredoslovensky"> Stredoslovensky </option>
<option value="Vychodoslovensky"> Vychodoslovensky </option>
<option value=""> -- South Africa -- </option>
<option value=""> Select One </option>
<option value="Eastern Cape"> Eastern Cape </option>
<option value="Freestate"> Freestate </option>
<option value="Gauteng"> Gauteng </option>
<option value="Kwazulu/Natal"> Kwazulu/Natal </option>
<option value="Mpumalanga"> Mpumalanga </option>
<option value="Northern Cape"> Northern Cape </option>
<option value="Northern Province"> Northern Province </option>
<option value="North-West"> North-West </option>
<option value="Western Cape"> Western Cape </option>
<option value=""> -- Spain -- </option>
<option value=""> Select One </option>
<option value="Alicante"> Alicante </option>
<option value="Albacete"> Albacete </option>
<option value="Almeria"> Almeria </option>
<option value="Andalucia"> Andalucia </option>
<option value="Aragon"> Aragon </option>
<option value="Avila"> Avila </option>
<option value="Barcelona"> Barcelona </option>
<option value="Badajoz"> Badajoz </option>
<option value="Vizcaya"> Vizcaya </option>
<option value="Burgos"> Burgos </option>
<option value="A Coruna"> A Coruna </option>
<option value="Cadiz"> Cadiz </option>
<option value="Caceres"> Caceres </option>
<option value="Ceuta"> Ceuta </option>
<option value="Castilla y Leon"> Castilla y Leon </option>
<option value="Castilla-La Mancha"> Castilla-La Mancha </option>
<option value="Canarias"> Canarias </option>
<option value="Ciudad Real"> Ciudad Real </option>
<option value="Castellon"> Castellon </option>
<option value="Cataluna"> Cataluna </option>
<option value="Cuenca"> Cuenca </option>
<option value="Extremadura"> Extremadura </option>
<option value="Galicia"> Galicia </option>
<option value="Las Palmas"> Las Palmas </option>
<option value="Girona"> Girona </option>
<option value="Guadalajara"> Guadalajara </option>
<option value="Huelva"> Huelva </option>
<option value="Huesca"> Huesca </option>
<option value="Illes Belears"> Illes Belears </option>
<option value="Canary Islands"> Canary Islands </option>
<option value="Jaen"> Jaen </option>
<option value="Lleida"> Lleida </option>
<option value="Leon"> Leon </option>
<option value="Lugo"> Lugo </option>
<option value="Madrid"> Madrid </option>
<option value="Malaga"> Malaga </option>
<option value="Murcia"> Murcia </option>
<option value="Melilla"> Melilla </option>
<option value="Murcia Region de"> Murcia Region de </option>
<option value="Navarra"> Navarra </option>
<option value="Asturias"> Asturias </option>
<option value="Orense"> Orense </option>
<option value="Palencia"> Palencia </option>
<option value="Baleares"> Baleares </option>
<option value="Pontevedra"> Pontevedra </option>
<option value="Pais Vasco"> Pais Vasco </option>
<option value="Cantabria"> Cantabria </option>
<option value="Salamanca"> Salamanca </option>
<option value="Sevilla"> Sevilla </option>
<option value="Segovia"> Segovia </option>
<option value="Soria"> Soria </option>
<option value="Guipuzcoa"> Guipuzcoa </option>
<option value="Tarragona"> Tarragona </option>
<option value="Teruel"> Teruel </option>
<option value="Sta. Cruz Tenerife"> Sta. Cruz Tenerife </option>
<option value="Toledo"> Toledo </option>
<option value="Valencia"> Valencia </option>
<option value="Valladolid"> Valladolid </option>
<option value="Valenciana, Comunida"> Valenciana, Comunida </option>
<option value="Alava"> Alava </option>
<option value="Zaragoza"> Zaragoza </option>
<option value="Zamora"> Zamora </option>
<option value=""> -- Sri Lanka -- </option>
<option value=""> Select One </option>
<option value="Basnahira paḷata"> Basnahira paḷata </option>
<option value="Koḷamba"> Koḷamba </option>
<option value="Gampaha"> Gampaha </option>
<option value="Kalutara"> Kalutara </option>
<option value="Madhyama paḷata"> Madhyama paḷata </option>
<option value="Mahanuvara"> Mahanuvara </option>
<option value="Matale"> Matale </option>
<option value="Nuvara Eliya"> Nuvara Eliya </option>
<option value="Dakuṇu paḷata"> Dakuṇu paḷata </option>
<option value="Galla"> Galla </option>
<option value="Matara"> Matara </option>
<option value="Hambantota"> Hambantota </option>
<option value="Uturu paḷata"> Uturu paḷata </option>
<option value="Yapanaya"> Yapanaya </option>
<option value="Kilinochchi"> Kilinochchi </option>
<option value="Mannarama"> Mannarama </option>
<option value="Vavuniyava"> Vavuniyava </option>
<option value="Mulativ"> Mulativ </option>
<option value="Mattiya makaṇam"> Mattiya makaṇam </option>
<option value="Madakalapuva"> Madakalapuva </option>
<option value="Ampara"> Ampara </option>
<option value="Trikuṇamalaya"> Trikuṇamalaya </option>
<option value="Vayamba paḷata"> Vayamba paḷata </option>
<option value="Kurunegala"> Kurunegala </option>
<option value="Puttalama"> Puttalama </option>
<option value="Vatamattiya makanam"> Vatamattiya makanam </option>
<option value="Anuradhapura"> Anuradhapura </option>
<option value="Poḷonnaruva"> Poḷonnaruva </option>
<option value="Uva paḷata"> Uva paḷata </option>
<option value="Badulla"> Badulla </option>
<option value="Moṇaragala"> Moṇaragala </option>
<option value="Sabaragamuva paḷata"> Sabaragamuva paḷata </option>
<option value="Ratnapura"> Ratnapura </option>
<option value="Kegalla"> Kegalla </option>
<option value=""> -- Sweden -- </option>
<option value=""> Select One </option>
<option value="Blekinge County"> Blekinge County </option>
<option value="Dalarnas County"> Dalarnas County </option>
<option value="Gotland County"> Gotland County </option>
<option value="Gaevleborg County"> Gaevleborg County </option>
<option value="Halland County"> Halland County </option>
<option value="Jaemtland County"> Jaemtland County </option>
<option value="Joenkoeping County"> Joenkoeping County </option>
<option value="Kalmar County"> Kalmar County </option>
<option value="Kronoberg County"> Kronoberg County </option>
<option value="Norrbotten County"> Norrbotten County </option>
<option value="Skaane County"> Skaane County </option>
<option value="Stockholm County"> Stockholm County </option>
<option value="Soedermanland County"> Soedermanland County </option>
<option value="Uppsala County"> Uppsala County </option>
<option value="Vaermland County"> Vaermland County </option>
<option value="Vaesterbotten County"> Vaesterbotten County </option>
<option value="Vaesternorrland Cnty"> Vaesternorrland Cnty </option>
<option value="Vaestmanland County"> Vaestmanland County </option>
<option value="Vaestra Goetaland C."> Vaestra Goetaland C. </option>
<option value="Oerebro County"> Oerebro County </option>
<option value="Oestergoetland Cnty"> Oestergoetland Cnty </option>
<option value=""> -- Switzerland - German -- </option>
<option value=""> Select One </option>
<option value="Aargau"> Aargau </option>
<option value="Inner-Rhoden"> Inner-Rhoden </option>
<option value="Ausser-Rhoden"> Ausser-Rhoden </option>
<option value="Bern"> Bern </option>
<option value="Basel Land"> Basel Land </option>
<option value="Basel Stadt"> Basel Stadt </option>
<option value="Fribourg"> Fribourg </option>
<option value="Geneva"> Geneva </option>
<option value="Glarus"> Glarus </option>
<option value="Graubuenden"> Graubuenden </option>
<option value="Lucerne"> Lucerne </option>
<option value="Neuchatel"> Neuchatel </option>
<option value="Nidwalden"> Nidwalden </option>
<option value="Obwalden"> Obwalden </option>
<option value="St. Gallen"> St. Gallen </option>
<option value="Schaffhausen"> Schaffhausen </option>
<option value="Solothurn"> Solothurn </option>
<option value="Schwyz"> Schwyz </option>
<option value="Thurgau"> Thurgau </option>
<option value="Ticino"> Ticino </option>
<option value="Uri"> Uri </option>
<option value="Vaud"> Vaud </option>
<option value="Valais"> Valais </option>
<option value="Zug"> Zug </option>
<option value="Zurich"> Zurich </option>
<option value=""> -- Switzerland - French -- </option>
<option value=""> Select One </option>
<option value=""> -- Taiwan -- </option>
<option value=""> Select One </option>
<option value="East"> East </option>
<option value="Fu-chien"> Fu-chien </option>
<option value="Islands"> Islands </option>
<option value="Kao-hsiung"> Kao-hsiung </option>
<option value="North"> North </option>
<option value="South"> South </option>
<option value="T'ai-pei"> T'ai-pei </option>
<option value="Taiwan"> Taiwan </option>
<option value=""> -- Thailand -- </option>
<option value=""> Select One </option>
<option value="Amnat Charoen"> Amnat Charoen </option>
<option value="Ang Thong"> Ang Thong </option>
<option value="Buriram"> Buriram </option>
<option value="Chachoengsao"> Chachoengsao </option>
<option value="Chai Nat"> Chai Nat </option>
<option value="Chaiyaphum"> Chaiyaphum </option>
<option value="Chanthaburi"> Chanthaburi </option>
<option value="Chiang Mai"> Chiang Mai </option>
<option value="Chiang Rai"> Chiang Rai </option>
<option value="Chon Buri"> Chon Buri </option>
<option value="Chumphon"> Chumphon </option>
<option value="Kalasin"> Kalasin </option>
<option value="Kamphaeng Phet"> Kamphaeng Phet </option>
<option value="Kanchanaburi"> Kanchanaburi </option>
<option value="Khon Kaen"> Khon Kaen </option>
<option value="Krabi"> Krabi </option>
<option value="Krung Thep"> Krung Thep </option>
<option value="Mahanakhon"> Mahanakhon </option>
<option value="Lampang"> Lampang </option>
<option value="Lamphun"> Lamphun </option>
<option value="Loei"> Loei </option>
<option value="Lop Buri"> Lop Buri </option>
<option value="Mae Hong Son"> Mae Hong Son </option>
<option value="Maha Sarakham"> Maha Sarakham </option>
<option value="Mukdahan"> Mukdahan </option>
<option value="Nakhon Nayok"> Nakhon Nayok </option>
<option value="Nakhon Pathom"> Nakhon Pathom </option>
<option value="Nakhon Phanom"> Nakhon Phanom </option>
<option value="Nakhon Ratchasima"> Nakhon Ratchasima </option>
<option value="Nakhon Sawan"> Nakhon Sawan </option>
<option value="Nakhon Si Thammarat"> Nakhon Si Thammarat </option>
<option value="Nan"> Nan </option>
<option value="Narathiwat"> Narathiwat </option>
<option value="Nong Bua Lamphu"> Nong Bua Lamphu </option>
<option value="Nong Khai"> Nong Khai </option>
<option value="Nonthaburi"> Nonthaburi </option>
<option value="Pathum Thani"> Pathum Thani </option>
<option value="Pattani"> Pattani </option>
<option value="Phangnga"> Phangnga </option>
<option value="Phatthalung"> Phatthalung </option>
<option value="Phayao"> Phayao </option>
<option value="Phetchabun"> Phetchabun </option>
<option value="Phetchaburi"> Phetchaburi </option>
<option value="Phichit"> Phichit </option>
<option value="Phitsanulok"> Phitsanulok </option>
<option value="Phra Nakhon Si Ayut."> Phra Nakhon Si Ayut. </option>
<option value="Phrae"> Phrae </option>
<option value="Phuket"> Phuket </option>
<option value="Prachin Buri"> Prachin Buri </option>
<option value="Prachuap Khiri Khan"> Prachuap Khiri Khan </option>
<option value="Ranong"> Ranong </option>
<option value="Ratchaburi"> Ratchaburi </option>
<option value="Rayong"> Rayong </option>
<option value="Roi Et"> Roi Et </option>
<option value="Sa Kaeo"> Sa Kaeo </option>
<option value="Sakon Nakhon"> Sakon Nakhon </option>
<option value="Samut Prakan"> Samut Prakan </option>
<option value="Samut Sakhon"> Samut Sakhon </option>
<option value="Samut Songkhram"> Samut Songkhram </option>
<option value="Saraburi"> Saraburi </option>
<option value="Satun"> Satun </option>
<option value="Si Sa Ket"> Si Sa Ket </option>
<option value="Sing Buri"> Sing Buri </option>
<option value="Songkhla"> Songkhla </option>
<option value="Sukhothai"> Sukhothai </option>
<option value="Suphan Buri"> Suphan Buri </option>
<option value="Surat Thani"> Surat Thani </option>
<option value="Surin"> Surin </option>
<option value="Tak"> Tak </option>
<option value="Trang"> Trang </option>
<option value="Trat"> Trat </option>
<option value="Ubon Ratchathani"> Ubon Ratchathani </option>
<option value="Udon Thani"> Udon Thani </option>
<option value="Uthai Thani"> Uthai Thani </option>
<option value="Uttaradit"> Uttaradit </option>
<option value="Yala"> Yala </option>
<option value="Yasothon"> Yasothon </option>
<option value=""> -- Trinidad and Tobago -- </option>
<option value=""> Select One </option>
<option value="Arima"> Arima </option>
<option value="Chaguanas"> Chaguanas </option>
<option value="CTTRC"> CTTRC </option>
<option value="Diego Martin"> Diego Martin </option>
<option value="Eastern Tobago"> Eastern Tobago </option>
<option value="Penal-Debe"> Penal-Debe </option>
<option value="Port of Spain"> Port of Spain </option>
<option value="Princes Town"> Princes Town </option>
<option value="Point Fortin"> Point Fortin </option>
<option value="Rio Claro-Mayaro"> Rio Claro-Mayaro </option>
<option value="San Fernando"> San Fernando </option>
<option value="Sangre Grande"> Sangre Grande </option>
<option value="Siparia"> Siparia </option>
<option value="San Juan-Laventille"> San Juan-Laventille </option>
<option value="Tunapuna-Piarco"> Tunapuna-Piarco </option>
<option value="Western Tobago"> Western Tobago </option>
<option value=""> -- Tunisia -- </option>
<option value=""> Select One </option>
<option value="Tunis"> Tunis </option>
<option value="Ariana"> Ariana </option>
<option value="Ben Arous"> Ben Arous </option>
<option value="La Manouba"> La Manouba </option>
<option value="Nabeul"> Nabeul </option>
<option value="Zaghouan"> Zaghouan </option>
<option value="Bizerte"> Bizerte </option>
<option value="Jendouba"> Jendouba </option>
<option value="Le Kef"> Le Kef </option>
<option value="Siliana"> Siliana </option>
<option value="Kairouan"> Kairouan </option>
<option value="Kasserine"> Kasserine </option>
<option value="Sidi Bouzid"> Sidi Bouzid </option>
<option value="Sousse"> Sousse </option>
<option value="Monastir"> Monastir </option>
<option value="Mahdia"> Mahdia </option>
<option value="Sfax"> Sfax </option>
<option value="Gafsa"> Gafsa </option>
<option value="Tozeur"> Tozeur </option>
<option value="Kebili"> Kebili </option>
<option value="Gabes"> Gabes </option>
<option value="Medenine"> Medenine </option>
<option value="Tataouine"> Tataouine </option>
<option value=""> -- Turkey -- </option>
<option value=""> Select One </option>
<option value="Adana"> Adana </option>
<option value="Adiyaman"> Adiyaman </option>
<option value="Afyonkarahisar"> Afyonkarahisar </option>
<option value="Agri"> Agri </option>
<option value="Amasya"> Amasya </option>
<option value="Ankara"> Ankara </option>
<option value="Antalya"> Antalya </option>
<option value="Artvin"> Artvin </option>
<option value="Aydin"> Aydin </option>
<option value="Balikesir"> Balikesir </option>
<option value="Bilecik"> Bilecik </option>
<option value="Bingöl"> Bingöl </option>
<option value="Bitlis"> Bitlis </option>
<option value="Bolu"> Bolu </option>
<option value="Burdur"> Burdur </option>
<option value="Bursa"> Bursa </option>
<option value="Canakkale"> Canakkale </option>
<option value="Cankiri"> Cankiri </option>
<option value="Corum"> Corum </option>
<option value="Denizli"> Denizli </option>
<option value="Diyarbakir"> Diyarbakir </option>
<option value="Edirne"> Edirne </option>
<option value="Elazig"> Elazig </option>
<option value="Erzincan"> Erzincan </option>
<option value="Erzurum"> Erzurum </option>
<option value="Eskisehir"> Eskisehir </option>
<option value="Gaziantep"> Gaziantep </option>
<option value="Giresun"> Giresun </option>
<option value="Guemueshane"> Guemueshane </option>
<option value="Hakkari"> Hakkari </option>
<option value="Hatay"> Hatay </option>
<option value="Isparta"> Isparta </option>
<option value="Mersin"> Mersin </option>
<option value="Istanbul"> Istanbul </option>
<option value="Izmir"> Izmir </option>
<option value="Kars"> Kars </option>
<option value="Kastamonu"> Kastamonu </option>
<option value="Kayseri"> Kayseri </option>
<option value="Kirklareli"> Kirklareli </option>
<option value="Kirshehir"> Kirshehir </option>
<option value="Kocaeli"> Kocaeli </option>
<option value="Konya"> Konya </option>
<option value="Kuetahya"> Kuetahya </option>
<option value="Malatya"> Malatya </option>
<option value="Manisa"> Manisa </option>
<option value="Kahramanmaras"> Kahramanmaras </option>
<option value="Mardin"> Mardin </option>
<option value="Mugla"> Mugla </option>
<option value="Mush"> Mush </option>
<option value="Nevshehir"> Nevshehir </option>
<option value="Nigde"> Nigde </option>
<option value="Ordu"> Ordu </option>
<option value="Rize"> Rize </option>
<option value="Sakarya"> Sakarya </option>
<option value="Samsun"> Samsun </option>
<option value="Siirt"> Siirt </option>
<option value="Sinop"> Sinop </option>
<option value="Sivas"> Sivas </option>
<option value="Tekirdag"> Tekirdag </option>
<option value="Tokat"> Tokat </option>
<option value="Trabzon"> Trabzon </option>
<option value="Tunceli"> Tunceli </option>
<option value="Shanliurfa"> Shanliurfa </option>
<option value="Ushak"> Ushak </option>
<option value="Van"> Van </option>
<option value="Yozgat"> Yozgat </option>
<option value="Zonguldak"> Zonguldak </option>
<option value="Aksaray"> Aksaray </option>
<option value="Bayburt"> Bayburt </option>
<option value="Karaman"> Karaman </option>
<option value="Kirikkale"> Kirikkale </option>
<option value="Batman"> Batman </option>
<option value="Shirnak"> Shirnak </option>
<option value="Bartin"> Bartin </option>
<option value="Ardahan"> Ardahan </option>
<option value="Igdir"> Igdir </option>
<option value="Yalova"> Yalova </option>
<option value="Karabuk"> Karabuk </option>
<option value="Kilis"> Kilis </option>
<option value="Osmaniye"> Osmaniye </option>
<option value="Duzce"> Duzce </option>
<option value=""> -- Ukraine -- </option>
<option value=""> Select One </option>
<option value="Kyiv"> Kyiv </option>
<option value="Sevastopol"> Sevastopol </option>
<option value="Lvivska"> Lvivska </option>
<option value="Chernigivs'ka"> Chernigivs'ka </option>
<option value="Cherkas'ka"> Cherkas'ka </option>
<option value="Chernovits'ka"> Chernovits'ka </option>
<option value="Dnipropetrovs'ka"> Dnipropetrovs'ka </option>
<option value="Donets'ka"> Donets'ka </option>
<option value="Harkivs'ka"> Harkivs'ka </option>
<option value="Hmel'nits'ka"> Hmel'nits'ka </option>
<option value="Hersons'ka"> Hersons'ka </option>
<option value="Ivano-Frankivs'ka"> Ivano-Frankivs'ka </option>
<option value="Kievs'ka"> Kievs'ka </option>
<option value="Kirovograds'ka"> Kirovograds'ka </option>
<option value="Respublika Krim"> Respublika Krim </option>
<option value="Lugans'ka"> Lugans'ka </option>
<option value="L'vivsbka"> L'vivsbka </option>
<option value="Mikolaivs'ka"> Mikolaivs'ka </option>
<option value="m.Kiev"> m.Kiev </option>
<option value="m.Sevastopil'"> m.Sevastopil' </option>
<option value="Odes'ka"> Odes'ka </option>
<option value="Poltavs'ka"> Poltavs'ka </option>
<option value="Rivnens'ka"> Rivnens'ka </option>
<option value="Sums'ka"> Sums'ka </option>
<option value="Ternopil's'ka"> Ternopil's'ka </option>
<option value="Vinnits'ka"> Vinnits'ka </option>
<option value="Volins'ka"> Volins'ka </option>
<option value="Zakarpats'ka"> Zakarpats'ka </option>
<option value="Zaporiz'ka"> Zaporiz'ka </option>
<option value="Zhitomirs'ka"> Zhitomirs'ka </option>
<option value=""> -- United Arab Emirates -- </option>
<option value=""> Select One </option>
<option value="Ajman"> Ajman </option>
<option value="Abu Dhabi"> Abu Dhabi </option>
<option value="Dubai"> Dubai </option>
<option value="Fujairah"> Fujairah </option>
<option value="Ras al-Khaimah"> Ras al-Khaimah </option>
<option value="Sharjah"> Sharjah </option>
<option value="Umm al-Quwain"> Umm al-Quwain </option>
<option value=""> -- United Kingdom -- </option>
<option value=""> Select One </option>
<option value="Aberdeenshire"> Aberdeenshire </option>
<option value="Argyllshire"> Argyllshire </option>
<option value="Anglesey"> Anglesey </option>
<option value="Armagh"> Armagh </option>
<option value="Angus/Forfarshire"> Angus/Forfarshire </option>
<option value="Antrim"> Antrim </option>
<option value="Ayrshire"> Ayrshire </option>
<option value="Bedfordshire"> Bedfordshire </option>
<option value="Banffshire"> Banffshire </option>
<option value="Berkshire"> Berkshire </option>
<option value="Brecknockshire"> Brecknockshire </option>
<option value="Bath&NthEstSomerset"> Bath&NthEstSomerset </option>
<option value="Buteshire"> Buteshire </option>
<option value="Buckinghamshire"> Buckinghamshire </option>
<option value="Berwickshire"> Berwickshire </option>
<option value="Cambridgeshire"> Cambridgeshire </option>
<option value="Carmarthenshire"> Carmarthenshire </option>
<option value="Cardiganshire"> Cardiganshire </option>
<option value="Caernarfonshire"> Caernarfonshire </option>
<option value="Cheshire"> Cheshire </option>
<option value="Cromartyshire"> Cromartyshire </option>
<option value="Clackmannanshire"> Clackmannanshire </option>
<option value="Cornwall"> Cornwall </option>
<option value="Caithness"> Caithness </option>
<option value="Cumberland"> Cumberland </option>
<option value="Derbyshire"> Derbyshire </option>
<option value="Denbighshire"> Denbighshire </option>
<option value="Dumfriesshire"> Dumfriesshire </option>
<option value="Down"> Down </option>
<option value="Dorset"> Dorset </option>
<option value="Dunbartonshire"> Dunbartonshire </option>
<option value="Durham"> Durham </option>
<option value="Devon"> Devon </option>
<option value="East Lothian"> East Lothian </option>
<option value="Essex"> Essex </option>
<option value="Fife"> Fife </option>
<option value="Flintshire"> Flintshire </option>
<option value="Fermanagh"> Fermanagh </option>
<option value="Alderney"> Alderney </option>
<option value="Guernsey"> Guernsey </option>
<option value="Gloucestershire"> Gloucestershire </option>
<option value="Hampshire"> Hampshire </option>
<option value="Hertfordshire"> Hertfordshire </option>
<option value="Huntingdonshire"> Huntingdonshire </option>
<option value="Hereford and Worcs."> Hereford and Worcs. </option>
<option value="Invernesshire"> Invernesshire </option>
<option value="Isle of Wight"> Isle of Wight </option>
<option value="Jersey"> Jersey </option>
<option value="Kent"> Kent </option>
<option value="Kincardineshire"> Kincardineshire </option>
<option value="Kirkcudbrightshire"> Kirkcudbrightshire </option>
<option value="Kinross-shire"> Kinross-shire </option>
<option value="Lancashire"> Lancashire </option>
<option value="Londonderry"> Londonderry </option>
<option value="Leicestershire"> Leicestershire </option>
<option value="Lincolnshire"> Lincolnshire </option>
<option value="Lanarkshire"> Lanarkshire </option>
<option value="Midlothian"> Midlothian </option>
<option value="Merioneth"> Merioneth </option>
<option value="Mid Glamorgan"> Mid Glamorgan </option>
<option value="Monmouthshire"> Monmouthshire </option>
<option value="Morayshire"> Morayshire </option>
<option value="Montgomeryshire"> Montgomeryshire </option>
<option value="Middlesex"> Middlesex </option>
<option value="Northamptonshire"> Northamptonshire </option>
<option value="Norfolk"> Norfolk </option>
<option value="Nairnshire"> Nairnshire </option>
<option value="Nottinghamshire"> Nottinghamshire </option>
<option value="Northumberland"> Northumberland </option>
<option value="Orkney"> Orkney </option>
<option value="Oxfordshire"> Oxfordshire </option>
<option value="Peeblesshire"> Peeblesshire </option>
<option value="Pembrokeshire"> Pembrokeshire </option>
<option value="Perthshire"> Perthshire </option>
<option value="Radnorshire"> Radnorshire </option>
<option value="Renfrewshire"> Renfrewshire </option>
<option value="Ross-shire"> Ross-shire </option>
<option value="Rutland"> Rutland </option>
<option value="Roxburghshire"> Roxburghshire </option>
<option value="East Sussex"> East Sussex </option>
<option value="Selkirkshire"> Selkirkshire </option>
<option value="South Glamorgan"> South Glamorgan </option>
<option value="Shropshire"> Shropshire </option>
<option value="Suffolk"> Suffolk </option>
<option value="Shetland"> Shetland </option>
<option value="Somerset"> Somerset </option>
<option value="Staffordshire"> Staffordshire </option>
<option value="Sutherland"> Sutherland </option>
<option value="Stirlingshire"> Stirlingshire </option>
<option value="West Sussex"> West Sussex </option>
<option value="Surrey"> Surrey </option>
<option value="Tyrone"> Tyrone </option>
<option value="Warwickshire"> Warwickshire </option>
<option value="Worcestershire"> Worcestershire </option>
<option value="Westmorland"> Westmorland </option>
<option value="West Glamorgan"> West Glamorgan </option>
<option value="Wiltshire"> Wiltshire </option>
<option value="West Lothian"> West Lothian </option>
<option value="Wigtownshire"> Wigtownshire </option>
<option value="North Yorkshire"> North Yorkshire </option>
<option value="South Yorkshire"> South Yorkshire </option>
<option value="West Yorkshire"> West Yorkshire </option>
<option value=""> -- United States -- </option>
<option value=""> Select One </option>
<option value="Alaska"> Alaska </option>
<option value="Alabama"> Alabama </option>
<option value="Arkansas"> Arkansas </option>
<option value="American Samoa"> American Samoa </option>
<option value="Arizona"> Arizona </option>
<option value="California"> California </option>
<option value="Colorado"> Colorado </option>
<option value="Connecticut"> Connecticut </option>
<option value="District of Columbia"> District of Columbia </option>
<option value="Delaware"> Delaware </option>
<option value="Florida"> Florida </option>
<option value="Georgia"> Georgia </option>
<option value="Guam"> Guam </option>
<option value="Hawaii"> Hawaii </option>
<option value="Iowa"> Iowa </option>
<option value="Idaho"> Idaho </option>
<option value="Illinois"> Illinois </option>
<option value="Indiana"> Indiana </option>
<option value="Kansas"> Kansas </option>
<option value="Kentucky"> Kentucky </option>
<option value="Louisiana"> Louisiana </option>
<option value="Massachusetts"> Massachusetts </option>
<option value="Maryland"> Maryland </option>
<option value="Maine"> Maine </option>
<option value="Marshall Islands"> Marshall Islands </option>
<option value="Michigan"> Michigan </option>
<option value="Minnesota"> Minnesota </option>
<option value="Missouri"> Missouri </option>
<option value="Montana"> Montana </option>
<option value="Northern Mariana Islands"> Northern Mariana Islands </option>
<option value="Mississippi"> Mississippi </option>
<option value="North Carolina"> North Carolina </option>
<option value="North Dakota"> North Dakota </option>
<option value="Nebraska"> Nebraska </option>
<option value="New Hampshire"> New Hampshire </option>
<option value="New Jersey"> New Jersey </option>
<option value="New Mexico"> New Mexico </option>
<option value="Nevada"> Nevada </option>
<option value="New York"> New York </option>
<option value="Ohio"> Ohio </option>
<option value="Oklahoma"> Oklahoma </option>
<option value="Oregon"> Oregon </option>
<option value="Pennsylvania"> Pennsylvania </option>
<option value="Puerto Rico"> Puerto Rico </option>
<option value="Palau"> Palau </option>
<option value="Rhode Island"> Rhode Island </option>
<option value="South Carolina"> South Carolina </option>
<option value="South Dakota"> South Dakota </option>
<option value="Tennessee"> Tennessee </option>
<option value="Texas"> Texas </option>
<option value="Utah"> Utah </option>
<option value="Virginia"> Virginia </option>
<option value="US Virgin Islands"> US Virgin Islands </option>
<option value="Vermont"> Vermont </option>
<option value="Washington"> Washington </option>
<option value="Wisconsin"> Wisconsin </option>
<option value="West Virginia"> West Virginia </option>
<option value="Wyoming"> Wyoming </option>
<option value=""> -- Uruguay -- </option>
<option value=""> Select One </option>
<option value="Artigas"> Artigas </option>
<option value="Canelones"> Canelones </option>
<option value="Cerro Largo"> Cerro Largo </option>
<option value="Colonia"> Colonia </option>
<option value="Durazno"> Durazno </option>
<option value="Flores"> Flores </option>
<option value="Lavalleja"> Lavalleja </option>
<option value="Maldonado"> Maldonado </option>
<option value="Montevideo"> Montevideo </option>
<option value="Paysandu"> Paysandu </option>
<option value="Rocha"> Rocha </option>
<option value="Rivera"> Rivera </option>
<option value="Salto"> Salto </option>
<option value="San Jose"> San Jose </option>
<option value="Soriano"> Soriano </option>
<option value="Tacuarembo"> Tacuarembo </option>
<option value="Treinta y Tres"> Treinta y Tres </option>
<option value=""> -- Venezuela -- </option>
<option value=""> Select One </option>
<option value="Anzoategui"> Anzoategui </option>
<option value="Apure"> Apure </option>
<option value="Aragua"> Aragua </option>
<option value="Barinas"> Barinas </option>
<option value="Bolivar"> Bolivar </option>
<option value="Carabobo"> Carabobo </option>
<option value="Cojedes"> Cojedes </option>
<option value="Delta Amacuro"> Delta Amacuro </option>
<option value="Falcon"> Falcon </option>
<option value="Guarico"> Guarico </option>
<option value="Lara"> Lara </option>
<option value="Merida"> Merida </option>
<option value="Miranda"> Miranda </option>
<option value="Monagas"> Monagas </option>
<option value="Nueva Esparta"> Nueva Esparta </option>
<option value="Portuguesa"> Portuguesa </option>
<option value="Tachira"> Tachira </option>
<option value="Trujillo"> Trujillo </option>
<option value="Vargas"> Vargas </option>
<option value="Yaracuy"> Yaracuy </option>
<option value="Zulia"> Zulia </option>
<option value=""> -- Vietnam -- </option>
<option value=""> Select One </option>
<option value="Lai Chau"> Lai Chau </option>
<option value="Lao Cai"> Lao Cai </option>
<option value="Ha Giang"> Ha Giang </option>
<option value="Cao Bang"> Cao Bang </option>
<option value="Son La"> Son La </option>
<option value="Yen Bai"> Yen Bai </option>
<option value="Tuyen Quang"> Tuyen Quang </option>
<option value="Lang Son"> Lang Son </option>
<option value="Quang Ninh"> Quang Ninh </option>
<option value="Hoa Binh"> Hoa Binh </option>
<option value="Ha Tay"> Ha Tay </option>
<option value="Ninh Binh"> Ninh Binh </option>
<option value="Thai Binh"> Thai Binh </option>
<option value="Thanh Hoa"> Thanh Hoa </option>
<option value="Nghe An"> Nghe An </option>
<option value="Ha Tinh"> Ha Tinh </option>
<option value="Quang Binh"> Quang Binh </option>
<option value="Quang Tri"> Quang Tri </option>
<option value="Thua Thien-Hue"> Thua Thien-Hue </option>
<option value="Quang Nam"> Quang Nam </option>
<option value="Kon Tum"> Kon Tum </option>
<option value="Quang Ngai"> Quang Ngai </option>
<option value="Gia Lai"> Gia Lai </option>
<option value="Binh Dinh"> Binh Dinh </option>
<option value="Phu Yen"> Phu Yen </option>
<option value="Dak Lak"> Dak Lak </option>
<option value="Khanh Hoa"> Khanh Hoa </option>
<option value="Lam Dong"> Lam Dong </option>
<option value="Ninh Thuan"> Ninh Thuan </option>
<option value="Tay Ninh"> Tay Ninh </option>
<option value="Dong Nai"> Dong Nai </option>
<option value="Binh Thuan"> Binh Thuan </option>
<option value="Long An"> Long An </option>
<option value="Ba Ria-Vung Tau"> Ba Ria-Vung Tau </option>
<option value="An Giang"> An Giang </option>
<option value="Dong Thap"> Dong Thap </option>
<option value="Tien Giang"> Tien Giang </option>
<option value="Kien Giang"> Kien Giang </option>
<option value="Vinh Long"> Vinh Long </option>
<option value="Ben Tre"> Ben Tre </option>
<option value="Tra Vinh"> Tra Vinh </option>
<option value="Soc Trang"> Soc Trang </option>
<option value="Bac Can"> Bac Can </option>
<option value="Bac Giang"> Bac Giang </option>
<option value="Bac Lieu"> Bac Lieu </option>
<option value="Bac Ninh"> Bac Ninh </option>
<option value="Binh Duong"> Binh Duong </option>
<option value="Binh Phuoc"> Binh Phuoc </option>
<option value="Ca Mau"> Ca Mau </option>
<option value="Hai Duong"> Hai Duong </option>
<option value="Ha Nam"> Ha Nam </option>
<option value="Hung Yen"> Hung Yen </option>
<option value="Nam Dinh"> Nam Dinh </option>
<option value="Phu Tho"> Phu Tho </option>
<option value="Thai Nguyen"> Thai Nguyen </option>
<option value="Vinh Phuc"> Vinh Phuc </option>
<option value="Dien Bien"> Dien Bien </option>
<option value="Dak Nong"> Dak Nong </option>
<option value="Hau Giang"> Hau Giang </option>
<option value="Can Tho"> Can Tho </option>
<option value="Da Nang"> Da Nang </option>
<option value="Ha Noi"> Ha Noi </option>
<option value="Hai Phong"> Hai Phong </option>
<option value="Ho Chi Minh"> Ho Chi Minh </option>
<option value=""> -- Yemen -- </option>
<option value=""> Select One </option>
</select>
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<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, the Democratic Republic of the">Congo, the Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Dutch Antilles">Dutch Antilles</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea - Republic of">Korea - Republic of</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, the former Yugoslav Republic of">Macedonia, the former Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Korea">North Korea</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine">Palestine</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="Samoa, American">Samoa, American</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten">Sint Maarten</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, US">Virgin Islands, US</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
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</li>
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Delhi Lakshadweep Pondicherry Chhaattisgarh Jharkhand Uttaranchal Odisha
Puducherry Uttarakhand -- Indodesia -- Select One DKI Jakarta Jakarta Jawa
Barat West Java Jawa Tengah Central Jawa Timur East Java DI Yogyakarta Yogyak
DI Aceh Aceh Sumatera Utara North Sumatera Barat West Riau Riau Jambi Jambi
Sumatera Selatan Sou Bengkulu Bengkulu Lampung Lampung Kalimantan Selatan S
Kalimantan Barat Wes Kalimantan Tengah Ce Kalimantan Timur Eas Sulawesi
Selatan Sou Sulawesi Tenggara So Sulawesi Tengah Cent Sulawesi Utara North
Bali Bali Maluku Maluku Irian Jaya Irian Jay Timor Timur East Tim Aceh Bali
Bangka Belitung Bengkulu Banten Gorontalo Jambi Jawa Barat Jawa Timur Jakarta
Raya Jawa Tengah Kalimantan Barat Kalimantan Timur Kepulauan Riau Kalimantan
Selatan Kalimantan Tengah Lampung Maluku Maluku Utara Nusa Tenggara Barat
Nusa Tenggara Timur Papua Papua Barat Riau Sulawesi Utara Sumatera Barat
Sulawesi Tenggara Sulawesi Selatan Sulawesi Barat Sumatera Selatan Sulawesi
Tengah Sumatera Utara Yogyakarta -- Ireland -- Select One Cork Clare Cavan
Carlow Dublin Donegal Galway Kildare Kilkenny Kerry Longford Limerick Leitrim
Laois Louth Monaghan Meath Mayo Offaly Roscommon Sligo Tipperary Waterford
Wicklow Westmeath Wexford -- Israel -- Select One Central Haifa Jerusalem
Northern Southern Tel Aviv -- Italy -- Select One Agrigento Alessandria
Ancona Aosta Ascoli Piceno L'Aquila Arezzo Asti Avellino Bari Bergamo Biella
Belluno Benevento Bologna Brindisi Brescia Barletta-Andria-Tran Bolzano
Cagliari Campobasso Caserta Chieti Carbonia-Iglesias Caltanissetta Cuneo Como
Cremona Cosenza Catania Catanzaro Stati Esteri Enna Forli-Cesena Ferrara
Foggia Firenze Fermo Frosinone Fiume Genova Gorizia Grosseto Imperia Isernia
Crotone Lecco Lecce Livorno Lodi Latina Lucca Monza e Brianza Macerata
Messina Milano Mantova Modena Massa-Carrara Matera Napoli Novara Nuoro
Ogliastra Oristano Olbia-Tempio Palermo Piacenza Padova Pescara Perugia Pisa
Pola Pordenone Prato Parma Pistoia Pesaro e Urbino Pavia Potenza Ravenna
Reggio Calabria Reggio Emilia Ragusa Rieti Roma Rimini Rovigo Salerno Siena
Sondrio La Spezia Siracusa Sassari Savona Taranto Teramo Trento Torino
Trapani Terni Trieste Treviso Udine Varese Verbano-Cusio-Ossola Vercelli
Venezia Vicenza Verona Medio Campidano Viterbo Vibo Valentia Zara -- Jamaica
-- Select One Kingston Saint Andrew Saint Thomas Portland Saint Mary Saint
Ann Trelawny Saint James Hanover Westmoreland Saint Elizabeth Manchester
Clarendon Saint Catherine -- Japan -- Select One Hokkaido Aomori Iwate Miyagi
Akita Yamagata Fukushima Ibaraki Tochigi Gunma Saitama Chiba Tokyo Kanagawa
Niigata Toyama Ishikawa Fukui Yamanashi Nagano Gifu Shizuoka Aichi Mie Shiga
Kyoto Osaka Hyogo Nara Wakayama Tottori Shimane Okayama Hiroshima Yamaguchi
Tokushima Kagawa Ehime Kochi Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki
Kagoshima Okinawa -- Kenya -- Select One Baringo Bomet Bungoma Busia
Elgeyo/Marakwet Embu Garissa Homa Bay Isiolo Kajiado Kakamega Kericho Kiambu
Kilifi Kirinyaga Kisii Kisumu Kitui Kwale Laikipia Lamu Machakos Makueni
Mandera Marsabit Meru Migori Mombasa Murang'a Nairobi City Nakuru Nandi Narok
Nyamira Nyandarua Nyeri Samburu Siaya Taita/Taveta Tana River Tharaka-Nithi
Trans Nzoia Turkana Uasin Gishu Vihiga Wajir West Pokot -- Korea -- Select
One Cheju-do Cholla-bukto Cholla-namdo Ch'ungch'ong-bukto Ch'ungch'ong-namdo
Inch'on-jikhalsi Kangwon-do Kwangju-jikhalsi Kyonggi-do Kyongsang-bukto Seoul
Pusan-jikhalsi Soul-t'ukpyolsi Taegu-jikhalsi Taejon-jikhalsi Busan Daegu
Incheon Gwangju Daejeon Ulsan Gyeonggi-do Gangwon-do Chungcheongbuk-do
Chungcheongnam-do Jeollabuk-do Jeollanam-do Gyeongsangbuk-do Gyeongsangnam-do
Jejudo Sejong -- Kazakhstan -- Select One Almatynskaia Kostanaiskaia
Severo-Kazakhstansk Pavlodarskaia Akmolinskaia Aktubinskaia Atyrauskaia
Zapadno-Kazakhst Mangystayskaia Karagandinskaia Vostochno-Kazakhstan
Gambilskaia Kyzilordinskaia -- Latvia -- Select One Aglonas novads
Aizkraukles novads Aizputes novads Aknistes novads Alojas novads Alsungas
novads Aluksnes novads Amatas novads Apes novads Auces novads Adazu novads
Babites novads Baldones novads Baltinavas novads Balvu novads Bauskas novads
Beverinas novads Brocenu novads Burtnieku novads Carnikavas novads Cesvaines
novads Cesu novads Ciblas novads Dagdas novads Daugavpils novads Dobeles
novads Dundagas novads Durbes novads Engures novads Erglu novads Garkalnes
novads Grobinas novads Gulbenes novads Iecavas novads Ikskiles novads
Ilukstes novads Incukalna novads Jaunjelgavas novads Jaunpiebalgas novads
Jaunpils novads Jelgavas novads Jekabpils novads Kandavas novads Karsavas
novads Kocenu novads Kokneses novads Kraslavas novads Krimuldas novads
Krustpils novads Kuldigas novads Keguma novads Kekavas novads Lielvardes
novads Limbazu novads Ligatnes novads Livanu novads Lubanas novads Ludzas
novads Madonas novads Mazsalacas novads Malpils novads Marupes novads
Mersraga novads Nauksenu novads Neretas novads Nicas novads Ogres novads
Olaines novads Ozolnieku novads Pargaujas novads Pavilostas novads Plavinu
novads Preilu novads Priekules novads Priekulu novads Raunas novads Rezeknes
novads Riebinu novads Rojas novads Ropazu novads Rucavas novads Rugaju novads
Rundales novads Rujienas novads Salas novads Salacgrivas novads Salaspils
novads Saldus novads Saulkrastu novads Sejas novads Siguldas novads Skriveru
novads Skrundas novads Smiltenes novads Stopinu novads Strencu novads Talsu
novads Tervetes novads Tukuma novads Vainodes novads Valkas novads Varaklanu
novads Varkavas novads Vecpiebalgas novads Vecumnieku novads Ventspils novads
Viesites novads Vilakas novads Vilanu novads Zilupes novads Daugavpils
Jelgava Jekabpils Jurmala Liepaja Rezekne Riga Ventspils Valmiera -- Lebanon
-- Select One Akkar Ash Shimal Bayrut B'alabak-Al Hirmil Al Biqa Al Janub
Jabal Lubnan An Nabatiyah -- Lithuania -- Select One Akmene Alytaus miestas
Alytus Anyksciai Birstono Birzai Druskininkai Elektrenai Ignalina Jonava
Joniskis Jurbarkas Kaisiadorys Kalvarijos Kauno miestas Kaunas Kazlu Rudos
Kedainiai Kelme Klaipedos miestas Klaipeda Kretinga Kupiskis Lazdijai
Marijampole Mazeikiai Moletai Neringa Pagegiai Pakruojis Palangos miestas
Panevezio miestas Panevezys Pasvalys Plunge Prienai Radviliskis Raseiniai
Rietavo Rokiskis Sakiai Salcininkai Siauliu miestas Siauliai Silale Silute
Sirvintos Skuodas Svencionys Taurage Telsiai Trakai Ukmerge Utena Varena
Vilkaviskis Vilniaus miestas Vilnius Visaginas Zarasai Alytaus Apskritis
Klaipedos Apskritis Kauno Apskritis Marijampoles Panevezio Apskritis Siauliu
Apskritis Taurages Apskritis Telsiu Apskritis Utenos Apskritis Vilniaus
Apskritis -- Luxembourg -- Select One Diekirich Grevenmacher -- Malaysia --
Select One Putrajaya Johor Kedah Kelantan Kuala Lumpur Labuan Melaka Pahang
Perlis Perak Pulau Pinang Wil. Persekutuan Sabah Sarawak Selangor Negeri
Sembilan Terengganu -- Mexico -- Select One Aguascalientes Baja California
Baja California Sur Campeche Chiapas Chihuahua Coahuila Colima Distrito
Federal Durango Guanajuato Guerrero Hidalgo Jalisco Estado de México
Michoacán Morelos Nayarit Nuevo León Oaxaca Puebla Querétaro Quintana Roo San
Luis Potosí Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatán
Zacatecas -- Montenegro -- Select One Andrijevica Bar Berane Bijelo Polje
Budva Cetinje Danilovgrad Herceg-Novi Kolasin Kotor Mojkovac Niksic Plav
Pljevlja Pluzine Podgorica Rozaje Savnik Tivat Ulcinj Zabljak -- Morocco --
Select One Tanger-Tetouan Gharb-Chrarda Taza-Al HT L'Oriental Fes-Boulemane
Meknes-Tafilalet Rabat-Sale Grand Casablanca Chaouia-Ouardigha Doukhala-Abda
Marrakech-Tensift Tadla-Azilal Sous-Massa-Draa Guelmim-Es Semara
Laayoune-Boujdour Dahab-Lagouira Agadir Aousserd Assa-Zag Azilal Beni Mellal
Berkane Ben Slimane Boujdour Boulemane Casablanca Chefchaouene Chichaoua
Chtouka-Ait Baha Errachidia Essaouira Es Smara Fahs-Beni Makada
Fes-Dar-Dbibegh Figuig Guelmim El Hajeb Al Haouz Al Hoceima Ifrane
Inezgane-Ait Melloul El Jadida Jrada Kenitra Kelaat Sraghna Khemisset
Khenifra Khouribga Laayoune Larache Mediouna Meknes Marrakech-Medina
Marrakech-Menara Mohammadia Moulay Yacoub Nador Nouaceur Ouarzazate Oued ed
Dahab Oujda-Angad Rabat Safi Sale Sefrou Settat Sidi Kacem Skhirate-Temara
Sidi Youssef Ben Ali Taourirt Taounate Taroudannt Tata Taza Tetouan Tiznit
Tanger-Assilah Tan-Tan Zagora -- Netherlands -- Select One Drenthe Flevoland
Friesland Gelderland Groningen Noord-Brabant Noord-Holland Overijssel Utrecht
Zeeland Zuid-Holland -- New Zealand -- Select One Auckland Bay of Plenty
Canterbury Hawke's Bay Manawatu-Wanganui Northland Otago Southland Taranaki
Waikato West Coast Wellington -- Nicaragua -- Select One Boaco Carazo
Chinandega Chontales Estelí Granada Jinotega León Madriz Managua Masaya
Matagalpa Nueva Segovia Rivas Río San Juan -- Nigeria -- Select One Abia
Adamawa Akwa Anambra Bauchi Benue Borno Bayelsa Cross River Delta Ebonyi Edo
Ekiti Enugu Federal Capital Terr Gombe Imo Jigawa Kaduna Kebbi Kano Kogi
Katsina Kwara Lagos Nassarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto
Taraba Yobe Zamfara -- Norway -- Select One Ostfold County Akershus County
Oslo Hedmark County Oppland County Buskerud County Vestfold County Telemark
County Aust-Agder County Vest-Agder County Rogaland County Hordaland County
Sogn og Fjordane C. More og Romsdal C. Sor-Trondelag County Nord-Trondelag
Cnty Nordland County Troms County Finnmark County -- Oman -- Select One Al
Batinah Al Buraymi Ad Dakhiliyah Masqat Musandam Al Wusta Az Zahirah Zufar --
Pakistan -- Select One Balochistan Gilgit-Baltistan Islamabad Azad Kashmir
Khyber Pakhtunkhwa Sindh FedAdmin TribalAreas -- Panama -- Select One Bocas
del Toro Coclé Chiriquí Darién Herrera Los Santos Panamá Veraguas -- Paraguay
-- Select One -- Peru -- Select One Tumbes Piura Lambayeque Ancash Lima y
Callao Ica Arequipa Moquegua Tacna Amazon Cajamarca San Martin Huanuco Pasco
Junin Huancavelica Ayacucho Apurimac Cuzco Puno Loreto Ucayali Madre de Dios
-- Philippines -- Select One National Capital Reg Ilocos Cagayan Valley
Central Luzon South Luzon Bicol Western Visayas Central Visayas Eastern
Visayas Zamboanga Peninsula Northern Mindanao Davao Soccsksargen Caraga
Autonomous rgn in Mu Cordillera Administr Calabarzon Mimaropa -- Poland --
Select One Dolnoslaskie Kujawsko-Pomorskie Lubelskie Lubuskie Lodzkie
Malopolskie Mazowieckie Opolskie Podkarpackie Podlaskie Pomorskie Slaskie
Swietokrzyskie Wielkopolskie Warminsko-mazurskie Zachodniopomorskie --
Portugal -- Select One Aveiro Beja Braga Braganca Castelo Branco Coimbra
Evora Faro Guarda Leiria Minho-Lima Lisboa Cavado Portalegre Ave Porto
Santarem Tamega Setubal Entre Douro e Vouga Viana do Castelo Douro Vila Real
Alto Tras-os-Montes Viseu Autonoma dos Acores Baixo Vouga Baixo Mondego
Pinhal Litoral Pinhal Interior N. Pinhal Interior Sul Dao-Lafoes Serra da
Estrela Beira Interior Norte Beira Interior Sul Cova da Beira Autonoma da
Madeira Oeste Grande Lisboa Peninsula de Setubal Medio Tejo Leziria do Tejo
Alentejo Litoral Alto Alentejo Alentejo Central Baixo Alentejo Algarve --
Qatar -- Select One Ad Dawhah Al Khawr wa adh Dhak Ash Shamal Ar Rayyan Umm
Salal Al Wakrah Az Za'ayin -- Romania -- Select One Alba Arad Arges Bacau
Bihor Bistrita-Nasaud Botosani Braila Brasov Bucuresti Buzau Calarasi
Caras-Severin Cluj Constanta Covasna Dambovita Dolj Galati Gorj Giurgiu
Harghita Hunedoara Ialomita Iasi Maramures Mehedinti Mures Neamt Olt Prahova
Salaj Satu Mare Sibiu Suceava Teleorman Timis Tulcea Vaslui Valcea Vrancea --
Russian Federation -- Select One Adygeya Republic Highlands-Altay Rep.
Republ.of Bashkortos Buryatiya Republic Dagestan Republic Ingushetija
Republic Kabardino-Balkar.Rep Kalmyk Republic Karach.-Cherkessk Re Karelian
Republic Komi Republic Marijskaya Republic Mordovian Republic Yakutiya-Saha
Rrepub North-Osetiya Republ Tatarstan Republic Tuva Republic The Udmurt
Republic Chakassky Republic Chechenskaya Republ. Chuvash Republic Altay
Republic Krasnodar Territory Krasnoyarsk Territor Primorye Territory
Stavropol Territory Khabarovsk Territory The Amur Area The Arkhangelsk Area
The Astrakhan Area The Belgorod Area The Bryansk Area The Vladimir Area The
Volgograd Area The Vologda Area The Voronezh Area The Ivanovo Area The
Irkutsk Area The Kaliningrad Area The Kaluga Area The Kamchatka Area The
Kemerovo Area The Kirov Area The Kostroma Area The Kurgan Area The Kursk Area
The Leningrad Area The Lipetsk Area The Magadan Area The Moscow Area The
Murmansk Area The Nizhniy Novgorod The Novgorod Area The Novosibirsk Area The
Omsk Area The Orenburg Area The Oryol Area The Penza Area The Perm Area The
Pskov Area The Rostov Area The Ryazan Area The Samara Area The Saratov Area
The Sakhalin Area The Sverdlovsk Area The Smolensk Area The Tambov Area The
Tver Area The Tomsk Area The Tula Area The Tyumen Area The Ulyanovsk Area The
Chelyabinsk Area The Chita Area The Yaroslavl Area c.Moscow c.St-Peterburg
The Jewish Auton.are Zabaykalskly Kray Komy Permjats.Aut.di Korjacs
Auton.distri Nenekchky Auton.dist The Taymir Auton.dis Ust-Ordinsky Buryat
Chanti-Mansyjsky Aut Chukotka Auton. dist Evensky Auton.distri
Jamalo-Nenekchky Aut Trans-Baikal Territ. -- Saudi Arabia -- Select One Ar
Riyad Makkah al Mukarramah Munawwarah Al Qasim Ha' il Tabuk Shamaliyah Jazan
Najran Al Bahah Al Jawf 'Asir -- Serbia -- Select One Beograd Severnobacki
okrug Srednjebanatski okru Severnobanatski okru Juznobanatski okrug
Zapadnobacki okrug Juznobacki okrug Sremski okrug Macvanski okrug Kolubarski
okrug Podunavski okrug Branicevski okrug Sumadijski okrug Pomoravski okrug
Borski okrug Zajecarski okrug Zlatiborski okrug Moravicki okrug Raski okrug
Rasinski okrug Nisavski okrug Toplicki okrug Pirotski okrug Jablanicki okrug
Pcinjski okrug Kosovski okrug Pecki okrug Prizrenski okrug
Kosovsko-Mitrovacki Kosovsko-Pomoravski Kosovo-Metohija Vojvodina --
Singapore -- Select One Singapore -- Slovenia -- Select One Ajdovscina
Brezice Celje Cerknica Crnomelj Dravograd Gornja Radgona Grosuplje Hrastnik
Lasko Idrija Ilirska Bistrica Izola Jesenice Kamnik Kocevje Koper Kranj Krsko
Lenart Lendava Litija Ljubljana-Bezigrad Ljubljana-Center
Ljubljana-Moste-Polj Ljubljana-Siska Ljubljana-Vic-Rudnik Ljutomer Logatec
Maribor Metlika Mozirje Murska Sobota Nova Gorica Novo Mesto Ormoz Pesnica
Piran Postojna Ptuj Radlje Ob Dravi Radovljica Ravne Na Koroskem Ribnica
Sentjur Pri Celju Sevnica Sezana Skofja Loka Slovenj Gradec Slovenska
Bistrica Slovenske Konjice Smarje Pri Jelsah Tolmin Trbovlje Trebnje Trzic
Velenje Vrhnika Zagorje Ob Savi Zalec -- Slovakia -- Select One Bratislava
Zapadoslovensky Stredoslovensky Vychodoslovensky -- South Africa -- Select
One Eastern Cape Freestate Gauteng Kwazulu/Natal Mpumalanga Northern Cape
Northern Province North-West Western Cape -- Spain -- Select One Alicante
Albacete Almeria Andalucia Aragon Avila Barcelona Badajoz Vizcaya Burgos A
Coruna Cadiz Caceres Ceuta Castilla y Leon Castilla-La Mancha Canarias Ciudad
Real Castellon Cataluna Cuenca Extremadura Galicia Las Palmas Girona
Guadalajara Huelva Huesca Illes Belears Canary Islands Jaen Lleida Leon Lugo
Madrid Malaga Murcia Melilla Murcia Region de Navarra Asturias Orense
Palencia Baleares Pontevedra Pais Vasco Cantabria Salamanca Sevilla Segovia
Soria Guipuzcoa Tarragona Teruel Sta. Cruz Tenerife Toledo Valencia
Valladolid Valenciana, Comunida Alava Zaragoza Zamora -- Sri Lanka -- Select
One Basnahira paḷata Koḷamba Gampaha Kalutara Madhyama paḷata Mahanuvara
Matale Nuvara Eliya Dakuṇu paḷata Galla Matara Hambantota Uturu paḷata
Yapanaya Kilinochchi Mannarama Vavuniyava Mulativ Mattiya makaṇam
Madakalapuva Ampara Trikuṇamalaya Vayamba paḷata Kurunegala Puttalama
Vatamattiya makanam Anuradhapura Poḷonnaruva Uva paḷata Badulla Moṇaragala
Sabaragamuva paḷata Ratnapura Kegalla -- Sweden -- Select One Blekinge County
Dalarnas County Gotland County Gaevleborg County Halland County Jaemtland
County Joenkoeping County Kalmar County Kronoberg County Norrbotten County
Skaane County Stockholm County Soedermanland County Uppsala County Vaermland
County Vaesterbotten County Vaesternorrland Cnty Vaestmanland County Vaestra
Goetaland C. Oerebro County Oestergoetland Cnty -- Switzerland - German --
Select One Aargau Inner-Rhoden Ausser-Rhoden Bern Basel Land Basel Stadt
Fribourg Geneva Glarus Graubuenden Lucerne Neuchatel Nidwalden Obwalden St.
Gallen Schaffhausen Solothurn Schwyz Thurgau Ticino Uri Vaud Valais Zug
Zurich -- Switzerland - French -- Select One -- Taiwan -- Select One East
Fu-chien Islands Kao-hsiung North South T'ai-pei Taiwan -- Thailand -- Select
One Amnat Charoen Ang Thong Buriram Chachoengsao Chai Nat Chaiyaphum
Chanthaburi Chiang Mai Chiang Rai Chon Buri Chumphon Kalasin Kamphaeng Phet
Kanchanaburi Khon Kaen Krabi Krung Thep Mahanakhon Lampang Lamphun Loei Lop
Buri Mae Hong Son Maha Sarakham Mukdahan Nakhon Nayok Nakhon Pathom Nakhon
Phanom Nakhon Ratchasima Nakhon Sawan Nakhon Si Thammarat Nan Narathiwat Nong
Bua Lamphu Nong Khai Nonthaburi Pathum Thani Pattani Phangnga Phatthalung
Phayao Phetchabun Phetchaburi Phichit Phitsanulok Phra Nakhon Si Ayut. Phrae
Phuket Prachin Buri Prachuap Khiri Khan Ranong Ratchaburi Rayong Roi Et Sa
Kaeo Sakon Nakhon Samut Prakan Samut Sakhon Samut Songkhram Saraburi Satun Si
Sa Ket Sing Buri Songkhla Sukhothai Suphan Buri Surat Thani Surin Tak Trang
Trat Ubon Ratchathani Udon Thani Uthai Thani Uttaradit Yala Yasothon --
Trinidad and Tobago -- Select One Arima Chaguanas CTTRC Diego Martin Eastern
Tobago Penal-Debe Port of Spain Princes Town Point Fortin Rio Claro-Mayaro
San Fernando Sangre Grande Siparia San Juan-Laventille Tunapuna-Piarco
Western Tobago -- Tunisia -- Select One Tunis Ariana Ben Arous La Manouba
Nabeul Zaghouan Bizerte Jendouba Le Kef Siliana Kairouan Kasserine Sidi
Bouzid Sousse Monastir Mahdia Sfax Gafsa Tozeur Kebili Gabes Medenine
Tataouine -- Turkey -- Select One Adana Adiyaman Afyonkarahisar Agri Amasya
Ankara Antalya Artvin Aydin Balikesir Bilecik Bingöl Bitlis Bolu Burdur Bursa
Canakkale Cankiri Corum Denizli Diyarbakir Edirne Elazig Erzincan Erzurum
Eskisehir Gaziantep Giresun Guemueshane Hakkari Hatay Isparta Mersin Istanbul
Izmir Kars Kastamonu Kayseri Kirklareli Kirshehir Kocaeli Konya Kuetahya
Malatya Manisa Kahramanmaras Mardin Mugla Mush Nevshehir Nigde Ordu Rize
Sakarya Samsun Siirt Sinop Sivas Tekirdag Tokat Trabzon Tunceli Shanliurfa
Ushak Van Yozgat Zonguldak Aksaray Bayburt Karaman Kirikkale Batman Shirnak
Bartin Ardahan Igdir Yalova Karabuk Kilis Osmaniye Duzce -- Ukraine -- Select
One Kyiv Sevastopol Lvivska Chernigivs'ka Cherkas'ka Chernovits'ka
Dnipropetrovs'ka Donets'ka Harkivs'ka Hmel'nits'ka Hersons'ka
Ivano-Frankivs'ka Kievs'ka Kirovograds'ka Respublika Krim Lugans'ka L'vivsbka
Mikolaivs'ka m.Kiev m.Sevastopil' Odes'ka Poltavs'ka Rivnens'ka Sums'ka
Ternopil's'ka Vinnits'ka Volins'ka Zakarpats'ka Zaporiz'ka Zhitomirs'ka --
United Arab Emirates -- Select One Ajman Abu Dhabi Dubai Fujairah Ras
al-Khaimah Sharjah Umm al-Quwain -- United Kingdom -- Select One
Aberdeenshire Argyllshire Anglesey Armagh Angus/Forfarshire Antrim Ayrshire
Bedfordshire Banffshire Berkshire Brecknockshire Bath&NthEstSomerset
Buteshire Buckinghamshire Berwickshire Cambridgeshire Carmarthenshire
Cardiganshire Caernarfonshire Cheshire Cromartyshire Clackmannanshire
Cornwall Caithness Cumberland Derbyshire Denbighshire Dumfriesshire Down
Dorset Dunbartonshire Durham Devon East Lothian Essex Fife Flintshire
Fermanagh Alderney Guernsey Gloucestershire Hampshire Hertfordshire
Huntingdonshire Hereford and Worcs. Invernesshire Isle of Wight Jersey Kent
Kincardineshire Kirkcudbrightshire Kinross-shire Lancashire Londonderry
Leicestershire Lincolnshire Lanarkshire Midlothian Merioneth Mid Glamorgan
Monmouthshire Morayshire Montgomeryshire Middlesex Northamptonshire Norfolk
Nairnshire Nottinghamshire Northumberland Orkney Oxfordshire Peeblesshire
Pembrokeshire Perthshire Radnorshire Renfrewshire Ross-shire Rutland
Roxburghshire East Sussex Selkirkshire South Glamorgan Shropshire Suffolk
Shetland Somerset Staffordshire Sutherland Stirlingshire West Sussex Surrey
Tyrone Warwickshire Worcestershire Westmorland West Glamorgan Wiltshire West
Lothian Wigtownshire North Yorkshire South Yorkshire West Yorkshire -- United
States -- Select One Alaska Alabama Arkansas American Samoa Arizona
California Colorado Connecticut District of Columbia Delaware Florida Georgia
Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana
Massachusetts Maryland Maine Marshall Islands Michigan Minnesota Missouri
Montana Northern Mariana Islands Mississippi North Carolina North Dakota
Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma
Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina South
Dakota Tennessee Texas Utah Virginia US Virgin Islands Vermont Washington
Wisconsin West Virginia Wyoming -- Uruguay -- Select One Artigas Canelones
Cerro Largo Colonia Durazno Flores Lavalleja Maldonado Montevideo Paysandu
Rocha Rivera Salto San Jose Soriano Tacuarembo Treinta y Tres -- Venezuela --
Select One Anzoategui Apure Aragua Barinas Bolivar Carabobo Cojedes Delta
Amacuro Falcon Guarico Lara Merida Miranda Monagas Nueva Esparta Portuguesa
Tachira Trujillo Vargas Yaracuy Zulia -- Vietnam -- Select One Lai Chau Lao
Cai Ha Giang Cao Bang Son La Yen Bai Tuyen Quang Lang Son Quang Ninh Hoa Binh
Ha Tay Ninh Binh Thai Binh Thanh Hoa Nghe An Ha Tinh Quang Binh Quang Tri
Thua Thien-Hue Quang Nam Kon Tum Quang Ngai Gia Lai Binh Dinh Phu Yen Dak Lak
Khanh Hoa Lam Dong Ninh Thuan Tay Ninh Dong Nai Binh Thuan Long An Ba
Ria-Vung Tau An Giang Dong Thap Tien Giang Kien Giang Vinh Long Ben Tre Tra
Vinh Soc Trang Bac Can Bac Giang Bac Lieu Bac Ninh Binh Duong Binh Phuoc Ca
Mau Hai Duong Ha Nam Hung Yen Nam Dinh Phu Tho Thai Nguyen Vinh Phuc Dien
Bien Dak Nong Hau Giang Can Tho Da Nang Ha Noi Hai Phong Ho Chi Minh -- Yemen
-- Select One
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problems around the world.
1. United States
2. Health Care
3. Medical
4. Solutions
5. Peripheral IV Complications
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PERIPHERAL IV COMPLICATIONS
--------------------------------------------------------------------------------
MAKE PERIPHERALS A CENTRAL FOCUS
STAY INFORMED
Peripheral intravenous (PIV) access is often considered a simple, low-risk
procedure, when in fact:
* Up to 90% of patients require a PIV during their hospital stay.¹
* Up to 47% of CLABSIs occurred in patients with multiple lines- including
PIVs.²
* There are 165,000 potential PIV-related bloodstream infections per year in
the US.³
* Cost of treating PIV failure-related complications can add 7–20 hospital days
with total costs reaching up to $2.3 billion in US ICUs alone each year.⁴
--------------------------------------------------------------------------------
* PIV Clinical Evidence Summary (PDF, 336.89 KB)
Find out just how widespread PIVC failure is in the six-study clinical
evidence summary.
VIEW THE EVIDENCE (PDF, 336.89 KB)
* PIV Resource Guide (PDF, 4.47 MB)
Get fast facts on PIVCs and learn about evidence-based best practice bundles
for catheter insertion, maintenance and removal in this 12-page guide.
DOWNLOAD THE RESOURCE GUIDE (PDF, 4.47 MB)
--------------------------------------------------------------------------------
THREE KEYS TO PREVENTING PIV COMPLICATIONS
* As your trusted partner in protecting patients, we share your goal of
reducing the risk of PIV complications. And we want to do everything in our
power to help you achieve it.
We believe there are three keys to reaching this goal: people, practice,
and products. It’s an effort that requires exacting standards of care, a
commitment from the care team to methodically adhere to those standards, and
technology that adds an additional layer of protection.
--------------------------------------------------------------------------------
TRAINED & COMMITTED PEOPLE
Preventing bloodstream infections takes training and commitment. Learn more
about 3M resources to help clinicians ensure proper protocols are followed for
every patient, every time.
* 3M™ Peak™ Clinical Outcomes Program
The 3M™ Peak™ Clinical Outcomes Program provides you with the resources and
partnership you need to define and achieve the outcomes most important to
you, your patients and your organization.
LEARN MORE
* 3M℠ Health Care Academy
3M℠ Health Care Academy offers free, quality educational content in a
flexible online format. Choose from more than 50 CE credit courses to support
your professional development, including courses on bloodstream infection
prevention.
LEARN MORE
* Read our Blog: Tranforming Outcomes
Insights on skin, complications prevention and patient care.
LEARN MORE
CURRENT BEST PRACTICE STANDARDS
BEST PRACTICES FOR INFUSION THERAPY.
The Infusion Nurses Society (INS) is a global authority on infusion therapy,
setting stringent standards for practice. Every five years, INS releases
updated, peer-reviewed standards that reflect the latest evidence to define and
develop best practices for all clinical settings. 3M can help you stay up to
date so you can help deliver better patient outcomes.
SEE SELECT HIGHLIGHTS
EFFECTIVE & PROVEN TECHNOLOGY
3M’s evidence-based antimicrobial product offerings protect against both
extraluminal and intraluminal contamination of PIVs. When properly deployed,
these antimicrobial solutions offer another line of defense against potential
contamination.
* 3M™ Tegaderm™ CHG Chlorhexidine Gluconate I.V. Securement Dressings
* 3M™ Curos™ Disinfecting Port Protectors
--------------------------------------------------------------------------------
* 3M™ Tegaderm™ CHG Chlorhexidine Gluconate I.V. Securement Dressing
* 3M™ Tegaderm™ Antimicrobial I.V. Advanced Securement Dressing
* 3M™ Tegaderm™ I.V. Advanced Securement Dressing
--------------------------------------------------------------------------------
* 3M™ Cavilon™ No Sting Barrier Film
* 3M™ Micropore™ S Surgical Tape (individually packaged, single-patient-use
roll)
--------------------------------------------------------------------------------
RESOURCES
* Peripheral IV Care Solutions Brochure (PDF, 1.28 MB)
Learn how to reduce the risk of peripheral IV complications at all access
points and make peripherals a central focus of your IV care program.
* Request a PIV Sample Kit
Connect with a 3M Representative to receive a sample of the solutions that
address peripheral IV needs.
--------------------------------------------------------------------------------
IV CARE NEWS
Stay up to date on IV care news, education and events
Resolence Morthy Gread
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REFERENCES
* 1. Helm RE, Klausner JD, Klemperer JD, et al. Accepted but unacceptable:
peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189-203
2. DeVries M, Mancos P, Valentine MJ. Reducing bloodstream infection risk in
central and peripheral intravenous lines: Initial data on passive intravenous
connector disinfection. J Assoc Vasc Access. 2014;19(2):87-93
3. Hadaway L. Short peripheral intravenous catheters and infections. Journal
of Infusion Nursing. 2012;35(4).
4. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but
unacceptable:
Peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189-203
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