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https://archive.org/donate/?amt=10&origin=email-20221208eoyappl3nndnrt2-v2
Submission: On December 13 via manual from IL — Scanned from DE
Submission: On December 13 via manual from IL — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<fieldset>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-email" required="">
<label for="donation-contact-form-email"><!--?lit$330872426$-->Email</label>
<input class="donation-contact-form-input" type="email" id="donation-contact-form-email" name="email" aria-label="Email" placeholder="Email" maxlength="255" autocomplete="email" required="">
</badged-input>
</div>
</fieldset>
<fieldset>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-first-name" required="">
<label for="donation-contact-form-first-name"><!--?lit$330872426$-->First name</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-first-name" name="fname" aria-label="First name" placeholder="First name" maxlength="255" autocomplete="given-name" required="">
</badged-input>
</div>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-last-name" required="">
<label for="donation-contact-form-last-name"><!--?lit$330872426$-->Last name</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-last-name" name="lname" aria-label="Last name" placeholder="Last name" maxlength="255" autocomplete="family-name" required="">
</badged-input>
</div>
</fieldset>
<fieldset>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-street-address" required="">
<label for="donation-contact-form-street-address"><!--?lit$330872426$-->Address Line 1</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-street-address" name="street-address" aria-label="Address Line 1" placeholder="Address Line 1" autocomplete="address-line1" required="">
</badged-input>
</div>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-extended-address">
<label for="donation-contact-form-extended-address"><!--?lit$330872426$-->Address Line 2 (optional)</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-extended-address" name="extended-address" aria-label="Address Line 2 (optional)" placeholder="Address Line 2 (optional)" autocomplete="address-line2">
</badged-input>
</div>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-locality" required="">
<label for="donation-contact-form-locality"><!--?lit$330872426$-->City</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-locality" name="locality" aria-label="City" placeholder="City" autocomplete="address-level2" required="">
</badged-input>
</div>
<div class="row">
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-region" required="">
<label for="donation-contact-form-region"><!--?lit$330872426$-->State / Province</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-region" name="region" aria-label="State / Province" placeholder="State / Province" autocomplete="address-level1" required="">
</badged-input>
<!--?lit$330872426$-->
<badged-input class="donation-contact-form-postal-code" required="">
<label for="donation-contact-form-postal-code"><!--?lit$330872426$-->Zip / Postal</label>
<input class="donation-contact-form-input" type="text" id="donation-contact-form-postal-code" name="postal" aria-label="Zip / Postal" placeholder="Zip / Postal" maxlength="9" autocomplete="postal-code" pattern="[a-zA-Z\-\d]+[a-zA-Z\-\d\s]*"
required="">
</badged-input>
</div>
<div class="row">
<!--?lit$330872426$-->
<badged-input>
<select id="donation-contact-form-countryCodeAlpha2">
<!--?lit$330872426$--><!---->
<option value="AF"><!--?lit$330872426$-->Afghanistan</option>
<!----><!---->
<option value="AX"><!--?lit$330872426$-->Aland Islands</option>
<!----><!---->
<option value="AL"><!--?lit$330872426$-->Albania</option>
<!----><!---->
<option value="DZ"><!--?lit$330872426$-->Algeria</option>
<!----><!---->
<option value="AS"><!--?lit$330872426$-->American Samoa</option>
<!----><!---->
<option value="AD"><!--?lit$330872426$-->Andorra</option>
<!----><!---->
<option value="AO"><!--?lit$330872426$-->Angola</option>
<!----><!---->
<option value="AI"><!--?lit$330872426$-->Anguilla</option>
<!----><!---->
<option value="AQ"><!--?lit$330872426$-->Antarctica</option>
<!----><!---->
<option value="AG"><!--?lit$330872426$-->Antigua and Barbuda</option>
<!----><!---->
<option value="AR"><!--?lit$330872426$-->Argentina</option>
<!----><!---->
<option value="AM"><!--?lit$330872426$-->Armenia</option>
<!----><!---->
<option value="AW"><!--?lit$330872426$-->Aruba</option>
<!----><!---->
<option value="AU"><!--?lit$330872426$-->Australia</option>
<!----><!---->
<option value="AT"><!--?lit$330872426$-->Austria</option>
<!----><!---->
<option value="AZ"><!--?lit$330872426$-->Azerbaijan</option>
<!----><!---->
<option value="BS"><!--?lit$330872426$-->Bahamas</option>
<!----><!---->
<option value="BH"><!--?lit$330872426$-->Bahrain</option>
<!----><!---->
<option value="BD"><!--?lit$330872426$-->Bangladesh</option>
<!----><!---->
<option value="BB"><!--?lit$330872426$-->Barbados</option>
<!----><!---->
<option value="BY"><!--?lit$330872426$-->Belarus</option>
<!----><!---->
<option value="BE"><!--?lit$330872426$-->Belgium</option>
<!----><!---->
<option value="BZ"><!--?lit$330872426$-->Belize</option>
<!----><!---->
<option value="BJ"><!--?lit$330872426$-->Benin</option>
<!----><!---->
<option value="BM"><!--?lit$330872426$-->Bermuda</option>
<!----><!---->
<option value="BT"><!--?lit$330872426$-->Bhutan</option>
<!----><!---->
<option value="BO"><!--?lit$330872426$-->Bolivia</option>
<!----><!---->
<option value="BQ"><!--?lit$330872426$-->Bonaire, Saint Eustatius and Saba </option>
<!----><!---->
<option value="BA"><!--?lit$330872426$-->Bosnia and Herzegovina</option>
<!----><!---->
<option value="BW"><!--?lit$330872426$-->Botswana</option>
<!----><!---->
<option value="BV"><!--?lit$330872426$-->Bouvet Island</option>
<!----><!---->
<option value="BR"><!--?lit$330872426$-->Brazil</option>
<!----><!---->
<option value="IO"><!--?lit$330872426$-->British Indian Ocean Territory</option>
<!----><!---->
<option value="VG"><!--?lit$330872426$-->British Virgin Islands</option>
<!----><!---->
<option value="BN"><!--?lit$330872426$-->Brunei</option>
<!----><!---->
<option value="BG"><!--?lit$330872426$-->Bulgaria</option>
<!----><!---->
<option value="BF"><!--?lit$330872426$-->Burkina Faso</option>
<!----><!---->
<option value="BI"><!--?lit$330872426$-->Burundi</option>
<!----><!---->
<option value="KH"><!--?lit$330872426$-->Cambodia</option>
<!----><!---->
<option value="CM"><!--?lit$330872426$-->Cameroon</option>
<!----><!---->
<option value="CA"><!--?lit$330872426$-->Canada</option>
<!----><!---->
<option value="CV"><!--?lit$330872426$-->Cape Verde</option>
<!----><!---->
<option value="KY"><!--?lit$330872426$-->Cayman Islands</option>
<!----><!---->
<option value="CF"><!--?lit$330872426$-->Central African Republic</option>
<!----><!---->
<option value="TD"><!--?lit$330872426$-->Chad</option>
<!----><!---->
<option value="CL"><!--?lit$330872426$-->Chile</option>
<!----><!---->
<option value="CN"><!--?lit$330872426$-->China</option>
<!----><!---->
<option value="CX"><!--?lit$330872426$-->Christmas Island</option>
<!----><!---->
<option value="CC"><!--?lit$330872426$-->Cocos Islands</option>
<!----><!---->
<option value="CO"><!--?lit$330872426$-->Colombia</option>
<!----><!---->
<option value="KM"><!--?lit$330872426$-->Comoros</option>
<!----><!---->
<option value="CK"><!--?lit$330872426$-->Cook Islands</option>
<!----><!---->
<option value="CR"><!--?lit$330872426$-->Costa Rica</option>
<!----><!---->
<option value="HR"><!--?lit$330872426$-->Croatia</option>
<!----><!---->
<option value="CU"><!--?lit$330872426$-->Cuba</option>
<!----><!---->
<option value="CW"><!--?lit$330872426$-->Curacao</option>
<!----><!---->
<option value="CY"><!--?lit$330872426$-->Cyprus</option>
<!----><!---->
<option value="CZ"><!--?lit$330872426$-->Czech Republic</option>
<!----><!---->
<option value="CD"><!--?lit$330872426$-->Democratic Republic of the Congo</option>
<!----><!---->
<option value="DK"><!--?lit$330872426$-->Denmark</option>
<!----><!---->
<option value="DJ"><!--?lit$330872426$-->Djibouti</option>
<!----><!---->
<option value="DM"><!--?lit$330872426$-->Dominica</option>
<!----><!---->
<option value="DO"><!--?lit$330872426$-->Dominican Republic</option>
<!----><!---->
<option value="TL"><!--?lit$330872426$-->East Timor</option>
<!----><!---->
<option value="EC"><!--?lit$330872426$-->Ecuador</option>
<!----><!---->
<option value="EG"><!--?lit$330872426$-->Egypt</option>
<!----><!---->
<option value="SV"><!--?lit$330872426$-->El Salvador</option>
<!----><!---->
<option value="GQ"><!--?lit$330872426$-->Equatorial Guinea</option>
<!----><!---->
<option value="ER"><!--?lit$330872426$-->Eritrea</option>
<!----><!---->
<option value="EE"><!--?lit$330872426$-->Estonia</option>
<!----><!---->
<option value="ET"><!--?lit$330872426$-->Ethiopia</option>
<!----><!---->
<option value="FK"><!--?lit$330872426$-->Falkland Islands</option>
<!----><!---->
<option value="FO"><!--?lit$330872426$-->Faroe Islands</option>
<!----><!---->
<option value="FJ"><!--?lit$330872426$-->Fiji</option>
<!----><!---->
<option value="FI"><!--?lit$330872426$-->Finland</option>
<!----><!---->
<option value="FR"><!--?lit$330872426$-->France</option>
<!----><!---->
<option value="GF"><!--?lit$330872426$-->French Guiana</option>
<!----><!---->
<option value="PF"><!--?lit$330872426$-->French Polynesia</option>
<!----><!---->
<option value="TF"><!--?lit$330872426$-->French Southern Territories</option>
<!----><!---->
<option value="GA"><!--?lit$330872426$-->Gabon</option>
<!----><!---->
<option value="GM"><!--?lit$330872426$-->Gambia</option>
<!----><!---->
<option value="GE"><!--?lit$330872426$-->Georgia</option>
<!----><!---->
<option value="DE"><!--?lit$330872426$-->Germany</option>
<!----><!---->
<option value="GH"><!--?lit$330872426$-->Ghana</option>
<!----><!---->
<option value="GI"><!--?lit$330872426$-->Gibraltar</option>
<!----><!---->
<option value="GR"><!--?lit$330872426$-->Greece</option>
<!----><!---->
<option value="GL"><!--?lit$330872426$-->Greenland</option>
<!----><!---->
<option value="GD"><!--?lit$330872426$-->Grenada</option>
<!----><!---->
<option value="GP"><!--?lit$330872426$-->Guadeloupe</option>
<!----><!---->
<option value="GU"><!--?lit$330872426$-->Guam</option>
<!----><!---->
<option value="GT"><!--?lit$330872426$-->Guatemala</option>
<!----><!---->
<option value="GG"><!--?lit$330872426$-->Guernsey</option>
<!----><!---->
<option value="GN"><!--?lit$330872426$-->Guinea</option>
<!----><!---->
<option value="GW"><!--?lit$330872426$-->Guinea-Bissau</option>
<!----><!---->
<option value="GY"><!--?lit$330872426$-->Guyana</option>
<!----><!---->
<option value="HT"><!--?lit$330872426$-->Haiti</option>
<!----><!---->
<option value="HM"><!--?lit$330872426$-->Heard Island and McDonald Islands</option>
<!----><!---->
<option value="HN"><!--?lit$330872426$-->Honduras</option>
<!----><!---->
<option value="HK"><!--?lit$330872426$-->Hong Kong</option>
<!----><!---->
<option value="HU"><!--?lit$330872426$-->Hungary</option>
<!----><!---->
<option value="IS"><!--?lit$330872426$-->Iceland</option>
<!----><!---->
<option value="IN"><!--?lit$330872426$-->India</option>
<!----><!---->
<option value="ID"><!--?lit$330872426$-->Indonesia</option>
<!----><!---->
<option value="IR"><!--?lit$330872426$-->Iran</option>
<!----><!---->
<option value="IQ"><!--?lit$330872426$-->Iraq</option>
<!----><!---->
<option value="IE"><!--?lit$330872426$-->Ireland</option>
<!----><!---->
<option value="IM"><!--?lit$330872426$-->Isle of Man</option>
<!----><!---->
<option value="IL"><!--?lit$330872426$-->Israel</option>
<!----><!---->
<option value="IT"><!--?lit$330872426$-->Italy</option>
<!----><!---->
<option value="CI"><!--?lit$330872426$-->Ivory Coast</option>
<!----><!---->
<option value="JM"><!--?lit$330872426$-->Jamaica</option>
<!----><!---->
<option value="JP"><!--?lit$330872426$-->Japan</option>
<!----><!---->
<option value="JE"><!--?lit$330872426$-->Jersey</option>
<!----><!---->
<option value="JO"><!--?lit$330872426$-->Jordan</option>
<!----><!---->
<option value="KZ"><!--?lit$330872426$-->Kazakhstan</option>
<!----><!---->
<option value="KE"><!--?lit$330872426$-->Kenya</option>
<!----><!---->
<option value="KI"><!--?lit$330872426$-->Kiribati</option>
<!----><!---->
<option value="XK"><!--?lit$330872426$-->Kosovo</option>
<!----><!---->
<option value="KW"><!--?lit$330872426$-->Kuwait</option>
<!----><!---->
<option value="KG"><!--?lit$330872426$-->Kyrgyzstan</option>
<!----><!---->
<option value="LA"><!--?lit$330872426$-->Laos</option>
<!----><!---->
<option value="LV"><!--?lit$330872426$-->Latvia</option>
<!----><!---->
<option value="LB"><!--?lit$330872426$-->Lebanon</option>
<!----><!---->
<option value="LS"><!--?lit$330872426$-->Lesotho</option>
<!----><!---->
<option value="LR"><!--?lit$330872426$-->Liberia</option>
<!----><!---->
<option value="LY"><!--?lit$330872426$-->Libya</option>
<!----><!---->
<option value="LI"><!--?lit$330872426$-->Liechtenstein</option>
<!----><!---->
<option value="LT"><!--?lit$330872426$-->Lithuania</option>
<!----><!---->
<option value="LU"><!--?lit$330872426$-->Luxembourg</option>
<!----><!---->
<option value="MO"><!--?lit$330872426$-->Macao</option>
<!----><!---->
<option value="MK"><!--?lit$330872426$-->Macedonia</option>
<!----><!---->
<option value="MG"><!--?lit$330872426$-->Madagascar</option>
<!----><!---->
<option value="MW"><!--?lit$330872426$-->Malawi</option>
<!----><!---->
<option value="MY"><!--?lit$330872426$-->Malaysia</option>
<!----><!---->
<option value="MV"><!--?lit$330872426$-->Maldives</option>
<!----><!---->
<option value="ML"><!--?lit$330872426$-->Mali</option>
<!----><!---->
<option value="MT"><!--?lit$330872426$-->Malta</option>
<!----><!---->
<option value="MH"><!--?lit$330872426$-->Marshall Islands</option>
<!----><!---->
<option value="MQ"><!--?lit$330872426$-->Martinique</option>
<!----><!---->
<option value="MR"><!--?lit$330872426$-->Mauritania</option>
<!----><!---->
<option value="MU"><!--?lit$330872426$-->Mauritius</option>
<!----><!---->
<option value="YT"><!--?lit$330872426$-->Mayotte</option>
<!----><!---->
<option value="MX"><!--?lit$330872426$-->Mexico</option>
<!----><!---->
<option value="FM"><!--?lit$330872426$-->Micronesia</option>
<!----><!---->
<option value="MD"><!--?lit$330872426$-->Moldova</option>
<!----><!---->
<option value="MC"><!--?lit$330872426$-->Monaco</option>
<!----><!---->
<option value="MN"><!--?lit$330872426$-->Mongolia</option>
<!----><!---->
<option value="ME"><!--?lit$330872426$-->Montenegro</option>
<!----><!---->
<option value="MS"><!--?lit$330872426$-->Montserrat</option>
<!----><!---->
<option value="MA"><!--?lit$330872426$-->Morocco</option>
<!----><!---->
<option value="MZ"><!--?lit$330872426$-->Mozambique</option>
<!----><!---->
<option value="MM"><!--?lit$330872426$-->Myanmar</option>
<!----><!---->
<option value="NA"><!--?lit$330872426$-->Namibia</option>
<!----><!---->
<option value="NR"><!--?lit$330872426$-->Nauru</option>
<!----><!---->
<option value="NP"><!--?lit$330872426$-->Nepal</option>
<!----><!---->
<option value="NL"><!--?lit$330872426$-->Netherlands</option>
<!----><!---->
<option value="NC"><!--?lit$330872426$-->New Caledonia</option>
<!----><!---->
<option value="NZ"><!--?lit$330872426$-->New Zealand</option>
<!----><!---->
<option value="NI"><!--?lit$330872426$-->Nicaragua</option>
<!----><!---->
<option value="NE"><!--?lit$330872426$-->Niger</option>
<!----><!---->
<option value="NG"><!--?lit$330872426$-->Nigeria</option>
<!----><!---->
<option value="NU"><!--?lit$330872426$-->Niue</option>
<!----><!---->
<option value="NF"><!--?lit$330872426$-->Norfolk Island</option>
<!----><!---->
<option value="KP"><!--?lit$330872426$-->North Korea</option>
<!----><!---->
<option value="MP"><!--?lit$330872426$-->Northern Mariana Islands</option>
<!----><!---->
<option value="NO"><!--?lit$330872426$-->Norway</option>
<!----><!---->
<option value="OM"><!--?lit$330872426$-->Oman</option>
<!----><!---->
<option value="PK"><!--?lit$330872426$-->Pakistan</option>
<!----><!---->
<option value="PW"><!--?lit$330872426$-->Palau</option>
<!----><!---->
<option value="PS"><!--?lit$330872426$-->Palestinian Territory</option>
<!----><!---->
<option value="PA"><!--?lit$330872426$-->Panama</option>
<!----><!---->
<option value="PG"><!--?lit$330872426$-->Papua New Guinea</option>
<!----><!---->
<option value="PY"><!--?lit$330872426$-->Paraguay</option>
<!----><!---->
<option value="PE"><!--?lit$330872426$-->Peru</option>
<!----><!---->
<option value="PH"><!--?lit$330872426$-->Philippines</option>
<!----><!---->
<option value="PN"><!--?lit$330872426$-->Pitcairn</option>
<!----><!---->
<option value="PL"><!--?lit$330872426$-->Poland</option>
<!----><!---->
<option value="PT"><!--?lit$330872426$-->Portugal</option>
<!----><!---->
<option value="PR"><!--?lit$330872426$-->Puerto Rico</option>
<!----><!---->
<option value="QA"><!--?lit$330872426$-->Qatar</option>
<!----><!---->
<option value="CG"><!--?lit$330872426$-->Republic of the Congo</option>
<!----><!---->
<option value="RE"><!--?lit$330872426$-->Reunion</option>
<!----><!---->
<option value="RO"><!--?lit$330872426$-->Romania</option>
<!----><!---->
<option value="RU"><!--?lit$330872426$-->Russia</option>
<!----><!---->
<option value="RW"><!--?lit$330872426$-->Rwanda</option>
<!----><!---->
<option value="BL"><!--?lit$330872426$-->Saint Barthelemy</option>
<!----><!---->
<option value="SH"><!--?lit$330872426$-->Saint Helena</option>
<!----><!---->
<option value="KN"><!--?lit$330872426$-->Saint Kitts and Nevis</option>
<!----><!---->
<option value="LC"><!--?lit$330872426$-->Saint Lucia</option>
<!----><!---->
<option value="MF"><!--?lit$330872426$-->Saint Martin</option>
<!----><!---->
<option value="PM"><!--?lit$330872426$-->Saint Pierre and Miquelon</option>
<!----><!---->
<option value="VC"><!--?lit$330872426$-->Saint Vincent and the Grenadines</option>
<!----><!---->
<option value="WS"><!--?lit$330872426$-->Samoa</option>
<!----><!---->
<option value="SM"><!--?lit$330872426$-->San Marino</option>
<!----><!---->
<option value="ST"><!--?lit$330872426$-->Sao Tome and Principe</option>
<!----><!---->
<option value="SA"><!--?lit$330872426$-->Saudi Arabia</option>
<!----><!---->
<option value="SN"><!--?lit$330872426$-->Senegal</option>
<!----><!---->
<option value="RS"><!--?lit$330872426$-->Serbia</option>
<!----><!---->
<option value="SC"><!--?lit$330872426$-->Seychelles</option>
<!----><!---->
<option value="SL"><!--?lit$330872426$-->Sierra Leone</option>
<!----><!---->
<option value="SG"><!--?lit$330872426$-->Singapore</option>
<!----><!---->
<option value="SX"><!--?lit$330872426$-->Sint Maarten</option>
<!----><!---->
<option value="SK"><!--?lit$330872426$-->Slovakia</option>
<!----><!---->
<option value="SI"><!--?lit$330872426$-->Slovenia</option>
<!----><!---->
<option value="SB"><!--?lit$330872426$-->Solomon Islands</option>
<!----><!---->
<option value="SO"><!--?lit$330872426$-->Somalia</option>
<!----><!---->
<option value="ZA"><!--?lit$330872426$-->South Africa</option>
<!----><!---->
<option value="GS"><!--?lit$330872426$-->South Georgia and the South Sandwich Islands</option>
<!----><!---->
<option value="KR"><!--?lit$330872426$-->South Korea</option>
<!----><!---->
<option value="SS"><!--?lit$330872426$-->South Sudan</option>
<!----><!---->
<option value="ES"><!--?lit$330872426$-->Spain</option>
<!----><!---->
<option value="LK"><!--?lit$330872426$-->Sri Lanka</option>
<!----><!---->
<option value="SD"><!--?lit$330872426$-->Sudan</option>
<!----><!---->
<option value="SR"><!--?lit$330872426$-->Suriname</option>
<!----><!---->
<option value="SJ"><!--?lit$330872426$-->Svalbard and Jan Mayen</option>
<!----><!---->
<option value="SZ"><!--?lit$330872426$-->Swaziland</option>
<!----><!---->
<option value="SE"><!--?lit$330872426$-->Sweden</option>
<!----><!---->
<option value="CH"><!--?lit$330872426$-->Switzerland</option>
<!----><!---->
<option value="SY"><!--?lit$330872426$-->Syria</option>
<!----><!---->
<option value="TW"><!--?lit$330872426$-->Taiwan</option>
<!----><!---->
<option value="TJ"><!--?lit$330872426$-->Tajikistan</option>
<!----><!---->
<option value="TZ"><!--?lit$330872426$-->Tanzania</option>
<!----><!---->
<option value="TH"><!--?lit$330872426$-->Thailand</option>
<!----><!---->
<option value="TG"><!--?lit$330872426$-->Togo</option>
<!----><!---->
<option value="TK"><!--?lit$330872426$-->Tokelau</option>
<!----><!---->
<option value="TO"><!--?lit$330872426$-->Tonga</option>
<!----><!---->
<option value="TT"><!--?lit$330872426$-->Trinidad and Tobago</option>
<!----><!---->
<option value="TN"><!--?lit$330872426$-->Tunisia</option>
<!----><!---->
<option value="TR"><!--?lit$330872426$-->Turkey</option>
<!----><!---->
<option value="TM"><!--?lit$330872426$-->Turkmenistan</option>
<!----><!---->
<option value="TC"><!--?lit$330872426$-->Turks and Caicos Islands</option>
<!----><!---->
<option value="TV"><!--?lit$330872426$-->Tuvalu</option>
<!----><!---->
<option value="VI"><!--?lit$330872426$-->U.S. Virgin Islands</option>
<!----><!---->
<option value="UG"><!--?lit$330872426$-->Uganda</option>
<!----><!---->
<option value="UA"><!--?lit$330872426$-->Ukraine</option>
<!----><!---->
<option value="AE"><!--?lit$330872426$-->United Arab Emirates</option>
<!----><!---->
<option value="GB"><!--?lit$330872426$-->United Kingdom</option>
<!----><!---->
<option value="UM"><!--?lit$330872426$-->United States Minor Outlying Islands</option>
<!----><!---->
<option value="US" selected=""><!--?lit$330872426$-->United States</option>
<!----><!---->
<option value="UY"><!--?lit$330872426$-->Uruguay</option>
<!----><!---->
<option value="UZ"><!--?lit$330872426$-->Uzbekistan</option>
<!----><!---->
<option value="VU"><!--?lit$330872426$-->Vanuatu</option>
<!----><!---->
<option value="VA"><!--?lit$330872426$-->Vatican</option>
<!----><!---->
<option value="VE"><!--?lit$330872426$-->Venezuela</option>
<!----><!---->
<option value="VN"><!--?lit$330872426$-->Vietnam</option>
<!----><!---->
<option value="WF"><!--?lit$330872426$-->Wallis and Futuna</option>
<!----><!---->
<option value="EH"><!--?lit$330872426$-->Western Sahara</option>
<!----><!---->
<option value="YE"><!--?lit$330872426$-->Yemen</option>
<!----><!---->
<option value="ZM"><!--?lit$330872426$-->Zambia</option>
<!----><!---->
<option value="ZW"><!--?lit$330872426$-->Zimbabwe</option>
<!---->
</select>
</badged-input>
</div>
</fieldset>
</form>Text Content
Email First name Last name Address Line 1 Address Line 2 (optional) City State / Province Zip / Postal Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands United States Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe REDIRECTING YOU TO A LITE VERSION OF ARCHIVE.ORG...