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Subject: Nonresident Alien Tax Assessment Form
Date: Thu, 22 Mar 2012 09:26:25 -0500
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Content-Location: http://www.washburn.edu/admin/finance/nra/NRA_tax_assessment_form.html

=EF=BB=BF<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD><TITLE>Nonresident Alien Tax Assessment Form</TITLE>
<META content=3D"text/html; charset=3Dutf-8" http-equiv=3DContent-Type>
<META name=3DGENERATOR content=3D"MSHTML 8.00.7601.17744"></HEAD>
<BODY bgColor=3D#ffffcc>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+2><FONT =

      color=3Dblack><B>Washburn University Nonresident Alien Tax =
Assessment=20
      Form</B></FONT></FONT></TD></TR></TBODY></TABLE>
<P>This form must be completed before you can receive any form of =
payment from=20
Washburn University. All applicable questions below must be answered. =
The=20
completed form must be presented with your passport and immigration =
documents as=20
soon as possible before payment will be made (for Washburn employees, =
including=20
student employees, at the time of appointment).=20
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>PERSONAL/PASSPORT=20
  INFORMATION</B></FONT></FONT></U></TD></TR></TBODY></TABLE>
<FORM method=3Dpost action=3Dmu_reg.tax_assess_add_pub.insert_record>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"10%" align=3Dleft><B>Last or Family Name:</B></TD>
    <TD width=3D"20%" align=3Dleft><INPUT maxLength=3D35 size=3D35=20
  name=3Dvlastname></TD></TR>
  <TR>
    <TD width=3D"10%" align=3Dleft><B>First:</B></TD>
    <TD width=3D"20%" align=3Dleft><INPUT maxLength=3D35 size=3D35=20
  name=3Dvfirstname></TD></TR>
  <TR>
    <TD width=3D"10%" align=3Dleft><B>Middle:</B></TD>
    <TD width=3D"20%" align=3Dleft><INPUT maxLength=3D35 size=3D35=20
  name=3Dvmiddlename></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"25%" align=3Dleft><FONT color=3Dblack size=3D3><B>Date =
of=20
      Birth:</B></FONT> (mm/dd/yyyy)</TD>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2 =
name=3Dvbdate1>/<INPUT=20
      maxLength=3D2 size=3D2 name=3Dvbdate2>/<INPUT maxLength=3D4 =
size=3D4=20
name=3Dvbdate3></TD>
    <TD width=3D"15%" align=3Dleft><B>E-mail Address:</B></TD>
    <TD width=3D"35%" align=3Dleft><INPUT maxLength=3D50 size=3D50=20
  name=3Dvemailaddr></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"25%" align=3Dleft><FONT color=3Dblack =
size=3D3><B>Social Security=20
      #</B></FONT> (or Individual Taxpayer ID # if no SS#):</TD>
    <TD width=3D"25%" align=3Dleft><INPUT maxLength=3D3 size=3D3 =
name=3Dvssn1>-<INPUT=20
      maxLength=3D2 size=3D2 name=3Dvssn2>-<INPUT maxLength=3D4 size=3D4 =

  name=3Dvssn3></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"15%" align=3Dleft><FONT color=3Dblack size=3D3><B>WIN=20
#</B></FONT>:</TD>
    <TD width=3D"35%" align=3Dleft><INPUT maxLength=3D9 size=3D9=20
  name=3Dvstunum></TD></TR></TBODY></TABLE>
<TABLE width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"25%" align=3Dleft>Country of citizenship:</TH>
    <TD width=3D"50%" align=3Dleft><SELECT size=3D1 name=3Dvcitcountry> =
<OPTION=20
        selected><OPTION value=3D"AF AFGHANISTAN">AFGHANISTAN<OPTION=20
        value=3D"AL ALBANIA">ALBANIA<OPTION value=3D"AG =
ALGERIA">ALGERIA<OPTION=20
        value=3D"AQ AMERICAN SAMOA">AMERICAN SAMOA<OPTION=20
        value=3D"AN ANDORRA">ANDORRA<OPTION value=3D"AO =
ANGOLA">ANGOLA<OPTION=20
        value=3D"AV ANGUILLA">ANGUILLA<OPTION=20
        value=3D"AY ANTARCTICA">ANTARCTICA<OPTION=20
        value=3D"AC ANTIGUA AND BARBUDA">ANTIGUA AND BARBUDA<OPTION=20
        value=3D"AR ARGENTINA">ARGENTINA<OPTION value=3D"AM =
ARMENIA">ARMENIA<OPTION=20
        value=3D"AA ARUBA">ARUBA<OPTION=20
        value=3D"AT ASHMORE AND CARTIER ISLANDS">ASHMORE AND CARTIER=20
        ISLANDS<OPTION value=3D"AS AUSTRALIA">AUSTRALIA<OPTION=20
        value=3D"AU AUSTRIA">AUSTRIA<OPTION=20
        value=3D"AJ AZERBAIJAN">AZERBAIJAN<OPTION value=3D"BF BAHAMAS, =
THE">BAHAMAS,=20
        THE<OPTION value=3D"BA BAHRAIN">BAHRAIN<OPTION=20
        value=3D"FQ BAKER ISLAND">BAKER ISLAND<OPTION=20
        value=3D"BG BANGLADESH">BANGLADESH<OPTION=20
        value=3D"BB BARBADOS">BARBADOS<OPTION value=3D"BS BASSAS DA =
INDIA">BASSAS DA=20
        INDIA<OPTION value=3D"BO BELARUS">BELARUS<OPTION=20
        value=3D"BE BELGIUM">BELGIUM<OPTION value=3D"BH =
BELIZE">BELIZE<OPTION=20
        value=3D"BN BENIN">BENIN<OPTION value=3D"BD =
BERMUDA">BERMUDA<OPTION=20
        value=3D"BT BHUTAN">BHUTAN<OPTION value=3D"BL =
BOLIVIA">BOLIVIA<OPTION=20
        value=3D"BK BOSNIA-HERZEGOVINA">BOSNIA-HERZEGOVINA<OPTION=20
        value=3D"BC BOTSWANA">BOTSWANA<OPTION value=3D"BV BOUVET =
ISLAND">BOUVET=20
        ISLAND<OPTION value=3D"BR BRAZIL">BRAZIL<OPTION=20
        value=3D"IO BRITISH INDIAN OCEAN TERRITORY">BRITISH INDIAN OCEAN =

        TERRITORY<OPTION value=3D"BX BRUNEI">BRUNEI<OPTION=20
        value=3D"BU BULGARIA">BULGARIA<OPTION value=3D"UV BURKINA =
FASO">BURKINA=20
        FASO<OPTION value=3D"BY BURUNDI">BURUNDI<OPTION=20
        value=3D"CB CAMBODIA">CAMBODIA<OPTION value=3D"CM =
CAMEROON">CAMEROON<OPTION=20
        value=3D"CA CANADA">CANADA<OPTION value=3D"CV CAPE VERDE">CAPE =
VERDE<OPTION=20
        value=3D"CJ CAYMAN ISLANDS">CAYMAN ISLANDS<OPTION=20
        value=3D"CT CENTRAL AFRICAN REPUBLIC">CENTRAL AFRICAN =
REPUBLIC<OPTION=20
        value=3D"CD CHAD">CHAD<OPTION value=3D"CI CHILE">CHILE<OPTION=20
        value=3D"CH CHINA, PEOPLE'S REPUBLIC">CHINA, PEOPLE'S =
REPUBLIC<OPTION=20
        value=3D"KT CHRISTMAS ISLAND (INDIAN OC)">CHRISTMAS ISLAND =
(INDIAN=20
        OC)<OPTION value=3D"IP CLIPPERTON ISLAND">CLIPPERTON =
ISLAND<OPTION=20
        value=3D"CK COCOS (KEELING) ISLANDS">COCOS (KEELING) =
ISLANDS<OPTION=20
        value=3D"CO COLOMBIA">COLOMBIA<OPTION value=3D"CN =
COMOROS">COMOROS<OPTION=20
        value=3D"CF CONGO">CONGO<OPTION value=3D"CW COOK ISLANDS">COOK=20
        ISLANDS<OPTION value=3D"CR CORAL SEA ISLANDS">CORAL SEA =
ISLANDS<OPTION=20
        value=3D"VP CORSICA">CORSICA<OPTION value=3D"CS COSTA =
RICA">COSTA=20
        RICA<OPTION value=3D"IV COTE D'IVOIRE (IVORY COAST)">COTE =
D'IVOIRE (IVORY=20
        COAST)<OPTION value=3D"HR CROATIA">CROATIA<OPTION=20
        value=3D"CU CUBA">CUBA<OPTION value=3D"CY CYPRUS">CYPRUS<OPTION=20
        value=3D"EZ CZECH REPUBLIC">CZECH REPUBLIC<OPTION=20
        value=3D"DA DENMARK">DENMARK<OPTION value=3D"DJ =
DJIBOUTI">DJIBOUTI<OPTION=20
        value=3D"DO DOMINICA">DOMINICA<OPTION=20
        value=3D"DR DOMINICAN REPUBLIC">DOMINICAN REPUBLIC<OPTION=20
        value=3D"EC ECUADOR">ECUADOR<OPTION value=3D"EG =
EGYPT">EGYPT<OPTION=20
        value=3D"ES EL SALVADOR">EL SALVADOR<OPTION=20
        value=3D"EK EQUATORIAL GUINEA">EQUATORIAL GUINEA<OPTION=20
        value=3D"ER ERITREA">ERITREA<OPTION value=3D"EN =
ESTONIA">ESTONIA<OPTION=20
        value=3D"ET ETHIOPIA">ETHIOPIA<OPTION value=3D"EU EUROPA =
ISLAND">EUROPA=20
        ISLAND<OPTION value=3D"FK FALKLAND ISL (ISL MALVINAS)">FALKLAND =
ISL (ISL=20
        MALVINAS)<OPTION value=3D"FO FAROE ISLANDS">FAROE ISLANDS<OPTION =

        value=3D"FJ FIJI">FIJI<OPTION value=3D"FI =
FINLAND">FINLAND<OPTION=20
        value=3D"FS FR SOUTHERN AND ANTARCTIC">FR SOUTHERN AND =
ANTARCTIC<OPTION=20
        value=3D"FR FRANCE">FRANCE<OPTION value=3D"FG FRENCH =
GUIANA">FRENCH=20
        GUIANA<OPTION value=3D"FP FRENCH POLYNESIA">FRENCH =
POLYNESIA<OPTION=20
        value=3D"GB GABON">GABON<OPTION value=3D"GA GAMBIA, THE">GAMBIA, =
THE<OPTION=20
        value=3D"GZ GAZA STRIP">GAZA STRIP<OPTION=20
        value=3D"GG GEORGIA">GEORGIA<OPTION value=3D"GM =
GERMANY">GERMANY<OPTION=20
        value=3D"GH GHANA">GHANA<OPTION value=3D"GI =
GIBRALTAR">GIBRALTAR<OPTION=20
        value=3D"GO GLORIOSO ISLANDS">GLORIOSO ISLANDS<OPTION=20
        value=3D"GR GREECE">GREECE<OPTION value=3D"GL =
GREENLAND">GREENLAND<OPTION=20
        value=3D"GJ GRENADA">GRENADA<OPTION=20
        value=3D"GP GUADELOUPE">GUADELOUPE<OPTION value=3D"GQ =
GUAM">GUAM<OPTION=20
        value=3D"GT GUATEMALA">GUATEMALA<OPTION=20
        value=3D"GK GUERNSEY">GUERNSEY<OPTION value=3D"GV =
GUINEA">GUINEA<OPTION=20
        value=3D"PU GUINEA-BISSAU">GUINEA-BISSAU<OPTION=20
        value=3D"GY GUYANA">GUYANA<OPTION value=3D"HA =
HAITI">HAITI<OPTION=20
        value=3D"HM HEARD ISLAND AND MCDONALD ISLANDS">HEARD ISLAND AND =
MCDONALD=20
        ISLANDS<OPTION value=3D"HO HONDURAS">HONDURAS<OPTION=20
        value=3D"HK HONG KONG">HONG KONG<OPTION value=3D"HQ HOWLAND =
ISLAND">HOWLAND=20
        ISLAND<OPTION value=3D"HU HUNGARY">HUNGARY<OPTION=20
        value=3D"IC ICELAND">ICELAND<OPTION value=3D"IN =
INDIA">INDIA<OPTION=20
        value=3D"ID INDONESIA">INDONESIA<OPTION value=3D"IR =
IRAN">IRAN<OPTION=20
        value=3D"IZ IRAQ">IRAQ<OPTION value=3D"EI =
IRELAND">IRELAND<OPTION=20
        value=3D"IM ISLE OF MAN">ISLE OF MAN<OPTION=20
        value=3D"IS ISRAEL">ISRAEL<OPTION value=3D"IT =
ITALY">ITALY<OPTION=20
        value=3D"JM JAMAICA">JAMAICA<OPTION value=3D"JN JAN MAYEN">JAN =
MAYEN<OPTION=20
        value=3D"JA JAPAN">JAPAN<OPTION value=3D"JE =
JERSEY">JERSEY<OPTION=20
        value=3D"JQ JOHNSTON ATOLL">JOHNSTON ATOLL<OPTION=20
        value=3D"JO JORDAN">JORDAN<OPTION value=3D"JU JUAN DE NOVA =
ISLAND">JUAN DE=20
        NOVA ISLAND<OPTION value=3D"KZ KAZAKHSTAN">KAZAKHSTAN<OPTION=20
        value=3D"KE KENYA">KENYA<OPTION value=3D"KQ KINGMAN =
REEF">KINGMAN=20
        REEF<OPTION value=3D"KR KIRIBATI">KIRIBATI<OPTION=20
        value=3D"KN KOREA, DEMOCRATIC (NORTH)">KOREA, DEMOCRATIC =
(NORTH)<OPTION=20
        value=3D"KS KOREA, REPUBLIC (SOUTH)">KOREA, REPUBLIC =
(SOUTH)<OPTION=20
        value=3D"KU KUWAIT">KUWAIT<OPTION value=3D"KG =
KYRGYZSTAN">KYRGYZSTAN<OPTION=20
        value=3D"LA LAOS">LAOS<OPTION value=3D"LG LATVIA">LATVIA<OPTION=20
        value=3D"LE LEBANON">LEBANON<OPTION value=3D"LT =
LESOTHO">LESOTHO<OPTION=20
        value=3D"LI LIBERIA">LIBERIA<OPTION value=3D"LY =
LIBYA">LIBYA<OPTION=20
        value=3D"LS LIECHTENSTEIN">LIECHTENSTEIN<OPTION=20
        value=3D"LH LITHUANIA">LITHUANIA<OPTION=20
        value=3D"LU LUXEMBOURG">LUXEMBOURG<OPTION value=3D"MC =
MACAU">MACAU<OPTION=20
        value=3D"MK MACEDONIA">MACEDONIA<OPTION=20
        value=3D"MA MADAGASCAR">MADAGASCAR<OPTION value=3D"MI =
MALAWI">MALAWI<OPTION=20
        value=3D"MY MALAYSIA">MALAYSIA<OPTION value=3D"MV =
MALDIVES">MALDIVES<OPTION=20
        value=3D"ML MALI">MALI<OPTION value=3D"MT MALTA">MALTA<OPTION=20
        value=3D"RM MARSHALL ISLANDS">MARSHALL ISLANDS<OPTION=20
        value=3D"MB MARTINIQUE">MARTINIQUE<OPTION=20
        value=3D"MR MAURITANIA">MAURITANIA<OPTION=20
        value=3D"MP MAURITIUS">MAURITIUS<OPTION value=3D"MF =
MAYOTTE">MAYOTTE<OPTION=20
        value=3D"MX MEXICO">MEXICO<OPTION=20
        value=3D"FM MICRONESIA, FEDERATED STATES OF">MICRONESIA, =
FEDERATED STATES=20
        OF<OPTION value=3D"MQ MIDWAY ISLANDS">MIDWAY ISLANDS<OPTION=20
        value=3D"MD MOLDOVA">MOLDOVA<OPTION value=3D"MN =
MONACO">MONACO<OPTION=20
        value=3D"MG MONGOLIA">MONGOLIA<OPTION=20
        value=3D"MW MONTENEGRO">MONTENEGRO<OPTION=20
        value=3D"MH MONTSERRAT">MONTSERRAT<OPTION=20
        value=3D"MO MOROCCO">MOROCCO<OPTION=20
        value=3D"MZ MOZAMBIQUE">MOZAMBIQUE<OPTION=20
        value=3D"MM MYANMAR">MYANMAR<OPTION value=3D"WA =
NAMIBIA">NAMIBIA<OPTION=20
        value=3D"NR NAURU">NAURU<OPTION value=3D"BQ NAVASSA =
ISLAND">NAVASSA=20
        ISLAND<OPTION value=3D"NP NEPAL">NEPAL<OPTION=20
        value=3D"NL NETHERLANDS">NETHERLANDS<OPTION=20
        value=3D"NT NETHERLANDS ANTILLES">NETHERLANDS ANTILLES<OPTION=20
        value=3D"NC NEW CALEDONIA">NEW CALEDONIA<OPTION value=3D"NZ NEW =
ZEALAND">NEW=20
        ZEALAND<OPTION value=3D"NU NICARAGUA">NICARAGUA<OPTION=20
        value=3D"NG NIGER">NIGER<OPTION value=3D"NI =
NIGERIA">NIGERIA<OPTION=20
        value=3D"NE NIUE">NIUE<OPTION value=3D"NF NORFOLK =
ISLAND">NORFOLK=20
        ISLAND<OPTION value=3D"CQ NORTHERN MARIANA ISLANDS">NORTHERN =
MARIANA=20
        ISLANDS<OPTION value=3D"NO NORWAY">NORWAY<OPTION=20
        value=3D"MU OMAN">OMAN<OPTION value=3D"OC OTHER COUNTRIES">OTHER =

        COUNTRIES<OPTION value=3D"PK PAKISTAN">PAKISTAN<OPTION=20
        value=3D"PS PALAU, REPUBLIC OF">PALAU, REPUBLIC OF<OPTION=20
        value=3D"LQ PALMYRA ATOLL">PALMYRA ATOLL<OPTION=20
        value=3D"PM PANAMA">PANAMA<OPTION value=3D"PP PAPUA NEW =
GUINEA">PAPUA NEW=20
        GUINEA<OPTION value=3D"PF PARACEL ISLANDS">PARACEL =
ISLANDS<OPTION=20
        value=3D"PA PARAGUAY">PARAGUAY<OPTION value=3D"PE =
PERU">PERU<OPTION=20
        value=3D"RP PHILIPPINES">PHILIPPINES<OPTION=20
        value=3D"PC PITCAIRN ISLAND">PITCAIRN ISLAND<OPTION=20
        value=3D"PL POLAND">POLAND<OPTION value=3D"PO =
PORTUGAL">PORTUGAL<OPTION=20
        value=3D"RQ PUERTO RICO">PUERTO RICO<OPTION value=3D"QA =
QATAR">QATAR<OPTION=20
        value=3D"RE REUNION">REUNION<OPTION value=3D"RO =
ROMANIA">ROMANIA<OPTION=20
        value=3D"RS RUSSIA">RUSSIA<OPTION value=3D"RW =
RWANDA">RWANDA<OPTION=20
        value=3D"SC SAINT KITTS AND NEVIS (ST CHRISTOPHER &amp; =
NEVIS)">SAINT=20
        KITTS AND NEVIS (ST CHRISTOPHER &amp; NEVIS)<OPTION=20
        value=3D"SM SAN MARINO">SAN MARINO<OPTION=20
        value=3D"TP SAO TOME AND PRINCIPE">SAO TOME AND PRINCIPE<OPTION=20
        value=3D"SA SAUDI ARABIA">SAUDI ARABIA<OPTION=20
        value=3D"SG SENEGAL">SENEGAL<OPTION value=3D"SR =
SERBIA">SERBIA<OPTION=20
        value=3D"SE SEYCHELLES">SEYCHELLES<OPTION value=3D"SL SIERRA =
LEONE">SIERRA=20
        LEONE<OPTION value=3D"SN SINGAPORE">SINGAPORE<OPTION=20
        value=3D"LO SLOVAKIA">SLOVAKIA<OPTION value=3D"SI =
SLOVENIA">SLOVENIA<OPTION=20
        value=3D"SX SO GEORGIA,SO SANDWICH ISLANDS">SO GEORGIA,SO =
SANDWICH=20
        ISLANDS<OPTION value=3D"BP SOLOMON ISLANDS">SOLOMON =
ISLANDS<OPTION=20
        value=3D"SO SOMALIA">SOMALIA<OPTION value=3D"SF SOUTH =
AFRICA">SOUTH=20
        AFRICA<OPTION value=3D"SP SPAIN">SPAIN<OPTION=20
        value=3D"PG SPRATLY ISLANDS">SPRATLY ISLANDS<OPTION=20
        value=3D"CE SRI LANKA">SRI LANKA<OPTION value=3D"SH ST. =
HELENA">ST.=20
        HELENA<OPTION value=3D"ST ST. LUCIA">ST. LUCIA<OPTION=20
        value=3D"SB ST. PIERRE AND MIQUELON">ST. PIERRE AND =
MIQUELON<OPTION=20
        value=3D"VC ST. VINCENT AND GRENADINES">ST. VINCENT AND =
GRENADINES<OPTION=20
        value=3D"ZZ STATELESS - NO COUNTRY OF CITIZENSHIP">STATELESS - =
NO COUNTRY=20
        OF CITIZENSHIP<OPTION value=3D"SU SUDAN">SUDAN<OPTION=20
        value=3D"NS SURINAME">SURINAME<OPTION value=3D"SV =
SVALBARD">SVALBARD<OPTION=20
        value=3D"WZ SWAZILAND">SWAZILAND<OPTION value=3D"SW =
SWEDEN">SWEDEN<OPTION=20
        value=3D"SZ SWITZERLAND">SWITZERLAND<OPTION value=3D"SY =
SYRIA">SYRIA<OPTION=20
        value=3D"TW TAIWAN">TAIWAN<OPTION value=3D"TI =
TAJIKISTAN">TAJIKISTAN<OPTION=20
        value=3D"TZ TANZANIA, UNITED REPUBLIC OF">TANZANIA, UNITED =
REPUBLIC=20
        OF<OPTION value=3D"TH THAILAND">THAILAND<OPTION=20
        value=3D"TO TOGO">TOGO<OPTION value=3D"TL =
TOKELAU">TOKELAU<OPTION=20
        value=3D"TN TONGA">TONGA<OPTION value=3D"TD TRINIDAD AND =
TOBAGO">TRINIDAD=20
        AND TOBAGO<OPTION value=3D"TE TROMELIN ISLAND">TROMELIN =
ISLAND<OPTION=20
        value=3D"TS TUNISIA">TUNISIA<OPTION value=3D"TU =
TURKEY">TURKEY<OPTION=20
        value=3D"TX TURKMENISTAN">TURKMENISTAN<OPTION=20
        value=3D"TK TURKS AND CAICOS ISLANDS">TURKS AND CAICOS =
ISLANDS<OPTION=20
        value=3D"TV TUVALU">TUVALU<OPTION value=3D"UG =
UGANDA">UGANDA<OPTION=20
        value=3D"UP UKRAINE">UKRAINE<OPTION value=3D"TC UNITED ARAB =
EMIRATES">UNITED=20
        ARAB EMIRATES<OPTION value=3D"UK UNITED KINGDOM">UNITED =
KINGDOM<OPTION=20
        value=3D"US UNITED STATES">UNITED STATES<OPTION=20
        value=3D"UY URUGUAY">URUGUAY<OPTION=20
        value=3D"UZ UZBEKISTAN">UZBEKISTAN<OPTION=20
        value=3D"NH VANUATU">VANUATU<OPTION value=3D"VT VATICAN =
CITY">VATICAN=20
        CITY<OPTION value=3D"VE VENEZUELA">VENEZUELA<OPTION=20
        value=3D"VM VIETNAM">VIETNAM<OPTION=20
        value=3D"VI VIRGIN ISLANDS (BRITISH)">VIRGIN ISLANDS =
(BRITISH)<OPTION=20
        value=3D"VQ VIRGIN ISLANDS (U S)">VIRGIN ISLANDS (U S)<OPTION=20
        value=3D"WQ WAKE ISLAND">WAKE ISLAND<OPTION=20
        value=3D"WF WALLIS AND FUTUNA">WALLIS AND FUTUNA<OPTION=20
        value=3D"WE WEST BANK">WEST BANK<OPTION value=3D"WI WESTERN =
SAHARA">WESTERN=20
        SAHARA<OPTION value=3D"WS WESTERN SAMOA">WESTERN SAMOA<OPTION=20
        value=3D"YM YEMEN">YEMEN<OPTION value=3D"CG ZAIRE">ZAIRE<OPTION=20
        value=3D"ZA ZAMBIA">ZAMBIA<OPTION=20
      value=3D"ZI ZIMBABWE">ZIMBABWE</OPTION></SELECT> </TD></TR>
  <TR>
    <TH width=3D"25%" align=3Dleft>Country that issued passport:</TH>
    <TD width=3D"50%" align=3Dleft><SELECT size=3D1 name=3Dvpasscountry> =
<OPTION=20
        selected><OPTION value=3D"AF AFGHANISTAN">AFGHANISTAN<OPTION=20
        value=3D"AL ALBANIA">ALBANIA<OPTION value=3D"AG =
ALGERIA">ALGERIA<OPTION=20
        value=3D"AQ AMERICAN SAMOA">AMERICAN SAMOA<OPTION=20
        value=3D"AN ANDORRA">ANDORRA<OPTION value=3D"AO =
ANGOLA">ANGOLA<OPTION=20
        value=3D"AV ANGUILLA">ANGUILLA<OPTION=20
        value=3D"AY ANTARCTICA">ANTARCTICA<OPTION=20
        value=3D"AC ANTIGUA AND BARBUDA">ANTIGUA AND BARBUDA<OPTION=20
        value=3D"AR ARGENTINA">ARGENTINA<OPTION value=3D"AM =
ARMENIA">ARMENIA<OPTION=20
        value=3D"AA ARUBA">ARUBA<OPTION=20
        value=3D"AT ASHMORE AND CARTIER ISLANDS">ASHMORE AND CARTIER=20
        ISLANDS<OPTION value=3D"AS AUSTRALIA">AUSTRALIA<OPTION=20
        value=3D"AU AUSTRIA">AUSTRIA<OPTION=20
        value=3D"AJ AZERBAIJAN">AZERBAIJAN<OPTION value=3D"BF BAHAMAS, =
THE">BAHAMAS,=20
        THE<OPTION value=3D"BA BAHRAIN">BAHRAIN<OPTION=20
        value=3D"FQ BAKER ISLAND">BAKER ISLAND<OPTION=20
        value=3D"BG BANGLADESH">BANGLADESH<OPTION=20
        value=3D"BB BARBADOS">BARBADOS<OPTION value=3D"BS BASSAS DA =
INDIA">BASSAS DA=20
        INDIA<OPTION value=3D"BO BELARUS">BELARUS<OPTION=20
        value=3D"BE BELGIUM">BELGIUM<OPTION value=3D"BH =
BELIZE">BELIZE<OPTION=20
        value=3D"BN BENIN">BENIN<OPTION value=3D"BD =
BERMUDA">BERMUDA<OPTION=20
        value=3D"BT BHUTAN">BHUTAN<OPTION value=3D"BL =
BOLIVIA">BOLIVIA<OPTION=20
        value=3D"BK BOSNIA-HERZEGOVINA">BOSNIA-HERZEGOVINA<OPTION=20
        value=3D"BC BOTSWANA">BOTSWANA<OPTION value=3D"BV BOUVET =
ISLAND">BOUVET=20
        ISLAND<OPTION value=3D"BR BRAZIL">BRAZIL<OPTION=20
        value=3D"IO BRITISH INDIAN OCEAN TERRITORY">BRITISH INDIAN OCEAN =

        TERRITORY<OPTION value=3D"BX BRUNEI">BRUNEI<OPTION=20
        value=3D"BU BULGARIA">BULGARIA<OPTION value=3D"UV BURKINA =
FASO">BURKINA=20
        FASO<OPTION value=3D"BY BURUNDI">BURUNDI<OPTION=20
        value=3D"CB CAMBODIA">CAMBODIA<OPTION value=3D"CM =
CAMEROON">CAMEROON<OPTION=20
        value=3D"CA CANADA">CANADA<OPTION value=3D"CV CAPE VERDE">CAPE =
VERDE<OPTION=20
        value=3D"CJ CAYMAN ISLANDS">CAYMAN ISLANDS<OPTION=20
        value=3D"CT CENTRAL AFRICAN REPUBLIC">CENTRAL AFRICAN =
REPUBLIC<OPTION=20
        value=3D"CD CHAD">CHAD<OPTION value=3D"CI CHILE">CHILE<OPTION=20
        value=3D"CH CHINA, PEOPLE'S REPUBLIC">CHINA, PEOPLE'S =
REPUBLIC<OPTION=20
        value=3D"KT CHRISTMAS ISLAND (INDIAN OC)">CHRISTMAS ISLAND =
(INDIAN=20
        OC)<OPTION value=3D"IP CLIPPERTON ISLAND">CLIPPERTON =
ISLAND<OPTION=20
        value=3D"CK COCOS (KEELING) ISLANDS">COCOS (KEELING) =
ISLANDS<OPTION=20
        value=3D"CO COLOMBIA">COLOMBIA<OPTION value=3D"CN =
COMOROS">COMOROS<OPTION=20
        value=3D"CF CONGO">CONGO<OPTION value=3D"CW COOK ISLANDS">COOK=20
        ISLANDS<OPTION value=3D"CR CORAL SEA ISLANDS">CORAL SEA =
ISLANDS<OPTION=20
        value=3D"VP CORSICA">CORSICA<OPTION value=3D"CS COSTA =
RICA">COSTA=20
        RICA<OPTION value=3D"IV COTE D'IVOIRE (IVORY COAST)">COTE =
D'IVOIRE (IVORY=20
        COAST)<OPTION value=3D"HR CROATIA">CROATIA<OPTION=20
        value=3D"CU CUBA">CUBA<OPTION value=3D"CY CYPRUS">CYPRUS<OPTION=20
        value=3D"EZ CZECH REPUBLIC">CZECH REPUBLIC<OPTION=20
        value=3D"DA DENMARK">DENMARK<OPTION value=3D"DJ =
DJIBOUTI">DJIBOUTI<OPTION=20
        value=3D"DO DOMINICA">DOMINICA<OPTION=20
        value=3D"DR DOMINICAN REPUBLIC">DOMINICAN REPUBLIC<OPTION=20
        value=3D"EC ECUADOR">ECUADOR<OPTION value=3D"EG =
EGYPT">EGYPT<OPTION=20
        value=3D"ES EL SALVADOR">EL SALVADOR<OPTION=20
        value=3D"EK EQUATORIAL GUINEA">EQUATORIAL GUINEA<OPTION=20
        value=3D"ER ERITREA">ERITREA<OPTION value=3D"EN =
ESTONIA">ESTONIA<OPTION=20
        value=3D"ET ETHIOPIA">ETHIOPIA<OPTION value=3D"EU EUROPA =
ISLAND">EUROPA=20
        ISLAND<OPTION value=3D"FK FALKLAND ISL (ISL MALVINAS)">FALKLAND =
ISL (ISL=20
        MALVINAS)<OPTION value=3D"FO FAROE ISLANDS">FAROE ISLANDS<OPTION =

        value=3D"FJ FIJI">FIJI<OPTION value=3D"FI =
FINLAND">FINLAND<OPTION=20
        value=3D"FS FR SOUTHERN AND ANTARCTIC">FR SOUTHERN AND =
ANTARCTIC<OPTION=20
        value=3D"FR FRANCE">FRANCE<OPTION value=3D"FG FRENCH =
GUIANA">FRENCH=20
        GUIANA<OPTION value=3D"FP FRENCH POLYNESIA">FRENCH =
POLYNESIA<OPTION=20
        value=3D"GB GABON">GABON<OPTION value=3D"GA GAMBIA, THE">GAMBIA, =
THE<OPTION=20
        value=3D"GZ GAZA STRIP">GAZA STRIP<OPTION=20
        value=3D"GG GEORGIA">GEORGIA<OPTION value=3D"GM =
GERMANY">GERMANY<OPTION=20
        value=3D"GH GHANA">GHANA<OPTION value=3D"GI =
GIBRALTAR">GIBRALTAR<OPTION=20
        value=3D"GO GLORIOSO ISLANDS">GLORIOSO ISLANDS<OPTION=20
        value=3D"GR GREECE">GREECE<OPTION value=3D"GL =
GREENLAND">GREENLAND<OPTION=20
        value=3D"GJ GRENADA">GRENADA<OPTION=20
        value=3D"GP GUADELOUPE">GUADELOUPE<OPTION value=3D"GQ =
GUAM">GUAM<OPTION=20
        value=3D"GT GUATEMALA">GUATEMALA<OPTION=20
        value=3D"GK GUERNSEY">GUERNSEY<OPTION value=3D"GV =
GUINEA">GUINEA<OPTION=20
        value=3D"PU GUINEA-BISSAU">GUINEA-BISSAU<OPTION=20
        value=3D"GY GUYANA">GUYANA<OPTION value=3D"HA =
HAITI">HAITI<OPTION=20
        value=3D"HM HEARD ISLAND AND MCDONALD ISLANDS">HEARD ISLAND AND =
MCDONALD=20
        ISLANDS<OPTION value=3D"HO HONDURAS">HONDURAS<OPTION=20
        value=3D"HK HONG KONG">HONG KONG<OPTION value=3D"HQ HOWLAND =
ISLAND">HOWLAND=20
        ISLAND<OPTION value=3D"HU HUNGARY">HUNGARY<OPTION=20
        value=3D"IC ICELAND">ICELAND<OPTION value=3D"IN =
INDIA">INDIA<OPTION=20
        value=3D"ID INDONESIA">INDONESIA<OPTION value=3D"IR =
IRAN">IRAN<OPTION=20
        value=3D"IZ IRAQ">IRAQ<OPTION value=3D"EI =
IRELAND">IRELAND<OPTION=20
        value=3D"IM ISLE OF MAN">ISLE OF MAN<OPTION=20
        value=3D"IS ISRAEL">ISRAEL<OPTION value=3D"IT =
ITALY">ITALY<OPTION=20
        value=3D"JM JAMAICA">JAMAICA<OPTION value=3D"JN JAN MAYEN">JAN =
MAYEN<OPTION=20
        value=3D"JA JAPAN">JAPAN<OPTION value=3D"JE =
JERSEY">JERSEY<OPTION=20
        value=3D"JQ JOHNSTON ATOLL">JOHNSTON ATOLL<OPTION=20
        value=3D"JO JORDAN">JORDAN<OPTION value=3D"JU JUAN DE NOVA =
ISLAND">JUAN DE=20
        NOVA ISLAND<OPTION value=3D"KZ KAZAKHSTAN">KAZAKHSTAN<OPTION=20
        value=3D"KE KENYA">KENYA<OPTION value=3D"KQ KINGMAN =
REEF">KINGMAN=20
        REEF<OPTION value=3D"KR KIRIBATI">KIRIBATI<OPTION=20
        value=3D"KN KOREA, DEMOCRATIC (NORTH)">KOREA, DEMOCRATIC =
(NORTH)<OPTION=20
        value=3D"KS KOREA, REPUBLIC (SOUTH)">KOREA, REPUBLIC =
(SOUTH)<OPTION=20
        value=3D"KU KUWAIT">KUWAIT<OPTION value=3D"KG =
KYRGYZSTAN">KYRGYZSTAN<OPTION=20
        value=3D"LA LAOS">LAOS<OPTION value=3D"LG LATVIA">LATVIA<OPTION=20
        value=3D"LE LEBANON">LEBANON<OPTION value=3D"LT =
LESOTHO">LESOTHO<OPTION=20
        value=3D"LI LIBERIA">LIBERIA<OPTION value=3D"LY =
LIBYA">LIBYA<OPTION=20
        value=3D"LS LIECHTENSTEIN">LIECHTENSTEIN<OPTION=20
        value=3D"LH LITHUANIA">LITHUANIA<OPTION=20
        value=3D"LU LUXEMBOURG">LUXEMBOURG<OPTION value=3D"MC =
MACAU">MACAU<OPTION=20
        value=3D"MK MACEDONIA">MACEDONIA<OPTION=20
        value=3D"MA MADAGASCAR">MADAGASCAR<OPTION value=3D"MI =
MALAWI">MALAWI<OPTION=20
        value=3D"MY MALAYSIA">MALAYSIA<OPTION value=3D"MV =
MALDIVES">MALDIVES<OPTION=20
        value=3D"ML MALI">MALI<OPTION value=3D"MT MALTA">MALTA<OPTION=20
        value=3D"RM MARSHALL ISLANDS">MARSHALL ISLANDS<OPTION=20
        value=3D"MB MARTINIQUE">MARTINIQUE<OPTION=20
        value=3D"MR MAURITANIA">MAURITANIA<OPTION=20
        value=3D"MP MAURITIUS">MAURITIUS<OPTION value=3D"MF =
MAYOTTE">MAYOTTE<OPTION=20
        value=3D"MX MEXICO">MEXICO<OPTION=20
        value=3D"FM MICRONESIA, FEDERATED STATES OF">MICRONESIA, =
FEDERATED STATES=20
        OF<OPTION value=3D"MQ MIDWAY ISLANDS">MIDWAY ISLANDS<OPTION=20
        value=3D"MD MOLDOVA">MOLDOVA<OPTION value=3D"MN =
MONACO">MONACO<OPTION=20
        value=3D"MG MONGOLIA">MONGOLIA<OPTION=20
        value=3D"MW MONTENEGRO">MONTENEGRO<OPTION=20
        value=3D"MH MONTSERRAT">MONTSERRAT<OPTION=20
        value=3D"MO MOROCCO">MOROCCO<OPTION=20
        value=3D"MZ MOZAMBIQUE">MOZAMBIQUE<OPTION=20
        value=3D"MM MYANMAR">MYANMAR<OPTION value=3D"WA =
NAMIBIA">NAMIBIA<OPTION=20
        value=3D"NR NAURU">NAURU<OPTION value=3D"BQ NAVASSA =
ISLAND">NAVASSA=20
        ISLAND<OPTION value=3D"NP NEPAL">NEPAL<OPTION=20
        value=3D"NL NETHERLANDS">NETHERLANDS<OPTION=20
        value=3D"NT NETHERLANDS ANTILLES">NETHERLANDS ANTILLES<OPTION=20
        value=3D"NC NEW CALEDONIA">NEW CALEDONIA<OPTION value=3D"NZ NEW =
ZEALAND">NEW=20
        ZEALAND<OPTION value=3D"NU NICARAGUA">NICARAGUA<OPTION=20
        value=3D"NG NIGER">NIGER<OPTION value=3D"NI =
NIGERIA">NIGERIA<OPTION=20
        value=3D"NE NIUE">NIUE<OPTION value=3D"NF NORFOLK =
ISLAND">NORFOLK=20
        ISLAND<OPTION value=3D"CQ NORTHERN MARIANA ISLANDS">NORTHERN =
MARIANA=20
        ISLANDS<OPTION value=3D"NO NORWAY">NORWAY<OPTION=20
        value=3D"MU OMAN">OMAN<OPTION value=3D"OC OTHER COUNTRIES">OTHER =

        COUNTRIES<OPTION value=3D"PK PAKISTAN">PAKISTAN<OPTION=20
        value=3D"PS PALAU, REPUBLIC OF">PALAU, REPUBLIC OF<OPTION=20
        value=3D"LQ PALMYRA ATOLL">PALMYRA ATOLL<OPTION=20
        value=3D"PM PANAMA">PANAMA<OPTION value=3D"PP PAPUA NEW =
GUINEA">PAPUA NEW=20
        GUINEA<OPTION value=3D"PF PARACEL ISLANDS">PARACEL =
ISLANDS<OPTION=20
        value=3D"PA PARAGUAY">PARAGUAY<OPTION value=3D"PE =
PERU">PERU<OPTION=20
        value=3D"RP PHILIPPINES">PHILIPPINES<OPTION=20
        value=3D"PC PITCAIRN ISLAND">PITCAIRN ISLAND<OPTION=20
        value=3D"PL POLAND">POLAND<OPTION value=3D"PO =
PORTUGAL">PORTUGAL<OPTION=20
        value=3D"RQ PUERTO RICO">PUERTO RICO<OPTION value=3D"QA =
QATAR">QATAR<OPTION=20
        value=3D"RE REUNION">REUNION<OPTION value=3D"RO =
ROMANIA">ROMANIA<OPTION=20
        value=3D"RS RUSSIA">RUSSIA<OPTION value=3D"RW =
RWANDA">RWANDA<OPTION=20
        value=3D"SC SAINT KITTS AND NEVIS (ST CHRISTOPHER &amp; =
NEVIS)">SAINT=20
        KITTS AND NEVIS (ST CHRISTOPHER &amp; NEVIS)<OPTION=20
        value=3D"SM SAN MARINO">SAN MARINO<OPTION=20
        value=3D"TP SAO TOME AND PRINCIPE">SAO TOME AND PRINCIPE<OPTION=20
        value=3D"SA SAUDI ARABIA">SAUDI ARABIA<OPTION=20
        value=3D"SG SENEGAL">SENEGAL<OPTION value=3D"SR =
SERBIA">SERBIA<OPTION=20
        value=3D"SE SEYCHELLES">SEYCHELLES<OPTION value=3D"SL SIERRA =
LEONE">SIERRA=20
        LEONE<OPTION value=3D"SN SINGAPORE">SINGAPORE<OPTION=20
        value=3D"LO SLOVAKIA">SLOVAKIA<OPTION value=3D"SI =
SLOVENIA">SLOVENIA<OPTION=20
        value=3D"SX SO GEORGIA,SO SANDWICH ISLANDS">SO GEORGIA,SO =
SANDWICH=20
        ISLANDS<OPTION value=3D"BP SOLOMON ISLANDS">SOLOMON =
ISLANDS<OPTION=20
        value=3D"SO SOMALIA">SOMALIA<OPTION value=3D"SF SOUTH =
AFRICA">SOUTH=20
        AFRICA<OPTION value=3D"SP SPAIN">SPAIN<OPTION=20
        value=3D"PG SPRATLY ISLANDS">SPRATLY ISLANDS<OPTION=20
        value=3D"CE SRI LANKA">SRI LANKA<OPTION value=3D"SH ST. =
HELENA">ST.=20
        HELENA<OPTION value=3D"ST ST. LUCIA">ST. LUCIA<OPTION=20
        value=3D"SB ST. PIERRE AND MIQUELON">ST. PIERRE AND =
MIQUELON<OPTION=20
        value=3D"VC ST. VINCENT AND GRENADINES">ST. VINCENT AND =
GRENADINES<OPTION=20
        value=3D"ZZ STATELESS - NO COUNTRY OF CITIZENSHIP">STATELESS - =
NO COUNTRY=20
        OF CITIZENSHIP<OPTION value=3D"SU SUDAN">SUDAN<OPTION=20
        value=3D"NS SURINAME">SURINAME<OPTION value=3D"SV =
SVALBARD">SVALBARD<OPTION=20
        value=3D"WZ SWAZILAND">SWAZILAND<OPTION value=3D"SW =
SWEDEN">SWEDEN<OPTION=20
        value=3D"SZ SWITZERLAND">SWITZERLAND<OPTION value=3D"SY =
SYRIA">SYRIA<OPTION=20
        value=3D"TW TAIWAN">TAIWAN<OPTION value=3D"TI =
TAJIKISTAN">TAJIKISTAN<OPTION=20
        value=3D"TZ TANZANIA, UNITED REPUBLIC OF">TANZANIA, UNITED =
REPUBLIC=20
        OF<OPTION value=3D"TH THAILAND">THAILAND<OPTION=20
        value=3D"TO TOGO">TOGO<OPTION value=3D"TL =
TOKELAU">TOKELAU<OPTION=20
        value=3D"TN TONGA">TONGA<OPTION value=3D"TD TRINIDAD AND =
TOBAGO">TRINIDAD=20
        AND TOBAGO<OPTION value=3D"TE TROMELIN ISLAND">TROMELIN =
ISLAND<OPTION=20
        value=3D"TS TUNISIA">TUNISIA<OPTION value=3D"TU =
TURKEY">TURKEY<OPTION=20
        value=3D"TX TURKMENISTAN">TURKMENISTAN<OPTION=20
        value=3D"TK TURKS AND CAICOS ISLANDS">TURKS AND CAICOS =
ISLANDS<OPTION=20
        value=3D"TV TUVALU">TUVALU<OPTION value=3D"UG =
UGANDA">UGANDA<OPTION=20
        value=3D"UP UKRAINE">UKRAINE<OPTION value=3D"TC UNITED ARAB =
EMIRATES">UNITED=20
        ARAB EMIRATES<OPTION value=3D"UK UNITED KINGDOM">UNITED =
KINGDOM<OPTION=20
        value=3D"US UNITED STATES">UNITED STATES<OPTION=20
        value=3D"UY URUGUAY">URUGUAY<OPTION=20
        value=3D"UZ UZBEKISTAN">UZBEKISTAN<OPTION=20
        value=3D"NH VANUATU">VANUATU<OPTION value=3D"VT VATICAN =
CITY">VATICAN=20
        CITY<OPTION value=3D"VE VENEZUELA">VENEZUELA<OPTION=20
        value=3D"VM VIETNAM">VIETNAM<OPTION=20
        value=3D"VI VIRGIN ISLANDS (BRITISH)">VIRGIN ISLANDS =
(BRITISH)<OPTION=20
        value=3D"VQ VIRGIN ISLANDS (U S)">VIRGIN ISLANDS (U S)<OPTION=20
        value=3D"WQ WAKE ISLAND">WAKE ISLAND<OPTION=20
        value=3D"WF WALLIS AND FUTUNA">WALLIS AND FUTUNA<OPTION=20
        value=3D"WE WEST BANK">WEST BANK<OPTION value=3D"WI WESTERN =
SAHARA">WESTERN=20
        SAHARA<OPTION value=3D"WS WESTERN SAMOA">WESTERN SAMOA<OPTION=20
        value=3D"YM YEMEN">YEMEN<OPTION value=3D"CG ZAIRE">ZAIRE<OPTION=20
        value=3D"ZA ZAMBIA">ZAMBIA<OPTION=20
      value=3D"ZI ZIMBABWE">ZIMBABWE</OPTION></SELECT> =
</TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"10%" align=3Dleft><B>Passport #:</B></TD>
    <TD width=3D"25%" align=3Dleft><INPUT maxLength=3D20 =
name=3Dvpassnumber></TD>
    <TD width=3D"30%" align=3Dleft><FONT color=3Dblack =
size=3D3><B>Passport Expiration=20
      Date:</B></FONT> (mm/dd/yyyy)</TD>
    <TD width=3D"25%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvpassexpdate1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvpassexpdate2>/<INPUT=20
      maxLength=3D4 size=3D4 =
name=3Dvpassexpdate3></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"20%" align=3Dleft><FONT color=3Dblack size=3D3><B>Visa =
#</B></FONT>=20
      (red number in lower right corner of stamp in passport):</TD>
    <TD width=3D"20%" align=3Dleft><INPUT maxLength=3D15 size=3D15=20
  name=3Dvvisanumber></TD></TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      =
color=3Dblack><B><U>ADDRESSES</B></FONT><BR><BR></FONT></U></TD></TR>
  <TR>
    <TH width=3D"50%" align=3Dmiddle>U.S. Local Street=20
Address:</TH></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"50%" align=3Dleft>Address Line 1</TH>
    <TH width=3D"50%" align=3Dleft>Address Line 2</TH></TR>
  <TR>
    <TD width=3D"50%" align=3Dleft><INPUT maxLength=3D20 =
name=3Dvaddress1></TD>
    <TD width=3D"50%" align=3Dleft><INPUT maxLength=3D20=20
  name=3Dvaddress2></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"33%" align=3Dleft>City</TH>
    <TH width=3D"33%" align=3Dleft>State</TH>
    <TH width=3D"33%" align=3Dleft>Zip Code</TH></TR>
  <TR>
    <TD width=3D"33%" align=3Dleft><INPUT maxLength=3D20 =
name=3Dvcity></TD>
    <TD width=3D"33%" align=3Dleft><SELECT size=3D1 name=3Dvstate> =
<OPTION selected=20
        value=3D""><OPTION value=3DKS>Kansas<OPTION =
value=3DAL>Alabama<OPTION=20
        value=3DAK>Alaska<OPTION value=3DAZ>Arizona<OPTION =
value=3DAR>Arkansas<OPTION=20
        value=3DCA>California<OPTION value=3DCO>Colorado<OPTION=20
        value=3DCT>Connecticut<OPTION value=3DDC>District of =
Columbia<OPTION=20
        value=3DDE>Delaware<OPTION value=3DFL>Florida<OPTION =
value=3DGA>Georgia<OPTION=20
        value=3DHI>Hawaii<OPTION value=3DID>Idaho<OPTION =
value=3DIL>Illinois<OPTION=20
        value=3DIN>Indiana<OPTION value=3DIA>Iowa<OPTION =
value=3DKS>Kansas<OPTION=20
        value=3DKY>Kentucky<OPTION value=3DLA>Louisiana<OPTION =
value=3DME>Maine<OPTION=20
        value=3DMD>Maryland<OPTION value=3DMA>Massachusetts<OPTION=20
        value=3DMI>Michigan<OPTION value=3DMN>Minnesota<OPTION=20
        value=3DMS>Mississippi<OPTION value=3DMO>Missouri<OPTION=20
        value=3DMT>Montana<OPTION value=3DNE>Nebraska<OPTION =
value=3DNV>Nevada<OPTION=20
        value=3DNH>New Hampshire<OPTION value=3DNJ>New Jersey<OPTION =
value=3DNM>New=20
        Mexico<OPTION value=3DNY>New York<OPTION value=3DNC>North =
Carolina<OPTION=20
        value=3DND>North Dakota<OPTION value=3DOH>Ohio<OPTION=20
        value=3DOK>Oklahoma<OPTION value=3DOR>Oregon<OPTION=20
        value=3DPA>Pennsylvania<OPTION value=3DRI>Rhode Island<OPTION =
value=3DSC>South=20
        Carolina<OPTION value=3DSD>South Dakota<OPTION =
value=3DTN>Tennessee<OPTION=20
        value=3DTX>Texas<OPTION value=3DUT>Utah<OPTION =
value=3DVT>Vermont<OPTION=20
        value=3DVA>Virginia<OPTION value=3DWA>Washington<OPTION =
value=3DWV>West=20
        Virginia<OPTION value=3DWI>Wisconsin<OPTION =
value=3DWY>Wyoming<OPTION=20
        value=3DYY>FOREIGN</OPTION></SELECT> </TD>
    <TD width=3D"33%" align=3Dleft><INPUT maxLength=3D10 size=3D10=20
  name=3Dvzipcode></TD></TR></TBODY></TABLE>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"100%" align=3Dmiddle><FONT color=3Dblack><B>Foreign =
(home)=20
      Residence Address</B> (should not be P.O. =
Box)</FONT></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"15%" align=3Dleft>Address Line 1:</TH>
    <TD width=3D"50%" align=3Dleft><INPUT maxLength=3D40 size=3D40=20
  name=3Dvforaddr1></TD></TR>
  <TR>
    <TH width=3D"15%" align=3Dleft>Address Line 2:</TH>
    <TD width=3D"50%" align=3Dleft><INPUT maxLength=3D40 size=3D40=20
  name=3Dvforaddr2></TD></TR>
  <TR>
    <TH width=3D"15%" align=3Dleft>Address Line 3:</TH>
    <TD width=3D"50%" align=3Dleft><INPUT maxLength=3D40 size=3D40=20
  name=3Dvforaddr3></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"33%" align=3Dleft>City</TH>
    <TH width=3D"33%" align=3Dleft>City Postal Code</TH></TR>
  <TR>
    <TD width=3D"33%" align=3Dleft><INPUT maxLength=3D35 size=3D35 =
name=3Dvforcity></TD>
    <TD width=3D"33%" align=3Dleft><INPUT maxLength=3D10 size=3D10=20
    name=3Dvforcityzipcd></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"33%" align=3Dleft>Province/Region</TH>
    <TH width=3D"33%" align=3Dleft>Region Postal Code</TH></TR>
  <TR>
    <TD width=3D"33%" align=3Dleft><INPUT maxLength=3D30 size=3D30=20
    name=3Dvforprovince></TD>
    <TD width=3D"33%" align=3Dleft><INPUT maxLength=3D10 size=3D10=20
  name=3Dvforzipcd></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"33%" align=3Dleft>Country</TH></TR>
  <TR>
    <TD width=3D"50%" align=3Dleft><SELECT size=3D1 name=3Dvforcntry> =
<OPTION=20
        selected><OPTION value=3D"AF AFGHANISTAN">AFGHANISTAN<OPTION=20
        value=3D"AL ALBANIA">ALBANIA<OPTION value=3D"AG =
ALGERIA">ALGERIA<OPTION=20
        value=3D"AQ AMERICAN SAMOA">AMERICAN SAMOA<OPTION=20
        value=3D"AN ANDORRA">ANDORRA<OPTION value=3D"AO =
ANGOLA">ANGOLA<OPTION=20
        value=3D"AV ANGUILLA">ANGUILLA<OPTION=20
        value=3D"AY ANTARCTICA">ANTARCTICA<OPTION=20
        value=3D"AC ANTIGUA AND BARBUDA">ANTIGUA AND BARBUDA<OPTION=20
        value=3D"AR ARGENTINA">ARGENTINA<OPTION value=3D"AM =
ARMENIA">ARMENIA<OPTION=20
        value=3D"AA ARUBA">ARUBA<OPTION=20
        value=3D"AT ASHMORE AND CARTIER ISLANDS">ASHMORE AND CARTIER=20
        ISLANDS<OPTION value=3D"AS AUSTRALIA">AUSTRALIA<OPTION=20
        value=3D"AU AUSTRIA">AUSTRIA<OPTION=20
        value=3D"AJ AZERBAIJAN">AZERBAIJAN<OPTION value=3D"BF BAHAMAS, =
THE">BAHAMAS,=20
        THE<OPTION value=3D"BA BAHRAIN">BAHRAIN<OPTION=20
        value=3D"FQ BAKER ISLAND">BAKER ISLAND<OPTION=20
        value=3D"BG BANGLADESH">BANGLADESH<OPTION=20
        value=3D"BB BARBADOS">BARBADOS<OPTION value=3D"BS BASSAS DA =
INDIA">BASSAS DA=20
        INDIA<OPTION value=3D"BO BELARUS">BELARUS<OPTION=20
        value=3D"BE BELGIUM">BELGIUM<OPTION value=3D"BH =
BELIZE">BELIZE<OPTION=20
        value=3D"BN BENIN">BENIN<OPTION value=3D"BD =
BERMUDA">BERMUDA<OPTION=20
        value=3D"BT BHUTAN">BHUTAN<OPTION value=3D"BL =
BOLIVIA">BOLIVIA<OPTION=20
        value=3D"BK BOSNIA-HERZEGOVINA">BOSNIA-HERZEGOVINA<OPTION=20
        value=3D"BC BOTSWANA">BOTSWANA<OPTION value=3D"BV BOUVET =
ISLAND">BOUVET=20
        ISLAND<OPTION value=3D"BR BRAZIL">BRAZIL<OPTION=20
        value=3D"IO BRITISH INDIAN OCEAN TERRITORY">BRITISH INDIAN OCEAN =

        TERRITORY<OPTION value=3D"BX BRUNEI">BRUNEI<OPTION=20
        value=3D"BU BULGARIA">BULGARIA<OPTION value=3D"UV BURKINA =
FASO">BURKINA=20
        FASO<OPTION value=3D"BY BURUNDI">BURUNDI<OPTION=20
        value=3D"CB CAMBODIA">CAMBODIA<OPTION value=3D"CM =
CAMEROON">CAMEROON<OPTION=20
        value=3D"CA CANADA">CANADA<OPTION value=3D"CV CAPE VERDE">CAPE =
VERDE<OPTION=20
        value=3D"CJ CAYMAN ISLANDS">CAYMAN ISLANDS<OPTION=20
        value=3D"CT CENTRAL AFRICAN REPUBLIC">CENTRAL AFRICAN =
REPUBLIC<OPTION=20
        value=3D"CD CHAD">CHAD<OPTION value=3D"CI CHILE">CHILE<OPTION=20
        value=3D"CH CHINA, PEOPLE'S REPUBLIC">CHINA, PEOPLE'S =
REPUBLIC<OPTION=20
        value=3D"KT CHRISTMAS ISLAND (INDIAN OC)">CHRISTMAS ISLAND =
(INDIAN=20
        OC)<OPTION value=3D"IP CLIPPERTON ISLAND">CLIPPERTON =
ISLAND<OPTION=20
        value=3D"CK COCOS (KEELING) ISLANDS">COCOS (KEELING) =
ISLANDS<OPTION=20
        value=3D"CO COLOMBIA">COLOMBIA<OPTION value=3D"CN =
COMOROS">COMOROS<OPTION=20
        value=3D"CF CONGO">CONGO<OPTION value=3D"CW COOK ISLANDS">COOK=20
        ISLANDS<OPTION value=3D"CR CORAL SEA ISLANDS">CORAL SEA =
ISLANDS<OPTION=20
        value=3D"VP CORSICA">CORSICA<OPTION value=3D"CS COSTA =
RICA">COSTA=20
        RICA<OPTION value=3D"IV COTE D'IVOIRE (IVORY COAST)">COTE =
D'IVOIRE (IVORY=20
        COAST)<OPTION value=3D"HR CROATIA">CROATIA<OPTION=20
        value=3D"CU CUBA">CUBA<OPTION value=3D"CY CYPRUS">CYPRUS<OPTION=20
        value=3D"EZ CZECH REPUBLIC">CZECH REPUBLIC<OPTION=20
        value=3D"DA DENMARK">DENMARK<OPTION value=3D"DJ =
DJIBOUTI">DJIBOUTI<OPTION=20
        value=3D"DO DOMINICA">DOMINICA<OPTION=20
        value=3D"DR DOMINICAN REPUBLIC">DOMINICAN REPUBLIC<OPTION=20
        value=3D"EC ECUADOR">ECUADOR<OPTION value=3D"EG =
EGYPT">EGYPT<OPTION=20
        value=3D"ES EL SALVADOR">EL SALVADOR<OPTION=20
        value=3D"EK EQUATORIAL GUINEA">EQUATORIAL GUINEA<OPTION=20
        value=3D"ER ERITREA">ERITREA<OPTION value=3D"EN =
ESTONIA">ESTONIA<OPTION=20
        value=3D"ET ETHIOPIA">ETHIOPIA<OPTION value=3D"EU EUROPA =
ISLAND">EUROPA=20
        ISLAND<OPTION value=3D"FK FALKLAND ISL (ISL MALVINAS)">FALKLAND =
ISL (ISL=20
        MALVINAS)<OPTION value=3D"FO FAROE ISLANDS">FAROE ISLANDS<OPTION =

        value=3D"FJ FIJI">FIJI<OPTION value=3D"FI =
FINLAND">FINLAND<OPTION=20
        value=3D"FS FR SOUTHERN AND ANTARCTIC">FR SOUTHERN AND =
ANTARCTIC<OPTION=20
        value=3D"FR FRANCE">FRANCE<OPTION value=3D"FG FRENCH =
GUIANA">FRENCH=20
        GUIANA<OPTION value=3D"FP FRENCH POLYNESIA">FRENCH =
POLYNESIA<OPTION=20
        value=3D"GB GABON">GABON<OPTION value=3D"GA GAMBIA, THE">GAMBIA, =
THE<OPTION=20
        value=3D"GZ GAZA STRIP">GAZA STRIP<OPTION=20
        value=3D"GG GEORGIA">GEORGIA<OPTION value=3D"GM =
GERMANY">GERMANY<OPTION=20
        value=3D"GH GHANA">GHANA<OPTION value=3D"GI =
GIBRALTAR">GIBRALTAR<OPTION=20
        value=3D"GO GLORIOSO ISLANDS">GLORIOSO ISLANDS<OPTION=20
        value=3D"GR GREECE">GREECE<OPTION value=3D"GL =
GREENLAND">GREENLAND<OPTION=20
        value=3D"GJ GRENADA">GRENADA<OPTION=20
        value=3D"GP GUADELOUPE">GUADELOUPE<OPTION value=3D"GQ =
GUAM">GUAM<OPTION=20
        value=3D"GT GUATEMALA">GUATEMALA<OPTION=20
        value=3D"GK GUERNSEY">GUERNSEY<OPTION value=3D"GV =
GUINEA">GUINEA<OPTION=20
        value=3D"PU GUINEA-BISSAU">GUINEA-BISSAU<OPTION=20
        value=3D"GY GUYANA">GUYANA<OPTION value=3D"HA =
HAITI">HAITI<OPTION=20
        value=3D"HM HEARD ISLAND AND MCDONALD ISLANDS">HEARD ISLAND AND =
MCDONALD=20
        ISLANDS<OPTION value=3D"HO HONDURAS">HONDURAS<OPTION=20
        value=3D"HK HONG KONG">HONG KONG<OPTION value=3D"HQ HOWLAND =
ISLAND">HOWLAND=20
        ISLAND<OPTION value=3D"HU HUNGARY">HUNGARY<OPTION=20
        value=3D"IC ICELAND">ICELAND<OPTION value=3D"IN =
INDIA">INDIA<OPTION=20
        value=3D"ID INDONESIA">INDONESIA<OPTION value=3D"IR =
IRAN">IRAN<OPTION=20
        value=3D"IZ IRAQ">IRAQ<OPTION value=3D"EI =
IRELAND">IRELAND<OPTION=20
        value=3D"IM ISLE OF MAN">ISLE OF MAN<OPTION=20
        value=3D"IS ISRAEL">ISRAEL<OPTION value=3D"IT =
ITALY">ITALY<OPTION=20
        value=3D"JM JAMAICA">JAMAICA<OPTION value=3D"JN JAN MAYEN">JAN =
MAYEN<OPTION=20
        value=3D"JA JAPAN">JAPAN<OPTION value=3D"JE =
JERSEY">JERSEY<OPTION=20
        value=3D"JQ JOHNSTON ATOLL">JOHNSTON ATOLL<OPTION=20
        value=3D"JO JORDAN">JORDAN<OPTION value=3D"JU JUAN DE NOVA =
ISLAND">JUAN DE=20
        NOVA ISLAND<OPTION value=3D"KZ KAZAKHSTAN">KAZAKHSTAN<OPTION=20
        value=3D"KE KENYA">KENYA<OPTION value=3D"KQ KINGMAN =
REEF">KINGMAN=20
        REEF<OPTION value=3D"KR KIRIBATI">KIRIBATI<OPTION=20
        value=3D"KN KOREA, DEMOCRATIC (NORTH)">KOREA, DEMOCRATIC =
(NORTH)<OPTION=20
        value=3D"KS KOREA, REPUBLIC (SOUTH)">KOREA, REPUBLIC =
(SOUTH)<OPTION=20
        value=3D"KU KUWAIT">KUWAIT<OPTION value=3D"KG =
KYRGYZSTAN">KYRGYZSTAN<OPTION=20
        value=3D"LA LAOS">LAOS<OPTION value=3D"LG LATVIA">LATVIA<OPTION=20
        value=3D"LE LEBANON">LEBANON<OPTION value=3D"LT =
LESOTHO">LESOTHO<OPTION=20
        value=3D"LI LIBERIA">LIBERIA<OPTION value=3D"LY =
LIBYA">LIBYA<OPTION=20
        value=3D"LS LIECHTENSTEIN">LIECHTENSTEIN<OPTION=20
        value=3D"LH LITHUANIA">LITHUANIA<OPTION=20
        value=3D"LU LUXEMBOURG">LUXEMBOURG<OPTION value=3D"MC =
MACAU">MACAU<OPTION=20
        value=3D"MK MACEDONIA">MACEDONIA<OPTION=20
        value=3D"MA MADAGASCAR">MADAGASCAR<OPTION value=3D"MI =
MALAWI">MALAWI<OPTION=20
        value=3D"MY MALAYSIA">MALAYSIA<OPTION value=3D"MV =
MALDIVES">MALDIVES<OPTION=20
        value=3D"ML MALI">MALI<OPTION value=3D"MT MALTA">MALTA<OPTION=20
        value=3D"RM MARSHALL ISLANDS">MARSHALL ISLANDS<OPTION=20
        value=3D"MB MARTINIQUE">MARTINIQUE<OPTION=20
        value=3D"MR MAURITANIA">MAURITANIA<OPTION=20
        value=3D"MP MAURITIUS">MAURITIUS<OPTION value=3D"MF =
MAYOTTE">MAYOTTE<OPTION=20
        value=3D"MX MEXICO">MEXICO<OPTION=20
        value=3D"FM MICRONESIA, FEDERATED STATES OF">MICRONESIA, =
FEDERATED STATES=20
        OF<OPTION value=3D"MQ MIDWAY ISLANDS">MIDWAY ISLANDS<OPTION=20
        value=3D"MD MOLDOVA">MOLDOVA<OPTION value=3D"MN =
MONACO">MONACO<OPTION=20
        value=3D"MG MONGOLIA">MONGOLIA<OPTION=20
        value=3D"MW MONTENEGRO">MONTENEGRO<OPTION=20
        value=3D"MH MONTSERRAT">MONTSERRAT<OPTION=20
        value=3D"MO MOROCCO">MOROCCO<OPTION=20
        value=3D"MZ MOZAMBIQUE">MOZAMBIQUE<OPTION=20
        value=3D"MM MYANMAR">MYANMAR<OPTION value=3D"WA =
NAMIBIA">NAMIBIA<OPTION=20
        value=3D"NR NAURU">NAURU<OPTION value=3D"BQ NAVASSA =
ISLAND">NAVASSA=20
        ISLAND<OPTION value=3D"NP NEPAL">NEPAL<OPTION=20
        value=3D"NL NETHERLANDS">NETHERLANDS<OPTION=20
        value=3D"NT NETHERLANDS ANTILLES">NETHERLANDS ANTILLES<OPTION=20
        value=3D"NC NEW CALEDONIA">NEW CALEDONIA<OPTION value=3D"NZ NEW =
ZEALAND">NEW=20
        ZEALAND<OPTION value=3D"NU NICARAGUA">NICARAGUA<OPTION=20
        value=3D"NG NIGER">NIGER<OPTION value=3D"NI =
NIGERIA">NIGERIA<OPTION=20
        value=3D"NE NIUE">NIUE<OPTION value=3D"NF NORFOLK =
ISLAND">NORFOLK=20
        ISLAND<OPTION value=3D"CQ NORTHERN MARIANA ISLANDS">NORTHERN =
MARIANA=20
        ISLANDS<OPTION value=3D"NO NORWAY">NORWAY<OPTION=20
        value=3D"MU OMAN">OMAN<OPTION value=3D"OC OTHER COUNTRIES">OTHER =

        COUNTRIES<OPTION value=3D"PK PAKISTAN">PAKISTAN<OPTION=20
        value=3D"PS PALAU, REPUBLIC OF">PALAU, REPUBLIC OF<OPTION=20
        value=3D"LQ PALMYRA ATOLL">PALMYRA ATOLL<OPTION=20
        value=3D"PM PANAMA">PANAMA<OPTION value=3D"PP PAPUA NEW =
GUINEA">PAPUA NEW=20
        GUINEA<OPTION value=3D"PF PARACEL ISLANDS">PARACEL =
ISLANDS<OPTION=20
        value=3D"PA PARAGUAY">PARAGUAY<OPTION value=3D"PE =
PERU">PERU<OPTION=20
        value=3D"RP PHILIPPINES">PHILIPPINES<OPTION=20
        value=3D"PC PITCAIRN ISLAND">PITCAIRN ISLAND<OPTION=20
        value=3D"PL POLAND">POLAND<OPTION value=3D"PO =
PORTUGAL">PORTUGAL<OPTION=20
        value=3D"RQ PUERTO RICO">PUERTO RICO<OPTION value=3D"QA =
QATAR">QATAR<OPTION=20
        value=3D"RE REUNION">REUNION<OPTION value=3D"RO =
ROMANIA">ROMANIA<OPTION=20
        value=3D"RS RUSSIA">RUSSIA<OPTION value=3D"RW =
RWANDA">RWANDA<OPTION=20
        value=3D"SC SAINT KITTS AND NEVIS (ST CHRISTOPHER &amp; =
NEVIS)">SAINT=20
        KITTS AND NEVIS (ST CHRISTOPHER &amp; NEVIS)<OPTION=20
        value=3D"SM SAN MARINO">SAN MARINO<OPTION=20
        value=3D"TP SAO TOME AND PRINCIPE">SAO TOME AND PRINCIPE<OPTION=20
        value=3D"SA SAUDI ARABIA">SAUDI ARABIA<OPTION=20
        value=3D"SG SENEGAL">SENEGAL<OPTION value=3D"SR =
SERBIA">SERBIA<OPTION=20
        value=3D"SE SEYCHELLES">SEYCHELLES<OPTION value=3D"SL SIERRA =
LEONE">SIERRA=20
        LEONE<OPTION value=3D"SN SINGAPORE">SINGAPORE<OPTION=20
        value=3D"LO SLOVAKIA">SLOVAKIA<OPTION value=3D"SI =
SLOVENIA">SLOVENIA<OPTION=20
        value=3D"SX SO GEORGIA,SO SANDWICH ISLANDS">SO GEORGIA,SO =
SANDWICH=20
        ISLANDS<OPTION value=3D"BP SOLOMON ISLANDS">SOLOMON =
ISLANDS<OPTION=20
        value=3D"SO SOMALIA">SOMALIA<OPTION value=3D"SF SOUTH =
AFRICA">SOUTH=20
        AFRICA<OPTION value=3D"SP SPAIN">SPAIN<OPTION=20
        value=3D"PG SPRATLY ISLANDS">SPRATLY ISLANDS<OPTION=20
        value=3D"CE SRI LANKA">SRI LANKA<OPTION value=3D"SH ST. =
HELENA">ST.=20
        HELENA<OPTION value=3D"ST ST. LUCIA">ST. LUCIA<OPTION=20
        value=3D"SB ST. PIERRE AND MIQUELON">ST. PIERRE AND =
MIQUELON<OPTION=20
        value=3D"VC ST. VINCENT AND GRENADINES">ST. VINCENT AND =
GRENADINES<OPTION=20
        value=3D"ZZ STATELESS - NO COUNTRY OF CITIZENSHIP">STATELESS - =
NO COUNTRY=20
        OF CITIZENSHIP<OPTION value=3D"SU SUDAN">SUDAN<OPTION=20
        value=3D"NS SURINAME">SURINAME<OPTION value=3D"SV =
SVALBARD">SVALBARD<OPTION=20
        value=3D"WZ SWAZILAND">SWAZILAND<OPTION value=3D"SW =
SWEDEN">SWEDEN<OPTION=20
        value=3D"SZ SWITZERLAND">SWITZERLAND<OPTION value=3D"SY =
SYRIA">SYRIA<OPTION=20
        value=3D"TW TAIWAN">TAIWAN<OPTION value=3D"TI =
TAJIKISTAN">TAJIKISTAN<OPTION=20
        value=3D"TZ TANZANIA, UNITED REPUBLIC OF">TANZANIA, UNITED =
REPUBLIC=20
        OF<OPTION value=3D"TH THAILAND">THAILAND<OPTION=20
        value=3D"TO TOGO">TOGO<OPTION value=3D"TL =
TOKELAU">TOKELAU<OPTION=20
        value=3D"TN TONGA">TONGA<OPTION value=3D"TD TRINIDAD AND =
TOBAGO">TRINIDAD=20
        AND TOBAGO<OPTION value=3D"TE TROMELIN ISLAND">TROMELIN =
ISLAND<OPTION=20
        value=3D"TS TUNISIA">TUNISIA<OPTION value=3D"TU =
TURKEY">TURKEY<OPTION=20
        value=3D"TX TURKMENISTAN">TURKMENISTAN<OPTION=20
        value=3D"TK TURKS AND CAICOS ISLANDS">TURKS AND CAICOS =
ISLANDS<OPTION=20
        value=3D"TV TUVALU">TUVALU<OPTION value=3D"UG =
UGANDA">UGANDA<OPTION=20
        value=3D"UP UKRAINE">UKRAINE<OPTION value=3D"TC UNITED ARAB =
EMIRATES">UNITED=20
        ARAB EMIRATES<OPTION value=3D"UK UNITED KINGDOM">UNITED =
KINGDOM<OPTION=20
        value=3D"US UNITED STATES">UNITED STATES<OPTION=20
        value=3D"UY URUGUAY">URUGUAY<OPTION=20
        value=3D"UZ UZBEKISTAN">UZBEKISTAN<OPTION=20
        value=3D"NH VANUATU">VANUATU<OPTION value=3D"VT VATICAN =
CITY">VATICAN=20
        CITY<OPTION value=3D"VE VENEZUELA">VENEZUELA<OPTION=20
        value=3D"VM VIETNAM">VIETNAM<OPTION=20
        value=3D"VI VIRGIN ISLANDS (BRITISH)">VIRGIN ISLANDS =
(BRITISH)<OPTION=20
        value=3D"VQ VIRGIN ISLANDS (U S)">VIRGIN ISLANDS (U S)<OPTION=20
        value=3D"WQ WAKE ISLAND">WAKE ISLAND<OPTION=20
        value=3D"WF WALLIS AND FUTUNA">WALLIS AND FUTUNA<OPTION=20
        value=3D"WE WEST BANK">WEST BANK<OPTION value=3D"WI WESTERN =
SAHARA">WESTERN=20
        SAHARA<OPTION value=3D"WS WESTERN SAMOA">WESTERN SAMOA<OPTION=20
        value=3D"YM YEMEN">YEMEN<OPTION value=3D"CG ZAIRE">ZAIRE<OPTION=20
        value=3D"ZA ZAMBIA">ZAMBIA<OPTION=20
      value=3D"ZI ZIMBABWE">ZIMBABWE</OPTION></SELECT> =
</TD></TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>CURRENT IMMIGRATION=20
    STATUS</B></FONT><BR><BR></FONT></U></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"30%" align=3Dleft><INPUT value=3DLPR type=3Dcheckbox=20
      name=3Dimstatus>U.S. Immigrant/Permanent Resident</TD>
    <TD width=3D"40%" align=3Dleft><INPUT value=3DF-1 type=3Dcheckbox=20
      name=3Dimstatus>F-1 Student</TD></TR>
  <TR>
    <TD width=3D"30%" align=3Dleft><INPUT value=3DH-1B type=3Dcheckbox=20
      name=3Dimstatus>H-1B Temporary Worker</TD>
    <TD width=3D"40%" align=3Dleft><INPUT value=3DJ-2 type=3Dcheckbox=20
      name=3Dimstatus>J-2 Dependent</TD></TR>
  <TR>
    <TD width=3D"30%" align=3Dleft><INPUT value=3DJ-1 type=3Dcheckbox=20
      name=3Dimstatus>J-1 Exchange Visitor</TD><INPUT value=3Dxxx =
type=3Dhidden=20
    name=3Dimstatus>=20
    <TD width=3D"40%" align=3Dleft><FONT color=3Dblack>Other: =
</FONT><SELECT size=3D1=20
      name=3Dvimstatusoth> <OPTION selected value=3D""><OPTION =
value=3DA-1>A-1=20
        Foreign Government Worker<OPTION value=3DA-2>A-2 Other foreign =
government=20
        official and family<OPTION value=3DA-3>A-3 Attendent,servant or =
employee=20
        of A-1 or A-2, and family<OPTION value=3DASLM>ASLM Political =
Asylum<OPTION=20
        value=3DB-1>B-1 Visitor for Business<OPTION value=3DB-2>B-2 =
Visitor for=20
        Pleasure<OPTION value=3DC-1>C-1 Continuous Transit Alien<OPTION=20
        value=3DC-2>C-2 Alien in transit to UN Headquarteres<OPTION =
value=3DC-3>C-3=20
        Foreign official, family, servants in transit<OPTION =
value=3DCPO>CPO=20
        Chinese Protective Order- Oct 90<OPTION value=3DCPR>CPR =
Conditional=20
        Permanent Resident (Spouse - Two Year)<OPTION value=3DD-1>D-1=20
        Crewman<OPTION value=3DE-1>E-1 Treaty Trader<OPTION =
value=3DE-2>E-2 Treaty=20
        Investor<OPTION value=3DF-1>F-1 Student<OPTION value=3DF-2>F-2 =
Student=20
        Dependent<OPTION value=3DG-1>G-1 Foreign Government =
Visitor<OPTION=20
        value=3DG-2>G-2 Other Representative of foreign member =
government<OPTION=20
        value=3DG-3>G-3 Representative of nonrecognized government and=20
        family<OPTION value=3DG-4>G-4 International organization officer =
or=20
        employee and family<OPTION value=3DH-1A>H-1A Professional =
Nurse<OPTION=20
        value=3DH-1B>H-1B Worker in Specialty Occupation<OPTION =
value=3DH-2A>H-2A=20
        Temporary Worker performing Agricultural services<OPTION =
value=3DH-2B>H-2B=20
        Temporary Worker<OPTION value=3DH-3>H-3 Temporary Trainee<OPTION =

        value=3DH-4>H-4 Worker Dependent<OPTION value=3DI>I =
Representative of=20
        foreign media, spouse,children<OPTION value=3DJ-1>J-1 Exchange=20
        Visitor<OPTION value=3DJ-2>J-2 Exchange Visitor Dependent<OPTION =

        value=3DK-1>K-1 Fiance of U.S. citizen<OPTION value=3DL-1>L-1 =
Intracompany=20
        Transferee<OPTION value=3DL-2>L-2 Intracompany Transferee =
Dependent<OPTION=20
        value=3DLPR>LPR U.S. Lawful Permanent Resident<OPTION =
value=3DM-1>M-1=20
        Non-Academic Student<OPTION value=3DM-2>M-2 Non-Academic Student =

        Dependent<OPTION value=3DN-8>N-8 Parent of SK-3 Special =
Immigrant<OPTION=20
        value=3DN-9>N-9 Child of N-8 or SK-1, SK-2, or SK4 Special=20
        Immigrant<OPTION value=3DNATO>NATO NATO<OPTION value=3DO-1>O-1 =
Alien of=20
        Extraordinary Ability in Sciences, Arts, Education<OPTION =
value=3DO-2>O-2=20
        Accompanying Alien<OPTION value=3DO-3>O-3 Spouse/child of O-1 or =

        O-2<OPTION value=3DP-1>P-1 Performing Entertainer or =
Athlete<OPTION=20
        value=3DP-2>P-2 Exchange Program Artist or Entertainer<OPTION=20
        value=3DP-3>P-3 Culturally Unique Artist or Entertainer<OPTION=20
        value=3DQ-1>Q-1 Cultural Exchange Visitor<OPTION value=3DR-1>R-1 =
Religious=20
        Worker<OPTION value=3DR-2>R-2 Religious Worker Dependent<OPTION=20
        value=3DRFGE>RFGE Refugee<OPTION value=3DSK-1>SK-1 Special =
Immigrant<OPTION=20
        value=3DSK-2>SK-2 Special Immigrant<OPTION value=3DSK-3>SK-3 =
Special=20
        Immigrant<OPTION value=3DSK-4>SK-4 Special Immigrant<OPTION =
value=3DTN>TN=20
        Canadian or Mexican Citizen Professional<OPTION value=3DVWB>VWB =
Visa=20
        Waiver - Business<OPTION value=3DVWP>VWP Visa Waiver -=20
      Pleasure</OPTION></SELECT> </TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack><B>--IF</B> J-1 Exchange =
Visitor, what=20
      category?</FONT> </TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><INPUT value=3D01 type=3Dcheckbox =
name=3Dimtype>Student</TD>
    <TD align=3Dleft><INPUT value=3D12 type=3Dcheckbox =
name=3Dimtype>Research=20
    Scholar</TD>
    <TD align=3Dleft><INPUT value=3D02 type=3Dcheckbox =
name=3Dimtype>Short Term=20
    Scholar</TD>
    <TD align=3Dleft><INPUT value=3D07 type=3Dcheckbox =
name=3Dimtype>Alien=20
    Physician</TD><INPUT value=3Dxxx type=3Dhidden name=3Dimtype>=20
    <TD align=3Dleft><FONT color=3Dblack>Other: </FONT><INPUT =
maxLength=3D20=20
      name=3Dvimtypeoth> </TD></TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>PRIMARY ACTIVITY DURING THIS VISIT (Choose =
only=20
      one)</B></FONT><BR><BR></FONT></U></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><INPUT value=3D01 type=3Dcheckbox =
name=3Dprimact>Studying in a=20
      degree program</TD>
    <TD align=3Dleft><INPUT value=3D05 type=3Dcheckbox =
name=3Dprimact>Observing</TD>
    <TD align=3Dleft><INPUT value=3D09 type=3Dcheckbox =
name=3Dprimact>Demonstrating=20
      special skills</TD></TR>
  <TR>
    <TD align=3Dleft><INPUT value=3D02 type=3Dcheckbox =
name=3Dprimact>Studying in a=20
      non-degree program</TD>
    <TD align=3Dleft><INPUT value=3D06 type=3Dcheckbox =
name=3Dprimact>Consulting</TD>
    <TD align=3Dleft><INPUT value=3D10 type=3Dcheckbox =
name=3Dprimact>Clinical=20
      activities</TD></TR>
  <TR>
    <TD align=3Dleft><INPUT value=3D03 type=3Dcheckbox =
name=3Dprimact>Teaching</TD>
    <TD align=3Dleft><INPUT value=3D07 type=3Dcheckbox =
name=3Dprimact>Conducting=20
      research</TD>
    <TD align=3Dleft><INPUT value=3D11 type=3Dcheckbox =
name=3Dprimact>Temporary=20
      employment</TD></TR>
  <TR>
    <TD align=3Dleft><INPUT value=3D04 type=3Dcheckbox =
name=3Dprimact>Lecturing</TD>
    <TD align=3Dleft><INPUT value=3D08 type=3Dcheckbox =
name=3Dprimact>Training</TD>
    <TD align=3Dleft><INPUT value=3D12 type=3Dcheckbox =
name=3Dprimact>Here with=20
    spouse</TD></TR><INPUT value=3Dxxx type=3Dhidden name=3Dprimact> =
</TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"50%" align=3Dleft><FONT color=3Dblack size=3D3><B>What =
was the start=20
      date of your immigration status for the current =
activity?</B></FONT></TD>
    <TD width=3D"25%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvimstartdate1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvimstartdate2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvimstartdate3></TD></TR>
  <TR>
    <TD width=3D"50%" align=3Dleft><FONT color=3Dblack size=3D3>(In many =
cases, this=20
      is the date you entered the U.S.)</B></FONT></TD>
    <TD width=3D"25%" align=3Dleft><FONT color=3Dblack=20
    size=3D3>month/day/year</FONT></TD></TR>
  <TR>
    <TD width=3D"50%" align=3Dleft><FONT color=3Dblack size=3D3><B>What =
is the=20
      projected end date of your primary activity?</B></FONT></TD>
    <TD width=3D"25%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvimenddate1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvimenddate2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvimenddate3></TD></TR>
  <TR>
    <TD width=3D"50%" align=3Dleft><FONT color=3Dblack size=3D3>(In many =
cases, this=20
      is the completion date on your immigration =
document.)</B></FONT></TD>
    <TD width=3D"25%" align=3Dleft><FONT color=3Dblack=20
    size=3D3>month/day/year</FONT></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack size=3D3><B>If you are a =
student, at what=20
      level do you study?</B></FONT></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><INPUT value=3DUndergraduate type=3Dcheckbox=20
      name=3Dvlevel>Undergraduate</TD>
    <TD align=3Dleft><INPUT value=3DMasters type=3Dcheckbox =
name=3Dvlevel>Masters</TD>
    <TD align=3Dleft><INPUT value=3DLaw type=3Dcheckbox =
name=3Dvlevel>Law=20
    School</TD><INPUT value=3Dxxx type=3Dhidden name=3Dvlevel>=20
    <TD align=3Dleft><FONT color=3Dblack>Other: </FONT><INPUT =
maxLength=3D15 size=3D15=20
      name=3Dvleveloth> </TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack size=3D3><B>Describe the =
activity that will=20
      result in U.S. income</B></FONT> (i.e., professor of physics, =
consulting,=20
      lecturer/speaker, food service worker, scholarship, contest prize, =

  etc.)</TD></TR>
  <TR>
    <TD width=3D"100%" align=3Dleft><INPUT maxLength=3D40 size=3D40=20
  name=3Dvactivity></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack size=3D3><B>WU department =
providing the=20
      income?</B></FONT></TD>
    <TD align=3Dleft><FONT color=3Dblack size=3D3><B>Annual =
Amount?</B></FONT></TD></TR>
  <TR>
    <TD align=3Dleft><SELECT size=3D1 name=3Dvdept> <OPTION=20
        selected><OPTION>Academic Affairs<OPTION>Academic &amp; =
Community Event=20
        Scheduling<OPTION>Administration &amp; =
Treasurer<OPTION>Administrative=20
        Information Systems<OPTION>Admissions<OPTION>Affirmative=20
        Action<OPTION>Allied Health<OPTION>Alumni=20
        Association<OPTION>Anthropology<OPTION>Applied Studies, School=20
        of<OPTION>Army ROTC<OPTION>Art<OPTION>Arts and Sciences, College =

        of<OPTION>Astronomy<OPTION>Athletics<OPTION>Biology<OPTION>Board =
of=20
        Regents<OPTION>Bookstore<OPTION>Budget Office<OPTION>Business, =
School=20
        of<OPTION>Business Office<OPTION>Business Services<OPTION>Campus =

        Safety<OPTION>Campus Police<OPTION>Catering<OPTION>Center for =
Kansas=20
        Studies<OPTION>Center for Learning &amp; Student=20
        Success<OPTION>Chemistry<OPTION>College of Arts and=20
        Sciences<OPTION>Communication<OPTION>Computer Information=20
        Sciences<OPTION>Continuing Education, Division =
of<OPTION>Criminal=20
        Justice<OPTION>Curriculum Resource Center<OPTION>Dean, College =
of Arts=20
        and Sciences<OPTION>Dean, Division of Continuing =
Education<OPTION>Dean,=20
        Enrollment Management<OPTION>Dean, Mabee Library<OPTION>Dean, =
School of=20
        Applied Studies<OPTION>Dean, School of Business<OPTION>Dean, =
School of=20
        Law<OPTION>Dean, School of Nursing<OPTION>Dean of =
Students<OPTION>Dining=20
        Services<OPTION>Disability Services<OPTION>Division of =
Continuing=20
        =
Education<OPTION>Education<OPTION>Engineering<OPTION>English<OPTION>Enrol=
lment=20
        Management<OPTION>Facilities Services<OPTION>Facilities Use=20
        Office<OPTION>Financial Aid<OPTION>Food=20
        Services<OPTION>Geology<OPTION>Governmental =
Relations<OPTION>Health, PE=20
        &amp; Exercise Science<OPTION>History<OPTION>Honors=20
        Program<OPTION>Housing<OPTION>Human Resources<OPTION>Human=20
        Services<OPTION>Ichabod Service Center<OPTION>Information =
Technology=20
        Services<OPTION>Institutional Research<OPTION>Instructional=20
        Media<OPTION>Intensive English<OPTION>International Programs, =
Office=20
        of<OPTION>KAN Be Healthy<OPTION>Kansas Curriculum=20
        Center<OPTION>KTWU-TV<OPTION>Kuehne Hall<OPTION>Law, School=20
        of<OPTION>Law Library<OPTION>Law School =
Development<OPTION>Leadership=20
        Institute<OPTION>Learning IN the Community =
(LINC)<OPTION>Library,=20
        Law<OPTION>Library, University (Mabee)<OPTION>Living Learning =
Center=20
        (LLC)<OPTION>Mass Media<OPTION>Mabee Library<OPTION>Mathematics =
and=20
        Statistics<OPTION>Memorial Union<OPTION>Modern=20
        Languages<OPTION>Multicultural Affairs<OPTION>Mulvane Art=20
        Museum<OPTION>Music<OPTION>Nursing, School of<OPTION>Office, =
Legal and=20
        Technology<OPTION>Office of the=20
        President<OPTION>Personnel<OPTION>Philosophy<OPTION>Physical=20
        Education<OPTION>Physics and =
Astronomy<OPTION>Police<OPTION>Political=20
        Science<OPTION>President, Office=20
        =
of<OPTION>Psychology<OPTION>Purchasing<OPTION>Registrar<OPTION>Religion<O=
PTION>Residential=20
        Living<OPTION>ROTC (Army)<OPTION>Safety<OPTION>School of Applied =

        Studies<OPTION>School of Business<OPTION>School of =
Law<OPTION>School of=20
        Nursing<OPTION>Security<OPTION>Service Area<OPTION>Small =
Business=20
        Development Center<OPTION>Social Work<OPTION>Sociology and=20
        Anthropology<OPTION>Special Assistant to the =
President<OPTION>Student=20
        Activities &amp; Greek Life<OPTION>Student Health=20
        Services<OPTION>Student Life<OPTION>Student =
Services<OPTION>Student=20
        =
Union<OPTION>Theatre<OPTION>Treasurer<OPTION>Tutoring<OPTION>Union<OPTION=
>University=20
        Counsel<OPTION>University Honors Program<OPTION>University=20
        Registrar<OPTION>University =
Relations<OPTION>Veterans<OPTION>Vice=20
        President, Academic Affairs<OPTION>Vice President, =
Administration &amp;=20
        Treasurer<OPTION>Vice President, Student Life<OPTION>Washburn=20
        Village<OPTION>West Hall<OPTION>Writing Center</OPTION></SELECT> =
</TD>
    <TD width=3D"100%" align=3Dleft><INPUT maxLength=3D10 size=3D10=20
  name=3Dvdeptamt></TD></TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>TAX EXEMPTIONS=20
    INFORMATION</B></FONT><BR><BR></FONT></U></TD></TR>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D2><FONT=20
      color=3Dred><B><I>Skip to next section if you are not=20
      married</B></FONT><BR><BR></FONT></I></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"80%">
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Is your spouse in the =
U.S.?</FONT></TH>
    <TD align=3Dleft><INPUT value=3DYes type=3Dcheckbox =
name=3Dspouse>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dspouse>No</TD><INPUT value=3Dxxx =
type=3Dhidden=20
    name=3Dspouse>=20
    <TH align=3Dleft><FONT color=3Dblack>Is your spouse =
employed?</FONT></TH>
    <TD align=3Dleft><INPUT value=3DYes type=3Dcheckbox =
name=3Dspempl>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dspempl>No</TD><INPUT value=3Dxxx =
type=3Dhidden=20
    name=3Dspempl> </TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"90%">
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Do you want to claim an =
exemption for=20
      your spouse if legally allowed to do so?</FONT></TH>
    <TD align=3Dleft><INPUT value=3DYes type=3Dcheckbox name=3Dclaim>Yes =
<INPUT=20
      value=3DNo type=3Dcheckbox name=3Dclaim>No</TD><INPUT value=3Dxxx =
type=3Dhidden=20
    name=3Dclaim> </TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"90%">
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Do you have other dependents in =
the U.S.=20
      you would like to claim exemptions =
for?</FONT></TH></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"60%">
  <TBODY>
  <TR>
    <TD align=3Dmiddle><INPUT value=3DYes type=3Dcheckbox =
name=3Dother>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dother>No</TD><INPUT value=3Dxxx =
type=3Dhidden=20
    name=3Dother>=20
    <TH width=3D"30%" align=3Dleft>If so, how many?</TH>
    <TD align=3Dleft><INPUT maxLength=3D2 size=3D2=20
name=3Dvhowmany></TD></TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>RESIDENCY=20
  VERIFICATION</B></FONT><BR><BR></FONT></U></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack size=3D3><B>What country did =
you live in=20
      for a least one year before this visit to the =
U.S.?</B></FONT></TD></TR>
  <TR>
    <TD align=3Dleft><SELECT size=3D1 name=3Dvpriorcntry> <OPTION =
selected><OPTION=20
        value=3D"AF AFGHANISTAN">AFGHANISTAN<OPTION=20
        value=3D"AL ALBANIA">ALBANIA<OPTION value=3D"AG =
ALGERIA">ALGERIA<OPTION=20
        value=3D"AQ AMERICAN SAMOA">AMERICAN SAMOA<OPTION=20
        value=3D"AN ANDORRA">ANDORRA<OPTION value=3D"AO =
ANGOLA">ANGOLA<OPTION=20
        value=3D"AV ANGUILLA">ANGUILLA<OPTION=20
        value=3D"AY ANTARCTICA">ANTARCTICA<OPTION=20
        value=3D"AC ANTIGUA AND BARBUDA">ANTIGUA AND BARBUDA<OPTION=20
        value=3D"AR ARGENTINA">ARGENTINA<OPTION value=3D"AM =
ARMENIA">ARMENIA<OPTION=20
        value=3D"AA ARUBA">ARUBA<OPTION=20
        value=3D"AT ASHMORE AND CARTIER ISLANDS">ASHMORE AND CARTIER=20
        ISLANDS<OPTION value=3D"AS AUSTRALIA">AUSTRALIA<OPTION=20
        value=3D"AU AUSTRIA">AUSTRIA<OPTION=20
        value=3D"AJ AZERBAIJAN">AZERBAIJAN<OPTION value=3D"BF BAHAMAS, =
THE">BAHAMAS,=20
        THE<OPTION value=3D"BA BAHRAIN">BAHRAIN<OPTION=20
        value=3D"FQ BAKER ISLAND">BAKER ISLAND<OPTION=20
        value=3D"BG BANGLADESH">BANGLADESH<OPTION=20
        value=3D"BB BARBADOS">BARBADOS<OPTION value=3D"BS BASSAS DA =
INDIA">BASSAS DA=20
        INDIA<OPTION value=3D"BO BELARUS">BELARUS<OPTION=20
        value=3D"BE BELGIUM">BELGIUM<OPTION value=3D"BH =
BELIZE">BELIZE<OPTION=20
        value=3D"BN BENIN">BENIN<OPTION value=3D"BD =
BERMUDA">BERMUDA<OPTION=20
        value=3D"BT BHUTAN">BHUTAN<OPTION value=3D"BL =
BOLIVIA">BOLIVIA<OPTION=20
        value=3D"BK BOSNIA-HERZEGOVINA">BOSNIA-HERZEGOVINA<OPTION=20
        value=3D"BC BOTSWANA">BOTSWANA<OPTION value=3D"BV BOUVET =
ISLAND">BOUVET=20
        ISLAND<OPTION value=3D"BR BRAZIL">BRAZIL<OPTION=20
        value=3D"IO BRITISH INDIAN OCEAN TERRITORY">BRITISH INDIAN OCEAN =

        TERRITORY<OPTION value=3D"BX BRUNEI">BRUNEI<OPTION=20
        value=3D"BU BULGARIA">BULGARIA<OPTION value=3D"UV BURKINA =
FASO">BURKINA=20
        FASO<OPTION value=3D"BY BURUNDI">BURUNDI<OPTION=20
        value=3D"CB CAMBODIA">CAMBODIA<OPTION value=3D"CM =
CAMEROON">CAMEROON<OPTION=20
        value=3D"CA CANADA">CANADA<OPTION value=3D"CV CAPE VERDE">CAPE =
VERDE<OPTION=20
        value=3D"CJ CAYMAN ISLANDS">CAYMAN ISLANDS<OPTION=20
        value=3D"CT CENTRAL AFRICAN REPUBLIC">CENTRAL AFRICAN =
REPUBLIC<OPTION=20
        value=3D"CD CHAD">CHAD<OPTION value=3D"CI CHILE">CHILE<OPTION=20
        value=3D"CH CHINA, PEOPLE'S REPUBLIC">CHINA, PEOPLE'S =
REPUBLIC<OPTION=20
        value=3D"KT CHRISTMAS ISLAND (INDIAN OC)">CHRISTMAS ISLAND =
(INDIAN=20
        OC)<OPTION value=3D"IP CLIPPERTON ISLAND">CLIPPERTON =
ISLAND<OPTION=20
        value=3D"CK COCOS (KEELING) ISLANDS">COCOS (KEELING) =
ISLANDS<OPTION=20
        value=3D"CO COLOMBIA">COLOMBIA<OPTION value=3D"CN =
COMOROS">COMOROS<OPTION=20
        value=3D"CF CONGO">CONGO<OPTION value=3D"CW COOK ISLANDS">COOK=20
        ISLANDS<OPTION value=3D"CR CORAL SEA ISLANDS">CORAL SEA =
ISLANDS<OPTION=20
        value=3D"VP CORSICA">CORSICA<OPTION value=3D"CS COSTA =
RICA">COSTA=20
        RICA<OPTION value=3D"IV COTE D'IVOIRE (IVORY COAST)">COTE =
D'IVOIRE (IVORY=20
        COAST)<OPTION value=3D"HR CROATIA">CROATIA<OPTION=20
        value=3D"CU CUBA">CUBA<OPTION value=3D"CY CYPRUS">CYPRUS<OPTION=20
        value=3D"EZ CZECH REPUBLIC">CZECH REPUBLIC<OPTION=20
        value=3D"DA DENMARK">DENMARK<OPTION value=3D"DJ =
DJIBOUTI">DJIBOUTI<OPTION=20
        value=3D"DO DOMINICA">DOMINICA<OPTION=20
        value=3D"DR DOMINICAN REPUBLIC">DOMINICAN REPUBLIC<OPTION=20
        value=3D"EC ECUADOR">ECUADOR<OPTION value=3D"EG =
EGYPT">EGYPT<OPTION=20
        value=3D"ES EL SALVADOR">EL SALVADOR<OPTION=20
        value=3D"EK EQUATORIAL GUINEA">EQUATORIAL GUINEA<OPTION=20
        value=3D"ER ERITREA">ERITREA<OPTION value=3D"EN =
ESTONIA">ESTONIA<OPTION=20
        value=3D"ET ETHIOPIA">ETHIOPIA<OPTION value=3D"EU EUROPA =
ISLAND">EUROPA=20
        ISLAND<OPTION value=3D"FK FALKLAND ISL (ISL MALVINAS)">FALKLAND =
ISL (ISL=20
        MALVINAS)<OPTION value=3D"FO FAROE ISLANDS">FAROE ISLANDS<OPTION =

        value=3D"FJ FIJI">FIJI<OPTION value=3D"FI =
FINLAND">FINLAND<OPTION=20
        value=3D"FS FR SOUTHERN AND ANTARCTIC">FR SOUTHERN AND =
ANTARCTIC<OPTION=20
        value=3D"FR FRANCE">FRANCE<OPTION value=3D"FG FRENCH =
GUIANA">FRENCH=20
        GUIANA<OPTION value=3D"FP FRENCH POLYNESIA">FRENCH =
POLYNESIA<OPTION=20
        value=3D"GB GABON">GABON<OPTION value=3D"GA GAMBIA, THE">GAMBIA, =
THE<OPTION=20
        value=3D"GZ GAZA STRIP">GAZA STRIP<OPTION=20
        value=3D"GG GEORGIA">GEORGIA<OPTION value=3D"GM =
GERMANY">GERMANY<OPTION=20
        value=3D"GH GHANA">GHANA<OPTION value=3D"GI =
GIBRALTAR">GIBRALTAR<OPTION=20
        value=3D"GO GLORIOSO ISLANDS">GLORIOSO ISLANDS<OPTION=20
        value=3D"GR GREECE">GREECE<OPTION value=3D"GL =
GREENLAND">GREENLAND<OPTION=20
        value=3D"GJ GRENADA">GRENADA<OPTION=20
        value=3D"GP GUADELOUPE">GUADELOUPE<OPTION value=3D"GQ =
GUAM">GUAM<OPTION=20
        value=3D"GT GUATEMALA">GUATEMALA<OPTION=20
        value=3D"GK GUERNSEY">GUERNSEY<OPTION value=3D"GV =
GUINEA">GUINEA<OPTION=20
        value=3D"PU GUINEA-BISSAU">GUINEA-BISSAU<OPTION=20
        value=3D"GY GUYANA">GUYANA<OPTION value=3D"HA =
HAITI">HAITI<OPTION=20
        value=3D"HM HEARD ISLAND AND MCDONALD ISLANDS">HEARD ISLAND AND =
MCDONALD=20
        ISLANDS<OPTION value=3D"HO HONDURAS">HONDURAS<OPTION=20
        value=3D"HK HONG KONG">HONG KONG<OPTION value=3D"HQ HOWLAND =
ISLAND">HOWLAND=20
        ISLAND<OPTION value=3D"HU HUNGARY">HUNGARY<OPTION=20
        value=3D"IC ICELAND">ICELAND<OPTION value=3D"IN =
INDIA">INDIA<OPTION=20
        value=3D"ID INDONESIA">INDONESIA<OPTION value=3D"IR =
IRAN">IRAN<OPTION=20
        value=3D"IZ IRAQ">IRAQ<OPTION value=3D"EI =
IRELAND">IRELAND<OPTION=20
        value=3D"IM ISLE OF MAN">ISLE OF MAN<OPTION=20
        value=3D"IS ISRAEL">ISRAEL<OPTION value=3D"IT =
ITALY">ITALY<OPTION=20
        value=3D"JM JAMAICA">JAMAICA<OPTION value=3D"JN JAN MAYEN">JAN =
MAYEN<OPTION=20
        value=3D"JA JAPAN">JAPAN<OPTION value=3D"JE =
JERSEY">JERSEY<OPTION=20
        value=3D"JQ JOHNSTON ATOLL">JOHNSTON ATOLL<OPTION=20
        value=3D"JO JORDAN">JORDAN<OPTION value=3D"JU JUAN DE NOVA =
ISLAND">JUAN DE=20
        NOVA ISLAND<OPTION value=3D"KZ KAZAKHSTAN">KAZAKHSTAN<OPTION=20
        value=3D"KE KENYA">KENYA<OPTION value=3D"KQ KINGMAN =
REEF">KINGMAN=20
        REEF<OPTION value=3D"KR KIRIBATI">KIRIBATI<OPTION=20
        value=3D"KN KOREA, DEMOCRATIC (NORTH)">KOREA, DEMOCRATIC =
(NORTH)<OPTION=20
        value=3D"KS KOREA, REPUBLIC (SOUTH)">KOREA, REPUBLIC =
(SOUTH)<OPTION=20
        value=3D"KU KUWAIT">KUWAIT<OPTION value=3D"KG =
KYRGYZSTAN">KYRGYZSTAN<OPTION=20
        value=3D"LA LAOS">LAOS<OPTION value=3D"LG LATVIA">LATVIA<OPTION=20
        value=3D"LE LEBANON">LEBANON<OPTION value=3D"LT =
LESOTHO">LESOTHO<OPTION=20
        value=3D"LI LIBERIA">LIBERIA<OPTION value=3D"LY =
LIBYA">LIBYA<OPTION=20
        value=3D"LS LIECHTENSTEIN">LIECHTENSTEIN<OPTION=20
        value=3D"LH LITHUANIA">LITHUANIA<OPTION=20
        value=3D"LU LUXEMBOURG">LUXEMBOURG<OPTION value=3D"MC =
MACAU">MACAU<OPTION=20
        value=3D"MK MACEDONIA">MACEDONIA<OPTION=20
        value=3D"MA MADAGASCAR">MADAGASCAR<OPTION value=3D"MI =
MALAWI">MALAWI<OPTION=20
        value=3D"MY MALAYSIA">MALAYSIA<OPTION value=3D"MV =
MALDIVES">MALDIVES<OPTION=20
        value=3D"ML MALI">MALI<OPTION value=3D"MT MALTA">MALTA<OPTION=20
        value=3D"RM MARSHALL ISLANDS">MARSHALL ISLANDS<OPTION=20
        value=3D"MB MARTINIQUE">MARTINIQUE<OPTION=20
        value=3D"MR MAURITANIA">MAURITANIA<OPTION=20
        value=3D"MP MAURITIUS">MAURITIUS<OPTION value=3D"MF =
MAYOTTE">MAYOTTE<OPTION=20
        value=3D"MX MEXICO">MEXICO<OPTION=20
        value=3D"FM MICRONESIA, FEDERATED STATES OF">MICRONESIA, =
FEDERATED STATES=20
        OF<OPTION value=3D"MQ MIDWAY ISLANDS">MIDWAY ISLANDS<OPTION=20
        value=3D"MD MOLDOVA">MOLDOVA<OPTION value=3D"MN =
MONACO">MONACO<OPTION=20
        value=3D"MG MONGOLIA">MONGOLIA<OPTION=20
        value=3D"MW MONTENEGRO">MONTENEGRO<OPTION=20
        value=3D"MH MONTSERRAT">MONTSERRAT<OPTION=20
        value=3D"MO MOROCCO">MOROCCO<OPTION=20
        value=3D"MZ MOZAMBIQUE">MOZAMBIQUE<OPTION=20
        value=3D"MM MYANMAR">MYANMAR<OPTION value=3D"WA =
NAMIBIA">NAMIBIA<OPTION=20
        value=3D"NR NAURU">NAURU<OPTION value=3D"BQ NAVASSA =
ISLAND">NAVASSA=20
        ISLAND<OPTION value=3D"NP NEPAL">NEPAL<OPTION=20
        value=3D"NL NETHERLANDS">NETHERLANDS<OPTION=20
        value=3D"NT NETHERLANDS ANTILLES">NETHERLANDS ANTILLES<OPTION=20
        value=3D"NC NEW CALEDONIA">NEW CALEDONIA<OPTION value=3D"NZ NEW =
ZEALAND">NEW=20
        ZEALAND<OPTION value=3D"NU NICARAGUA">NICARAGUA<OPTION=20
        value=3D"NG NIGER">NIGER<OPTION value=3D"NI =
NIGERIA">NIGERIA<OPTION=20
        value=3D"NE NIUE">NIUE<OPTION value=3D"NF NORFOLK =
ISLAND">NORFOLK=20
        ISLAND<OPTION value=3D"CQ NORTHERN MARIANA ISLANDS">NORTHERN =
MARIANA=20
        ISLANDS<OPTION value=3D"NO NORWAY">NORWAY<OPTION=20
        value=3D"MU OMAN">OMAN<OPTION value=3D"OC OTHER COUNTRIES">OTHER =

        COUNTRIES<OPTION value=3D"PK PAKISTAN">PAKISTAN<OPTION=20
        value=3D"PS PALAU, REPUBLIC OF">PALAU, REPUBLIC OF<OPTION=20
        value=3D"LQ PALMYRA ATOLL">PALMYRA ATOLL<OPTION=20
        value=3D"PM PANAMA">PANAMA<OPTION value=3D"PP PAPUA NEW =
GUINEA">PAPUA NEW=20
        GUINEA<OPTION value=3D"PF PARACEL ISLANDS">PARACEL =
ISLANDS<OPTION=20
        value=3D"PA PARAGUAY">PARAGUAY<OPTION value=3D"PE =
PERU">PERU<OPTION=20
        value=3D"RP PHILIPPINES">PHILIPPINES<OPTION=20
        value=3D"PC PITCAIRN ISLAND">PITCAIRN ISLAND<OPTION=20
        value=3D"PL POLAND">POLAND<OPTION value=3D"PO =
PORTUGAL">PORTUGAL<OPTION=20
        value=3D"RQ PUERTO RICO">PUERTO RICO<OPTION value=3D"QA =
QATAR">QATAR<OPTION=20
        value=3D"RE REUNION">REUNION<OPTION value=3D"RO =
ROMANIA">ROMANIA<OPTION=20
        value=3D"RS RUSSIA">RUSSIA<OPTION value=3D"RW =
RWANDA">RWANDA<OPTION=20
        value=3D"SC SAINT KITTS AND NEVIS (ST CHRISTOPHER &amp; =
NEVIS)">SAINT=20
        KITTS AND NEVIS (ST CHRISTOPHER &amp; NEVIS)<OPTION=20
        value=3D"SM SAN MARINO">SAN MARINO<OPTION=20
        value=3D"TP SAO TOME AND PRINCIPE">SAO TOME AND PRINCIPE<OPTION=20
        value=3D"SA SAUDI ARABIA">SAUDI ARABIA<OPTION=20
        value=3D"SG SENEGAL">SENEGAL<OPTION value=3D"SR =
SERBIA">SERBIA<OPTION=20
        value=3D"SE SEYCHELLES">SEYCHELLES<OPTION value=3D"SL SIERRA =
LEONE">SIERRA=20
        LEONE<OPTION value=3D"SN SINGAPORE">SINGAPORE<OPTION=20
        value=3D"LO SLOVAKIA">SLOVAKIA<OPTION value=3D"SI =
SLOVENIA">SLOVENIA<OPTION=20
        value=3D"SX SO GEORGIA,SO SANDWICH ISLANDS">SO GEORGIA,SO =
SANDWICH=20
        ISLANDS<OPTION value=3D"BP SOLOMON ISLANDS">SOLOMON =
ISLANDS<OPTION=20
        value=3D"SO SOMALIA">SOMALIA<OPTION value=3D"SF SOUTH =
AFRICA">SOUTH=20
        AFRICA<OPTION value=3D"SP SPAIN">SPAIN<OPTION=20
        value=3D"PG SPRATLY ISLANDS">SPRATLY ISLANDS<OPTION=20
        value=3D"CE SRI LANKA">SRI LANKA<OPTION value=3D"SH ST. =
HELENA">ST.=20
        HELENA<OPTION value=3D"ST ST. LUCIA">ST. LUCIA<OPTION=20
        value=3D"SB ST. PIERRE AND MIQUELON">ST. PIERRE AND =
MIQUELON<OPTION=20
        value=3D"VC ST. VINCENT AND GRENADINES">ST. VINCENT AND =
GRENADINES<OPTION=20
        value=3D"ZZ STATELESS - NO COUNTRY OF CITIZENSHIP">STATELESS - =
NO COUNTRY=20
        OF CITIZENSHIP<OPTION value=3D"SU SUDAN">SUDAN<OPTION=20
        value=3D"NS SURINAME">SURINAME<OPTION value=3D"SV =
SVALBARD">SVALBARD<OPTION=20
        value=3D"WZ SWAZILAND">SWAZILAND<OPTION value=3D"SW =
SWEDEN">SWEDEN<OPTION=20
        value=3D"SZ SWITZERLAND">SWITZERLAND<OPTION value=3D"SY =
SYRIA">SYRIA<OPTION=20
        value=3D"TW TAIWAN">TAIWAN<OPTION value=3D"TI =
TAJIKISTAN">TAJIKISTAN<OPTION=20
        value=3D"TZ TANZANIA, UNITED REPUBLIC OF">TANZANIA, UNITED =
REPUBLIC=20
        OF<OPTION value=3D"TH THAILAND">THAILAND<OPTION=20
        value=3D"TO TOGO">TOGO<OPTION value=3D"TL =
TOKELAU">TOKELAU<OPTION=20
        value=3D"TN TONGA">TONGA<OPTION value=3D"TD TRINIDAD AND =
TOBAGO">TRINIDAD=20
        AND TOBAGO<OPTION value=3D"TE TROMELIN ISLAND">TROMELIN =
ISLAND<OPTION=20
        value=3D"TS TUNISIA">TUNISIA<OPTION value=3D"TU =
TURKEY">TURKEY<OPTION=20
        value=3D"TX TURKMENISTAN">TURKMENISTAN<OPTION=20
        value=3D"TK TURKS AND CAICOS ISLANDS">TURKS AND CAICOS =
ISLANDS<OPTION=20
        value=3D"TV TUVALU">TUVALU<OPTION value=3D"UG =
UGANDA">UGANDA<OPTION=20
        value=3D"UP UKRAINE">UKRAINE<OPTION value=3D"TC UNITED ARAB =
EMIRATES">UNITED=20
        ARAB EMIRATES<OPTION value=3D"UK UNITED KINGDOM">UNITED =
KINGDOM<OPTION=20
        value=3D"US UNITED STATES">UNITED STATES<OPTION=20
        value=3D"UY URUGUAY">URUGUAY<OPTION=20
        value=3D"UZ UZBEKISTAN">UZBEKISTAN<OPTION=20
        value=3D"NH VANUATU">VANUATU<OPTION value=3D"VT VATICAN =
CITY">VATICAN=20
        CITY<OPTION value=3D"VE VENEZUELA">VENEZUELA<OPTION=20
        value=3D"VM VIETNAM">VIETNAM<OPTION=20
        value=3D"VI VIRGIN ISLANDS (BRITISH)">VIRGIN ISLANDS =
(BRITISH)<OPTION=20
        value=3D"VQ VIRGIN ISLANDS (U S)">VIRGIN ISLANDS (U S)<OPTION=20
        value=3D"WQ WAKE ISLAND">WAKE ISLAND<OPTION=20
        value=3D"WF WALLIS AND FUTUNA">WALLIS AND FUTUNA<OPTION=20
        value=3D"WE WEST BANK">WEST BANK<OPTION value=3D"WI WESTERN =
SAHARA">WESTERN=20
        SAHARA<OPTION value=3D"WS WESTERN SAMOA">WESTERN SAMOA<OPTION=20
        value=3D"YM YEMEN">YEMEN<OPTION value=3D"CG ZAIRE">ZAIRE<OPTION=20
        value=3D"ZA ZAMBIA">ZAMBIA<OPTION=20
      value=3D"ZI ZIMBABWE">ZIMBABWE</OPTION></SELECT> </TD></TR>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dleft><FONT size=3D2><FONT=20
      color=3Dred><B><I>If the country listed above is the same as your =
country of=20
      citizenship, please skip to the next=20
    section.</B></I></FONT><BR><BR></FONT></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"70%">
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Do you pay taxes as a resident =
of that=20
      country?</FONT></TH>
    <TD align=3Dleft><INPUT value=3DYes type=3Dcheckbox =
name=3Dpay_tax>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dpay_tax>No</TD><INPUT =
value=3Dxxx type=3Dhidden=20
    name=3Dpay_tax> </TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"90%">
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Does your tax residency in that =
country=20
      end prior to this visit to the =
U.S.?</FONT></TH></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"60%">
  <TBODY>
  <TR>
    <TD align=3Dmiddle><INPUT value=3DYes type=3Dcheckbox =
name=3Dtax_res>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dtax_res>No</TD><INPUT =
value=3Dxxx type=3Dhidden=20
    name=3Dtax_res>=20
    <TH width=3D"30%" align=3Dleft>If yes, when?</TH>
    <TD width=3D"25%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvtaxresdate1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvtaxresdate2>/<INPUT=20
      maxLength=3D4 size=3D4 =
name=3Dvtaxresdate3></TD></TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>U.S. IMMIGRATION HISTORY, Part=20
  1</B></FONT></FONT></U></TD></TR>
  <TR>
    <TD align=3Dleft><FONT color=3Dred size=3D3>This section is designed =
to provide=20
      information about previous visits to the U.S. for persons who have =
had a=20
      different immigration status than that which they now hold. It is =
also for=20
      persons who have had absences from the U.S. of more than 5 months, =
even if=20
      they returned in the same immigration status they had previously. =
Do NOT=20
      complete this section unless your immigration status has changed =
or you=20
      have been absent from the U.S. for more than 5 =
months.</FONT></TD></TR>
  <TR>
    <TD width=3D"15%" align=3Dleft>&nbsp;</TD></TR>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack size=3D3>If the answer to =
either of the=20
      questions below is yes, please complete U.S. Immigration History, =
Part=20
      2</FONT></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"90%">
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Have you ever had another =
immigration=20
      status in the United States?</FONT></TH>
    <TD align=3Dleft><INPUT value=3DYes type=3Dcheckbox =
name=3Dother_status>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dother_status>No</TD><INPUT =
value=3Dxxx type=3Dhidden=20
    name=3Dother_status> </TR>
  <TR>
    <TH align=3Dleft><FONT color=3Dblack>Have you ever been present in =
the United=20
      States before this visit?</FONT></TH>
    <TD align=3Dleft><INPUT value=3DYes type=3Dcheckbox =
name=3Dother_visit>Yes <INPUT=20
      value=3DNo type=3Dcheckbox name=3Dother_visit>No</TD><INPUT =
value=3Dxxx type=3Dhidden=20
    name=3Dother_visit> </TR></TBODY></TABLE>
<P>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dtop width=3D"100%" align=3Dmiddle><FONT size=3D+1><FONT =

      color=3Dblack><B><U>U.S. IMMIGRATION HISTORY, Part=20
  2</B></FONT></FONT></U></TD></TR>
  <TR>
    <TD align=3Dleft><FONT color=3Dblack size=3D3>Please list any <B>F, =
J, M or Q=20
      </B>visa immigration activity since January 1, 1985 and all other =
visa=20
      immigration activity only for the past three calendar=20
  years</FONT></TD></TR></TBODY></TABLE>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Entry=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dventry1date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dventry1date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dventry1date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Exit=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvexit1date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvexit1date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvexit1date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Visa/Immigration=20
      Status</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvvisa1stat> =
<OPTION=20
        selected value=3D""><OPTION value=3DA-1>A-1 Foreign Government =
Worker<OPTION=20
        value=3DA-2>A-2 Other foreign government official and =
family<OPTION=20
        value=3DA-3>A-3 Attendent,servant or employee of A-1 or A-2, and =

        family<OPTION value=3DASLM>ASLM Political Asylum<OPTION =
value=3DB-1>B-1=20
        Visitor for Business<OPTION value=3DB-2>B-2 Visitor for =
Pleasure<OPTION=20
        value=3DC-1>C-1 Continuous Transit Alien<OPTION value=3DC-2>C-2 =
Alien in=20
        transit to UN Headquarteres<OPTION value=3DC-3>C-3 Foreign =
official,=20
        family, servants in transit<OPTION value=3DCPO>CPO Chinese =
Protective=20
        Order- Oct 90<OPTION value=3DCPR>CPR Conditional Permanent =
Resident=20
        (Spouse - Two Year)<OPTION value=3DD-1>D-1 Crewman<OPTION =
value=3DE-1>E-1=20
        Treaty Trader<OPTION value=3DE-2>E-2 Treaty Investor<OPTION =
value=3DF-1>F-1=20
        Student<OPTION value=3DF-2>F-2 Student Dependent<OPTION =
value=3DG-1>G-1=20
        Foreign Government Visitor<OPTION value=3DG-2>G-2 Other =
Representative of=20
        foreign member government<OPTION value=3DG-3>G-3 Representative =
of=20
        nonrecognized government and family<OPTION value=3DG-4>G-4 =
International=20
        organization officer or employee and family<OPTION =
value=3DH-1A>H-1A=20
        Professional Nurse<OPTION value=3DH-1B>H-1B Worker in Specialty=20
        Occupation<OPTION value=3DH-2A>H-2A Temporary Worker performing=20
        Agricultural services<OPTION value=3DH-2B>H-2B Temporary =
Worker<OPTION=20
        value=3DH-3>H-3 Temporary Trainee<OPTION value=3DH-4>H-4 Worker=20
        Dependent<OPTION value=3DI>I Representative of foreign media,=20
        spouse,children<OPTION value=3DJ-1>J-1 Exchange Visitor<OPTION=20
        value=3DJ-2>J-2 Exchange Visitor Dependent<OPTION =
value=3DK-1>K-1 Fiance of=20
        U.S. citizen<OPTION value=3DL-1>L-1 Intracompany =
Transferee<OPTION=20
        value=3DL-2>L-2 Intracompany Transferee Dependent<OPTION =
value=3DLPR>LPR=20
        U.S. Lawful Permanent Resident<OPTION value=3DM-1>M-1 =
Non-Academic=20
        Student<OPTION value=3DM-2>M-2 Non-Academic Student =
Dependent<OPTION=20
        value=3DN-8>N-8 Parent of SK-3 Special Immigrant<OPTION =
value=3DN-9>N-9=20
        Child of N-8 or SK-1, SK-2, or SK4 Special Immigrant<OPTION=20
        value=3DNATO>NATO NATO<OPTION value=3DO-1>O-1 Alien of =
Extraordinary Ability=20
        in Sciences, Arts, Education<OPTION value=3DO-2>O-2 Accompanying =

        Alien<OPTION value=3DO-3>O-3 Spouse/child of O-1 or O-2<OPTION=20
        value=3DP-1>P-1 Performing Entertainer or Athlete<OPTION =
value=3DP-2>P-2=20
        Exchange Program Artist or Entertainer<OPTION value=3DP-3>P-3 =
Culturally=20
        Unique Artist or Entertainer<OPTION value=3DQ-1>Q-1 Cultural =
Exchange=20
        Visitor<OPTION value=3DR-1>R-1 Religious Worker<OPTION =
value=3DR-2>R-2=20
        Religious Worker Dependent<OPTION value=3DRFGE>RFGE =
Refugee<OPTION=20
        value=3DSK-1>SK-1 Special Immigrant<OPTION value=3DSK-2>SK-2 =
Special=20
        Immigrant<OPTION value=3DSK-3>SK-3 Special Immigrant<OPTION=20
        value=3DSK-4>SK-4 Special Immigrant<OPTION value=3DTN>TN =
Canadian or Mexican=20
        Citizen Professional<OPTION value=3DVW>VW Visa =
Waiver</OPTION></SELECT>=20
  </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>J-1 =
Subtype</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvj11subtype> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Student<OPTION =
value=3D02>Short term=20
        scholars<OPTION value=3D03>Trainees - Non Medical<OPTION=20
        value=3D04>Teachers<OPTION value=3D06>Specialists<OPTION =
value=3D07>Alien=20
        Physicians<OPTION value=3D08>Other - International =
Visitors<OPTION=20
        value=3D09>Other - Other Alien employee of the USIA<OPTION =
value=3D10>Other=20
        - Camp Counselors<OPTION value=3D11>Trainees - Medical<OPTION=20
        value=3D12>Research Scholars<OPTION value=3D13>Summer =
Travel/Work<OPTION=20
        value=3D99>Not Applicable</OPTION></SELECT> </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Primary=20
    Activity</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvprim1act> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Studying-Degree =
Program<OPTION=20
        value=3D02>Studying-Non-Degree Program<OPTION =
value=3D03>Teaching<OPTION=20
        value=3D04>Lecturing<OPTION value=3D05>Observing<OPTION=20
        value=3D06>Consulting<OPTION value=3D07>Conducting =
Research<OPTION=20
        value=3D08>Acquiring Training<OPTION value=3D09>Demonstrating =
Special=20
        Skills<OPTION value=3D10>Clinical Activities<OPTION =
value=3D11>Temporary=20
        Employment<OPTION value=3D12>Here with spouse/relative<OPTION=20
        value=3D13>Performing as an artist<OPTION value=3D14>Performing =
as an=20
        athlete<OPTION value=3D15>Supporting an artist/athlete<OPTION=20
        value=3D16>Tourist Activities<OPTION value=3D17>Business =
Activities<OPTION=20
        value=3D18>Board of Director Activities<OPTION =
value=3D19>Practical=20
        Training/J-1,F-1<OPTION value=3D20>Educational/Professional=20
        Activities<OPTION value=3D21>Summer Travel/Work<OPTION =
value=3D22>Unrelated=20
        Business Activities<OPTION value=3D23>In =
Transit</OPTION></SELECT> </TD></TR>
  <TR>
    <TH vAlign=3Dtop width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Have you=20
      Taken Any Treaty Benefits?</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT value=3DYes type=3Dcheckbox=20
      name=3Dtreat1_ben>Yes <INPUT value=3DNo type=3Dcheckbox=20
      name=3Dtreat1_ben>No<BR><BR></TD><INPUT value=3Dxxx type=3Dhidden =
name=3Dtreat1_ben>=20
  </TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Entry=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dventry2date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dventry2date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dventry2date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Exit=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvexit2date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvexit2date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvexit2date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Visa/Immigration=20
      Status</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvvisa2stat> =
<OPTION=20
        selected value=3D""><OPTION value=3DA-1>A-1 Foreign Government =
Worker<OPTION=20
        value=3DA-2>A-2 Other foreign government official and =
family<OPTION=20
        value=3DA-3>A-3 Attendent,servant or employee of A-1 or A-2, and =

        family<OPTION value=3DASLM>ASLM Political Asylum<OPTION =
value=3DB-1>B-1=20
        Visitor for Business<OPTION value=3DB-2>B-2 Visitor for =
Pleasure<OPTION=20
        value=3DC-1>C-1 Continuous Transit Alien<OPTION value=3DC-2>C-2 =
Alien in=20
        transit to UN Headquarteres<OPTION value=3DC-3>C-3 Foreign =
official,=20
        family, servants in transit<OPTION value=3DCPO>CPO Chinese =
Protective=20
        Order- Oct 90<OPTION value=3DCPR>CPR Conditional Permanent =
Resident=20
        (Spouse - Two Year)<OPTION value=3DD-1>D-1 Crewman<OPTION =
value=3DE-1>E-1=20
        Treaty Trader<OPTION value=3DE-2>E-2 Treaty Investor<OPTION =
value=3DF-1>F-1=20
        Student<OPTION value=3DF-2>F-2 Student Dependent<OPTION =
value=3DG-1>G-1=20
        Foreign Government Visitor<OPTION value=3DG-2>G-2 Other =
Representative of=20
        foreign member government<OPTION value=3DG-3>G-3 Representative =
of=20
        nonrecognized government and family<OPTION value=3DG-4>G-4 =
International=20
        organization officer or employee and family<OPTION =
value=3DH-1A>H-1A=20
        Professional Nurse<OPTION value=3DH-1B>H-1B Worker in Specialty=20
        Occupation<OPTION value=3DH-2A>H-2A Temporary Worker performing=20
        Agricultural services<OPTION value=3DH-2B>H-2B Temporary =
Worker<OPTION=20
        value=3DH-3>H-3 Temporary Trainee<OPTION value=3DH-4>H-4 Worker=20
        Dependent<OPTION value=3DI>I Representative of foreign media,=20
        spouse,children<OPTION value=3DJ-1>J-1 Exchange Visitor<OPTION=20
        value=3DJ-2>J-2 Exchange Visitor Dependent<OPTION =
value=3DK-1>K-1 Fiance of=20
        U.S. citizen<OPTION value=3DL-1>L-1 Intracompany =
Transferee<OPTION=20
        value=3DL-2>L-2 Intracompany Transferee Dependent<OPTION =
value=3DLPR>LPR=20
        U.S. Lawful Permanent Resident<OPTION value=3DM-1>M-1 =
Non-Academic=20
        Student<OPTION value=3DM-2>M-2 Non-Academic Student =
Dependent<OPTION=20
        value=3DN-8>N-8 Parent of SK-3 Special Immigrant<OPTION =
value=3DN-9>N-9=20
        Child of N-8 or SK-1, SK-2, or SK4 Special Immigrant<OPTION=20
        value=3DNATO>NATO NATO<OPTION value=3DO-1>O-1 Alien of =
Extraordinary Ability=20
        in Sciences, Arts, Education<OPTION value=3DO-2>O-2 Accompanying =

        Alien<OPTION value=3DO-3>O-3 Spouse/child of O-1 or O-2<OPTION=20
        value=3DP-1>P-1 Performing Entertainer or Athlete<OPTION =
value=3DP-2>P-2=20
        Exchange Program Artist or Entertainer<OPTION value=3DP-3>P-3 =
Culturally=20
        Unique Artist or Entertainer<OPTION value=3DQ-1>Q-1 Cultural =
Exchange=20
        Visitor<OPTION value=3DR-1>R-1 Religious Worker<OPTION =
value=3DR-2>R-2=20
        Religious Worker Dependent<OPTION value=3DRFGE>RFGE =
Refugee<OPTION=20
        value=3DSK-1>SK-1 Special Immigrant<OPTION value=3DSK-2>SK-2 =
Special=20
        Immigrant<OPTION value=3DSK-3>SK-3 Special Immigrant<OPTION=20
        value=3DSK-4>SK-4 Special Immigrant<OPTION value=3DTN>TN =
Canadian or Mexican=20
        Citizen Professional<OPTION value=3DVW>VW Visa =
Waiver</OPTION></SELECT>=20
  </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>J-1 =
Subtype</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvj12subtype> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Student<OPTION =
value=3D02>Short term=20
        scholars<OPTION value=3D03>Trainees - Non Medical<OPTION=20
        value=3D04>Teachers<OPTION value=3D06>Specialists<OPTION =
value=3D07>Alien=20
        Physicians<OPTION value=3D08>Other - International =
Visitors<OPTION=20
        value=3D09>Other - Other Alien employee of the USIA<OPTION =
value=3D10>Other=20
        - Camp Counselors<OPTION value=3D11>Trainees - Medical<OPTION=20
        value=3D12>Research Scholars<OPTION value=3D13>Summer =
Travel/Work<OPTION=20
        value=3D99>Not Applicable</OPTION></SELECT> </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Primary=20
    Activity</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvprim2act> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Studying-Degree =
Program<OPTION=20
        value=3D02>Studying-Non-Degree Program<OPTION =
value=3D03>Teaching<OPTION=20
        value=3D04>Lecturing<OPTION value=3D05>Observing<OPTION=20
        value=3D06>Consulting<OPTION value=3D07>Conducting =
Research<OPTION=20
        value=3D08>Acquiring Training<OPTION value=3D09>Demonstrating =
Special=20
        Skills<OPTION value=3D10>Clinical Activities<OPTION =
value=3D11>Temporary=20
        Employment<OPTION value=3D12>Here with spouse/relative<OPTION=20
        value=3D13>Performing as an artist<OPTION value=3D14>Performing =
as an=20
        athlete<OPTION value=3D15>Supporting an artist/athlete<OPTION=20
        value=3D16>Tourist Activities<OPTION value=3D17>Business =
Activities<OPTION=20
        value=3D18>Board of Director Activities<OPTION =
value=3D19>Practical=20
        Training/J-1,F-1<OPTION value=3D20>Educational/Professional=20
        Activities<OPTION value=3D21>Summer Travel/Work<OPTION =
value=3D22>Unrelated=20
        Business Activities<OPTION value=3D23>In =
Transit</OPTION></SELECT> </TD></TR>
  <TR>
    <TH vAlign=3Dtop width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Have you=20
      Taken Any Treaty Benefits?</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT value=3DYes type=3Dcheckbox=20
      name=3Dtreat2_ben>Yes <INPUT value=3DNo type=3Dcheckbox=20
      name=3Dtreat2_ben>No<BR><BR></TD><INPUT value=3Dxxx type=3Dhidden =
name=3Dtreat2_ben>=20
  </TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Entry=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dventry3date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dventry3date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dventry3date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Exit=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvexit3date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvexit3date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvexit3date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Visa/Immigration=20
      Status</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvvisa3stat> =
<OPTION=20
        selected value=3D""><OPTION value=3DA-1>A-1 Foreign Government =
Worker<OPTION=20
        value=3DA-2>A-2 Other foreign government official and =
family<OPTION=20
        value=3DA-3>A-3 Attendent,servant or employee of A-1 or A-2, and =

        family<OPTION value=3DASLM>ASLM Political Asylum<OPTION =
value=3DB-1>B-1=20
        Visitor for Business<OPTION value=3DB-2>B-2 Visitor for =
Pleasure<OPTION=20
        value=3DC-1>C-1 Continuous Transit Alien<OPTION value=3DC-2>C-2 =
Alien in=20
        transit to UN Headquarteres<OPTION value=3DC-3>C-3 Foreign =
official,=20
        family, servants in transit<OPTION value=3DCPO>CPO Chinese =
Protective=20
        Order- Oct 90<OPTION value=3DCPR>CPR Conditional Permanent =
Resident=20
        (Spouse - Two Year)<OPTION value=3DD-1>D-1 Crewman<OPTION =
value=3DE-1>E-1=20
        Treaty Trader<OPTION value=3DE-2>E-2 Treaty Investor<OPTION =
value=3DF-1>F-1=20
        Student<OPTION value=3DF-2>F-2 Student Dependent<OPTION =
value=3DG-1>G-1=20
        Foreign Government Visitor<OPTION value=3DG-2>G-2 Other =
Representative of=20
        foreign member government<OPTION value=3DG-3>G-3 Representative =
of=20
        nonrecognized government and family<OPTION value=3DG-4>G-4 =
International=20
        organization officer or employee and family<OPTION =
value=3DH-1A>H-1A=20
        Professional Nurse<OPTION value=3DH-1B>H-1B Worker in Specialty=20
        Occupation<OPTION value=3DH-2A>H-2A Temporary Worker performing=20
        Agricultural services<OPTION value=3DH-2B>H-2B Temporary =
Worker<OPTION=20
        value=3DH-3>H-3 Temporary Trainee<OPTION value=3DH-4>H-4 Worker=20
        Dependent<OPTION value=3DI>I Representative of foreign media,=20
        spouse,children<OPTION value=3DJ-1>J-1 Exchange Visitor<OPTION=20
        value=3DJ-2>J-2 Exchange Visitor Dependent<OPTION =
value=3DK-1>K-1 Fiance of=20
        U.S. citizen<OPTION value=3DL-1>L-1 Intracompany =
Transferee<OPTION=20
        value=3DL-2>L-2 Intracompany Transferee Dependent<OPTION =
value=3DLPR>LPR=20
        U.S. Lawful Permanent Resident<OPTION value=3DM-1>M-1 =
Non-Academic=20
        Student<OPTION value=3DM-2>M-2 Non-Academic Student =
Dependent<OPTION=20
        value=3DN-8>N-8 Parent of SK-3 Special Immigrant<OPTION =
value=3DN-9>N-9=20
        Child of N-8 or SK-1, SK-2, or SK4 Special Immigrant<OPTION=20
        value=3DNATO>NATO NATO<OPTION value=3DO-1>O-1 Alien of =
Extraordinary Ability=20
        in Sciences, Arts, Education<OPTION value=3DO-2>O-2 Accompanying =

        Alien<OPTION value=3DO-3>O-3 Spouse/child of O-1 or O-2<OPTION=20
        value=3DP-1>P-1 Performing Entertainer or Athlete<OPTION =
value=3DP-2>P-2=20
        Exchange Program Artist or Entertainer<OPTION value=3DP-3>P-3 =
Culturally=20
        Unique Artist or Entertainer<OPTION value=3DQ-1>Q-1 Cultural =
Exchange=20
        Visitor<OPTION value=3DR-1>R-1 Religious Worker<OPTION =
value=3DR-2>R-2=20
        Religious Worker Dependent<OPTION value=3DRFGE>RFGE =
Refugee<OPTION=20
        value=3DSK-1>SK-1 Special Immigrant<OPTION value=3DSK-2>SK-2 =
Special=20
        Immigrant<OPTION value=3DSK-3>SK-3 Special Immigrant<OPTION=20
        value=3DSK-4>SK-4 Special Immigrant<OPTION value=3DTN>TN =
Canadian or Mexican=20
        Citizen Professional<OPTION value=3DVW>VW Visa =
Waiver</OPTION></SELECT>=20
  </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>J-1 =
Subtype</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvj13subtype> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Student<OPTION =
value=3D02>Short term=20
        scholars<OPTION value=3D03>Trainees - Non Medical<OPTION=20
        value=3D04>Teachers<OPTION value=3D06>Specialists<OPTION =
value=3D07>Alien=20
        Physicians<OPTION value=3D08>Other - International =
Visitors<OPTION=20
        value=3D09>Other - Other Alien employee of the USIA<OPTION =
value=3D10>Other=20
        - Camp Counselors<OPTION value=3D11>Trainees - Medical<OPTION=20
        value=3D12>Research Scholars<OPTION value=3D13>Summer =
Travel/Work<OPTION=20
        value=3D99>Not Applicable</OPTION></SELECT> </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Primary=20
    Activity</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvprim3act> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Studying-Degree =
Program<OPTION=20
        value=3D02>Studying-Non-Degree Program<OPTION =
value=3D03>Teaching<OPTION=20
        value=3D04>Lecturing<OPTION value=3D05>Observing<OPTION=20
        value=3D06>Consulting<OPTION value=3D07>Conducting =
Research<OPTION=20
        value=3D08>Acquiring Training<OPTION value=3D09>Demonstrating =
Special=20
        Skills<OPTION value=3D10>Clinical Activities<OPTION =
value=3D11>Temporary=20
        Employment<OPTION value=3D12>Here with spouse/relative<OPTION=20
        value=3D13>Performing as an artist<OPTION value=3D14>Performing =
as an=20
        athlete<OPTION value=3D15>Supporting an artist/athlete<OPTION=20
        value=3D16>Tourist Activities<OPTION value=3D17>Business =
Activities<OPTION=20
        value=3D18>Board of Director Activities<OPTION =
value=3D19>Practical=20
        Training/J-1,F-1<OPTION value=3D20>Educational/Professional=20
        Activities<OPTION value=3D21>Summer Travel/Work<OPTION =
value=3D22>Unrelated=20
        Business Activities<OPTION value=3D23>In =
Transit</OPTION></SELECT> </TD></TR>
  <TR>
    <TH vAlign=3Dtop width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Have you=20
      Taken Any Treaty Benefits?</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT value=3DYes type=3Dcheckbox=20
      name=3Dtreat3_ben>Yes <INPUT value=3DNo type=3Dcheckbox=20
      name=3Dtreat3_ben>No<BR><BR></TD><INPUT value=3Dxxx type=3Dhidden =
name=3Dtreat3_ben>=20
  </TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Entry=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dventry4date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dventry4date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dventry4date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Exit=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvexit4date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvexit4date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvexit4date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Visa/Immigration=20
      Status</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvvisa4stat> =
<OPTION=20
        selected value=3D""><OPTION value=3DA-1>A-1 Foreign Government =
Worker<OPTION=20
        value=3DA-2>A-2 Other foreign government official and =
family<OPTION=20
        value=3DA-3>A-3 Attendent,servant or employee of A-1 or A-2, and =

        family<OPTION value=3DASLM>ASLM Political Asylum<OPTION =
value=3DB-1>B-1=20
        Visitor for Business<OPTION value=3DB-2>B-2 Visitor for =
Pleasure<OPTION=20
        value=3DC-1>C-1 Continuous Transit Alien<OPTION value=3DC-2>C-2 =
Alien in=20
        transit to UN Headquarteres<OPTION value=3DC-3>C-3 Foreign =
official,=20
        family, servants in transit<OPTION value=3DCPO>CPO Chinese =
Protective=20
        Order- Oct 90<OPTION value=3DCPR>CPR Conditional Permanent =
Resident=20
        (Spouse - Two Year)<OPTION value=3DD-1>D-1 Crewman<OPTION =
value=3DE-1>E-1=20
        Treaty Trader<OPTION value=3DE-2>E-2 Treaty Investor<OPTION =
value=3DF-1>F-1=20
        Student<OPTION value=3DF-2>F-2 Student Dependent<OPTION =
value=3DG-1>G-1=20
        Foreign Government Visitor<OPTION value=3DG-2>G-2 Other =
Representative of=20
        foreign member government<OPTION value=3DG-3>G-3 Representative =
of=20
        nonrecognized government and family<OPTION value=3DG-4>G-4 =
International=20
        organization officer or employee and family<OPTION =
value=3DH-1A>H-1A=20
        Professional Nurse<OPTION value=3DH-1B>H-1B Worker in Specialty=20
        Occupation<OPTION value=3DH-2A>H-2A Temporary Worker performing=20
        Agricultural services<OPTION value=3DH-2B>H-2B Temporary =
Worker<OPTION=20
        value=3DH-3>H-3 Temporary Trainee<OPTION value=3DH-4>H-4 Worker=20
        Dependent<OPTION value=3DI>I Representative of foreign media,=20
        spouse,children<OPTION value=3DJ-1>J-1 Exchange Visitor<OPTION=20
        value=3DJ-2>J-2 Exchange Visitor Dependent<OPTION =
value=3DK-1>K-1 Fiance of=20
        U.S. citizen<OPTION value=3DL-1>L-1 Intracompany =
Transferee<OPTION=20
        value=3DL-2>L-2 Intracompany Transferee Dependent<OPTION =
value=3DLPR>LPR=20
        U.S. Lawful Permanent Resident<OPTION value=3DM-1>M-1 =
Non-Academic=20
        Student<OPTION value=3DM-2>M-2 Non-Academic Student =
Dependent<OPTION=20
        value=3DN-8>N-8 Parent of SK-3 Special Immigrant<OPTION =
value=3DN-9>N-9=20
        Child of N-8 or SK-1, SK-2, or SK4 Special Immigrant<OPTION=20
        value=3DNATO>NATO NATO<OPTION value=3DO-1>O-1 Alien of =
Extraordinary Ability=20
        in Sciences, Arts, Education<OPTION value=3DO-2>O-2 Accompanying =

        Alien<OPTION value=3DO-3>O-3 Spouse/child of O-1 or O-2<OPTION=20
        value=3DP-1>P-1 Performing Entertainer or Athlete<OPTION =
value=3DP-2>P-2=20
        Exchange Program Artist or Entertainer<OPTION value=3DP-3>P-3 =
Culturally=20
        Unique Artist or Entertainer<OPTION value=3DQ-1>Q-1 Cultural =
Exchange=20
        Visitor<OPTION value=3DR-1>R-1 Religious Worker<OPTION =
value=3DR-2>R-2=20
        Religious Worker Dependent<OPTION value=3DRFGE>RFGE =
Refugee<OPTION=20
        value=3DSK-1>SK-1 Special Immigrant<OPTION value=3DSK-2>SK-2 =
Special=20
        Immigrant<OPTION value=3DSK-3>SK-3 Special Immigrant<OPTION=20
        value=3DSK-4>SK-4 Special Immigrant<OPTION value=3DTN>TN =
Canadian or Mexican=20
        Citizen Professional<OPTION value=3DVW>VW Visa =
Waiver</OPTION></SELECT>=20
  </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>J-1 =
Subtype</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvj14subtype> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Student<OPTION =
value=3D02>Short term=20
        scholars<OPTION value=3D03>Trainees - Non Medical<OPTION=20
        value=3D04>Teachers<OPTION value=3D06>Specialists<OPTION =
value=3D07>Alien=20
        Physicians<OPTION value=3D08>Other - International =
Visitors<OPTION=20
        value=3D09>Other - Other Alien employee of the USIA<OPTION =
value=3D10>Other=20
        - Camp Counselors<OPTION value=3D11>Trainees - Medical<OPTION=20
        value=3D12>Research Scholars<OPTION value=3D13>Summer =
Travel/Work<OPTION=20
        value=3D99>Not Applicable</OPTION></SELECT> </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Primary=20
    Activity</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvprim4act> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Studying-Degree =
Program<OPTION=20
        value=3D02>Studying-Non-Degree Program<OPTION =
value=3D03>Teaching<OPTION=20
        value=3D04>Lecturing<OPTION value=3D05>Observing<OPTION=20
        value=3D06>Consulting<OPTION value=3D07>Conducting =
Research<OPTION=20
        value=3D08>Acquiring Training<OPTION value=3D09>Demonstrating =
Special=20
        Skills<OPTION value=3D10>Clinical Activities<OPTION =
value=3D11>Temporary=20
        Employment<OPTION value=3D12>Here with spouse/relative<OPTION=20
        value=3D13>Performing as an artist<OPTION value=3D14>Performing =
as an=20
        athlete<OPTION value=3D15>Supporting an artist/athlete<OPTION=20
        value=3D16>Tourist Activities<OPTION value=3D17>Business =
Activities<OPTION=20
        value=3D18>Board of Director Activities<OPTION =
value=3D19>Practical=20
        Training/J-1,F-1<OPTION value=3D20>Educational/Professional=20
        Activities<OPTION value=3D21>Summer Travel/Work<OPTION =
value=3D22>Unrelated=20
        Business Activities<OPTION value=3D23>In =
Transit</OPTION></SELECT> </TD></TR>
  <TR>
    <TH vAlign=3Dtop width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Have you=20
      Taken Any Treaty Benefits?</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT value=3DYes type=3Dcheckbox=20
      name=3Dtreat4_ben>Yes <INPUT value=3DNo type=3Dcheckbox=20
      name=3Dtreat4_ben>No<BR><BR></TD><INPUT value=3Dxxx type=3Dhidden =
name=3Dtreat4_ben>=20
  </TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Entry=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dventry5date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dventry5date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dventry5date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Date of =
US Exit=20
      month/day/year</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT maxLength=3D2 size=3D2=20
      name=3Dvexit5date1>/<INPUT maxLength=3D2 size=3D2 =
name=3Dvexit5date2>/<INPUT=20
      maxLength=3D4 size=3D4 name=3Dvexit5date3></TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Visa/Immigration=20
      Status</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvvisa5stat> =
<OPTION=20
        selected value=3D""><OPTION value=3DA-1>A-1 Foreign Government =
Worker<OPTION=20
        value=3DA-2>A-2 Other foreign government official and =
family<OPTION=20
        value=3DA-3>A-3 Attendent,servant or employee of A-1 or A-2, and =

        family<OPTION value=3DASLM>ASLM Political Asylum<OPTION =
value=3DB-1>B-1=20
        Visitor for Business<OPTION value=3DB-2>B-2 Visitor for =
Pleasure<OPTION=20
        value=3DC-1>C-1 Continuous Transit Alien<OPTION value=3DC-2>C-2 =
Alien in=20
        transit to UN Headquarteres<OPTION value=3DC-3>C-3 Foreign =
official,=20
        family, servants in transit<OPTION value=3DCPO>CPO Chinese =
Protective=20
        Order- Oct 90<OPTION value=3DCPR>CPR Conditional Permanent =
Resident=20
        (Spouse - Two Year)<OPTION value=3DD-1>D-1 Crewman<OPTION =
value=3DE-1>E-1=20
        Treaty Trader<OPTION value=3DE-2>E-2 Treaty Investor<OPTION =
value=3DF-1>F-1=20
        Student<OPTION value=3DF-2>F-2 Student Dependent<OPTION =
value=3DG-1>G-1=20
        Foreign Government Visitor<OPTION value=3DG-2>G-2 Other =
Representative of=20
        foreign member government<OPTION value=3DG-3>G-3 Representative =
of=20
        nonrecognized government and family<OPTION value=3DG-4>G-4 =
International=20
        organization officer or employee and family<OPTION =
value=3DH-1A>H-1A=20
        Professional Nurse<OPTION value=3DH-1B>H-1B Worker in Specialty=20
        Occupation<OPTION value=3DH-2A>H-2A Temporary Worker performing=20
        Agricultural services<OPTION value=3DH-2B>H-2B Temporary =
Worker<OPTION=20
        value=3DH-3>H-3 Temporary Trainee<OPTION value=3DH-4>H-4 Worker=20
        Dependent<OPTION value=3DI>I Representative of foreign media,=20
        spouse,children<OPTION value=3DJ-1>J-1 Exchange Visitor<OPTION=20
        value=3DJ-2>J-2 Exchange Visitor Dependent<OPTION =
value=3DK-1>K-1 Fiance of=20
        U.S. citizen<OPTION value=3DL-1>L-1 Intracompany =
Transferee<OPTION=20
        value=3DL-2>L-2 Intracompany Transferee Dependent<OPTION =
value=3DLPR>LPR=20
        U.S. Lawful Permanent Resident<OPTION value=3DM-1>M-1 =
Non-Academic=20
        Student<OPTION value=3DM-2>M-2 Non-Academic Student =
Dependent<OPTION=20
        value=3DN-8>N-8 Parent of SK-3 Special Immigrant<OPTION =
value=3DN-9>N-9=20
        Child of N-8 or SK-1, SK-2, or SK4 Special Immigrant<OPTION=20
        value=3DNATO>NATO NATO<OPTION value=3DO-1>O-1 Alien of =
Extraordinary Ability=20
        in Sciences, Arts, Education<OPTION value=3DO-2>O-2 Accompanying =

        Alien<OPTION value=3DO-3>O-3 Spouse/child of O-1 or O-2<OPTION=20
        value=3DP-1>P-1 Performing Entertainer or Athlete<OPTION =
value=3DP-2>P-2=20
        Exchange Program Artist or Entertainer<OPTION value=3DP-3>P-3 =
Culturally=20
        Unique Artist or Entertainer<OPTION value=3DQ-1>Q-1 Cultural =
Exchange=20
        Visitor<OPTION value=3DR-1>R-1 Religious Worker<OPTION =
value=3DR-2>R-2=20
        Religious Worker Dependent<OPTION value=3DRFGE>RFGE =
Refugee<OPTION=20
        value=3DSK-1>SK-1 Special Immigrant<OPTION value=3DSK-2>SK-2 =
Special=20
        Immigrant<OPTION value=3DSK-3>SK-3 Special Immigrant<OPTION=20
        value=3DSK-4>SK-4 Special Immigrant<OPTION value=3DTN>TN =
Canadian or Mexican=20
        Citizen Professional<OPTION value=3DVW>VW Visa =
Waiver</OPTION></SELECT>=20
  </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>J-1 =
Subtype</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvj15subtype> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Student<OPTION =
value=3D02>Short term=20
        scholars<OPTION value=3D03>Trainees - Non Medical<OPTION=20
        value=3D04>Teachers<OPTION value=3D06>Specialists<OPTION =
value=3D07>Alien=20
        Physicians<OPTION value=3D08>Other - International =
Visitors<OPTION=20
        value=3D09>Other - Other Alien employee of the USIA<OPTION =
value=3D10>Other=20
        - Camp Counselors<OPTION value=3D11>Trainees - Medical<OPTION=20
        value=3D12>Research Scholars<OPTION value=3D13>Summer =
Travel/Work<OPTION=20
        value=3D99>Not Applicable</OPTION></SELECT> </TD></TR>
  <TR>
    <TH width=3D"60%" align=3Dleft><FONT color=3Dblack size=3D3>Primary=20
    Activity</FONT></TH>
    <TD width=3D"15%" align=3Dleft><SELECT size=3D1 name=3Dvprim5act> =
<OPTION=20
        selected value=3D""><OPTION value=3D01>Studying-Degree =
Program<OPTION=20
        value=3D02>Studying-Non-Degree Program<OPTION =
value=3D03>Teaching<OPTION=20
        value=3D04>Lecturing<OPTION value=3D05>Observing<OPTION=20
        value=3D06>Consulting<OPTION value=3D07>Conducting =
Research<OPTION=20
        value=3D08>Acquiring Training<OPTION value=3D09>Demonstrating =
Special=20
        Skills<OPTION value=3D10>Clinical Activities<OPTION =
value=3D11>Temporary=20
        Employment<OPTION value=3D12>Here with spouse/relative<OPTION=20
        value=3D13>Performing as an artist<OPTION value=3D14>Performing =
as an=20
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Activities<OPTION=20
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value=3D19>Practical=20
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        Activities<OPTION value=3D21>Summer Travel/Work<OPTION =
value=3D22>Unrelated=20
        Business Activities<OPTION value=3D23>In =
Transit</OPTION></SELECT> </TD></TR>
  <TR>
    <TH vAlign=3Dtop width=3D"60%" align=3Dleft><FONT color=3Dblack =
size=3D3>Have you=20
      Taken Any Treaty Benefits?</FONT></TH>
    <TD width=3D"15%" align=3Dleft><INPUT value=3DYes type=3Dcheckbox=20
      name=3Dtreat5_ben>Yes <INPUT value=3DNo type=3Dcheckbox=20
      name=3Dtreat5_ben>No<BR><BR></TD><INPUT value=3Dxxx type=3Dhidden =
name=3Dtreat5_ben>=20
  </TR></TBODY></TABLE>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD align=3Dleft><FONT color=3Dred size=3D3>I hereby certify that =
all of the=20
      above information is true and correct. I understand that if my =
status=20
      changes from that which I have indicated on the form I must submit =
a new=20
      Tax Assessment Form.</FONT></TD></TR></TBODY></TABLE>
<P>
<TABLE border=3D0 width=3D"100%">
  <TBODY>
  <TR>
    <TD width=3D"30%" align=3Dleft><FONT size=3D+0><B>Local Phone =
Number:=20
      </B></FONT><INPUT maxLength=3D3 size=3D3 name=3Dvlocalph1>/<INPUT =
maxLength=3D3=20
      size=3D3 name=3Dvlocalph2>/<INPUT maxLength=3D4 size=3D4 =
name=3Dvlocalph3></TD>
    <TD width=3D"30%" align=3Dleft><FONT size=3D+0><B>Date: =
</B></FONT><INPUT=20
      maxLength=3D2 size=3D2 name=3Dvauthdate1>/<INPUT maxLength=3D2 =
size=3D2=20
      name=3Dvauthdate2>/<INPUT maxLength=3D4 size=3D4=20
name=3Dvauthdate3></TD></TR></TBODY></TABLE><BR>
<TABLE width=3D"100%">
  <TBODY>
  <TR>
    <TD vAlign=3Dbottom align=3Dmiddle><FONT color=3Dblack>When you have =
completed=20
      this form, print out the form and take it with applicable =
documentation to=20
      either the Office of International Programs (students), the =
Academic=20
      Affairs office (faculty), Human Resources (other employees) or the =
Finance=20
      Office (all other foreign nationals).<BR>&nbsp;</FONT></TD></TR>
  <TR>
    <TD vAlign=3Dbottom align=3Dmiddle><FONT color=3Dblack>If you have =
questions=20
      about this application, please e-mail <A=20
      href=3D"mailto:chris.leach@washburn.edu">Chris =
Leach</A>.</FONT></TD></TR>
  <TR>
    <TD vAlign=3Dbottom align=3Dmiddle><B><FONT color=3Dblack>Adapted =
with=20
      permission of University of =
Missouri</FONT></B></TD></TR></TBODY></TABLE></FORM><!-- Beginning of: =
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,"cx","cy","cz","de","dj","dk","dm","do","dz","ec","ee","eg","er","es","e=
t","eu","fi","fj","fk","fm","fo","fr","ga","gb","gd","ge"=0A=
				=
,"gf","gg","gh","gi","gl","gm","gn","gp","gq","gr","gs","gt","gu","gw","g=
y","hk","hm","hn","hr","ht","hu","id","ie","il","im","in"=0A=
				=
,"io","iq","ir","is","it","je","jm","jo","jp","ke","kg","kh","ki","km","k=
n","kp","kr","kw","ky","kz","la","lb","lc","li","lk","lr"=0A=
				=
,"ls","lt","lu","lv","ly","ma","mc","md","me","mg","mh","mk","ml","mm","m=
n","mo","mp","mq","mr","ms","mt","mu","mv","mw","mx","my"=0A=
				=
,"mz","na","nc","ne","nf","ng","ni","nl","no","np","nr","nu","nz","om","p=
a","pe","pf","pg","ph","pk","pl","pm","pn","pr","ps","pt"=0A=
				=
,"pw","py","qa","re","ro","rs","ru","rw","sa","sb","sc","sd","se","sg","s=
h","si","sj","sk","sl","sm","sn","so","sr","st","su","sv"=0A=
				=
,"sy","sz","tc","td","tf","tg","th","tj","tk","tl","tm","tn","to","tp","t=
r","tt","tv","tw","tz","ua","ug","uk","us","uy","uz","va"=0A=
				,"vc","ve","vg","vi","vn","vu","wf","ws","ye","yt","za","zm","zw"=0A=
				=
,"aero","asia","biz","cat","com","coop","edu","gov","info","int","jobs","=
mil","mobi","museum","name","net","org","pro","tel","travel",];=0A=
=0A=
				try=0A=
				{=0A=
					var matches;=0A=
					var exp =3D new RegExp(/^([a-zA-Z]+:\/\/)([^\/]+)/);=0A=
					=0A=
					if (matches =3D exp.exec(referrer))=0A=
					{=0A=
						var hn =3D matches[2].toLowerCase().split(".").reverse();=0A=
						var x =3D "";=0A=
						while (hn.length > 0)=0A=
						{=0A=
							x =3D hn.shift();=0A=
							var istld =3D false;=0A=
							for (var tld in tlds)=0A=
								if (tlds[tld] =3D=3D x)=0A=
									istld =3D true;=0A=
							=0A=
							if (!istld)=0A=
								break;=0A=
						}=0A=
						=0A=
						var k =3D reinv_util.search_engines[x];=0A=
						=0A=
						var v =3D "";=0A=
						if (typeof k !=3D "undefined")=0A=
						{=0A=
							var pos =3D referrer.indexOf("?"+k[1]+"=3D");=0A=
							if (pos =3D=3D -1)=0A=
								pos =3D referrer.indexOf("&"+k[1]+"=3D");=0A=
								=0A=
							if (pos > -1)=0A=
							{=0A=
								v =3D referrer.substr(pos+k[1].length+2);=0A=
								pos =3D v.indexOf("&");=0A=
								if (pos > -1)=0A=
									v =3D v.substr(0,pos);=0A=
								v =3D decodeURIComponent(v.replace(/\+/g," "));=0A=
							}=0A=
						}=0A=
					}=0A=
					=0A=
					if (v !=3D "")=0A=
					{=0A=
						search_engine =3D k[0];=0A=
						search_keyword =3D v;=0A=
					}=0A=
				} catch (_e) {}=0A=
			}=0A=
		}=0A=
=0A=
		// build output map=0A=
 		var map =3D {};=0A=
=0A=
		map["std"] =3D 1;=0A=
		map["wkey"] =3D reinvigorate.wkey;=0A=
		map["ses"] =3D reinvigorate.get_cookie(reinvigorate.env.key.ses);=0A=
		map["ses_index"] =3D =
parseInt(reinvigorate.get_cookie(reinvigorate.env.key.ses_index));=0A=
		map["cook"] =3D !!document.cookie;=0A=
		map["lt"] =3D reinv_util.ltime();=0A=
		map["url"] =3D reinvigorate.url_filter(reinvigorate.session.url);=0A=
		map["title"] =3D (document.title && document.title !=3D "") ? =
document.title : "Untitled";=0A=
=0A=
		if (typeof re_name_tag !=3D "undefined")=0A=
			map["nt"] =3D re_name_tag;=0A=
		if (typeof re_context_tag !=3D "undefined")=0A=
			map["ct"] =3D re_context_tag;=0A=
		if (typeof re_comment_tag !=3D "undefined")=0A=
			map["cmmt"] =3D re_comment_tag;=0A=
		if (typeof re_context_tag !=3D "undefined")=0A=
			map["nwusr"] =3D re_new_user_tag;=0A=
		if (typeof re_purchase_tag !=3D "undefined")=0A=
			map["prchs"] =3D re_purchase_tag;=0A=
		=0A=
		function trim(str)=0A=
		{=0A=
			return str.replace(/^\s*|\s*$/g,'');=0A=
		}=0A=
		=0A=
		with (reinvigorate.session)=0A=
		{=0A=
			map["bwr"] =3D trim(browser);=0A=
			map["bwrv"] =3D trim(browser_version);=0A=
			map["os"] =3D trim(platform);=0A=
			map["osv"] =3D trim(platform_version);=0A=
		=0A=
			if (unique)=0A=
			{=0A=
				map["u"] =3D "1";=0A=
				map["ret_index"] =3D =
parseInt(reinvigorate.get_cookie(reinvigorate.env.key.ret));=0A=
				map["tz"] =3D (new Date()).getTimezoneOffset()/60;=0A=
				map["resw"] =3D screen.width;=0A=
				map["resh"] =3D screen.height;=0A=
			=0A=
				if (search_keyword !=3D "")=0A=
				{=0A=
					map["se"] =3D search_engine;=0A=
					map["kw"] =3D search_keyword;=0A=
				}=0A=
			=0A=
				if (referrer !=3D ""=0A=
					&& reinv_util.server_name(referrer)=0A=
					!=3D reinv_util.server_name(url))=0A=
					map["ref"] =3D referrer;=0A=
			} else=0A=
			{=0A=
				map["vt"] =3D =
Math.floor((reinvigorate.session.begin.getTime()-parseInt(reinvigorate.ge=
t_cookie(reinvigorate.env.key.visit_time)))/1000);=0A=
				if (document.referrer !=3D undefined)=0A=
					map["pp"] =3D reinvigorate.url_filter(document.referrer);=0A=
			}=0A=
		}=0A=
		=0A=
		reinvigorate.set_cookie(reinvigorate.env.key.visit_time, =
reinvigorate.session.begin.getTime(),86400,"/");=0A=
=0A=
		// modules=0A=
 		for (var i=3D0;i<reinvigorate.jobs.length;++i)=0A=
 		{=0A=
 			var r =3D reinvigorate.jobs[i]();=0A=
			if (typeof r =3D=3D "object")=0A=
			{=0A=
	 			for (var k in r)=0A=
				{=0A=
					try // safety=0A=
					{=0A=
 						map[k] =3D r[k];=0A=
					} catch (_e) {}=0A=
				}=0A=
			}=0A=
 		}=0A=
=0A=
		map["rnd"] =3D Math.floor(Math.random()*214748364);=0A=
=0A=
 		var buf =3D "";=0A=
 		for (var k in map)=0A=
 			buf +=3D encodeURIComponent(k) + "=3D" + encodeURIComponent(map[k]) =
+ "&";=0A=
 		if (buf.length > 0)=0A=
 			buf =3D buf.substr(0,buf.length-1);=0A=
=0A=
		var proto =3D document.location.protocol =3D=3D "https:" ? "https" : =
"http";=0A=
		reinvigorate.img_src =3D proto + "://" + reinvigorate.host + =
(reinvigorate.port =3D=3D 80 ? "" : (":"+reinvigorate.port)) + =
"/re_/ping?" + buf;=0A=
		var img =3D new Image(1,1);=0A=
		img.src =3D reinvigorate.img_src;=0A=
 	}=0A=
};=0A=
=0A=
=0A=
var reinv_util =3D=0A=
{=0A=
	ltime: function()=0A=
	{=0A=
		var d =3D new Date();=0A=
		var hr =3D d.getHours()%12;=0A=
		return (hr =3D=3D 0 ? 12 : hr) + ":" + =
(d.getMinutes().toString().length =3D=3D 1 ? "0" : "") + d.getMinutes() =
+ " " + (d.getHours() < 12 ? "am" : "pm");=0A=
	}=0A=
	, sid: function()=0A=
	{=0A=
		return Math.floor(Math.random()*214748364);=0A=
	}=0A=
	, get_ua: function(s)=0A=
	{=0A=
		return reinvigorate.session.user_agent.indexOf(s) + 1;=0A=
	}=0A=
	, search_engines:=0A=
	{=0A=
		"google":		["Google","q"]=0A=
		,"yahoo":		["Yahoo","p"]=0A=
		,"bing":		["Bing","q"]=0A=
		,"msn":			["MSN","q"]=0A=
		,"aol":			["AOL","q"]=0A=
		,"lycos":		["Lycos","query"]=0A=
		,"ask":			["Ask","q"]=0A=
		,"altavista":	["AltaVista","q"]=0A=
		,"search": 		["Search.com","q"]=0A=
		,"netscape":	["Netscape","s"]=0A=
		,"cnn": 		["CNN","query"]=0A=
		,"looksmart":	["LookSmart","qt"]=0A=
		,"about": 		["About","terms"]=0A=
		,"mamma": 		["Mamma","query"]=0A=
		,"alltheweb":	["AlltheWeb","q"]=0A=
		,"gigablast":	["Gigablast","q"]=0A=
		,"voila":		["Voila","kw"]=0A=
		,"virgilio":	["Virgilio","qs"]=0A=
		,"live":		["Live","q"]=0A=
		,"baidu":		["Baidu","wd"]=0A=
		,"seznam": 		["Seznam","w"]=0A=
		,"yandex": 		["Yandex","text"]=0A=
		,"najdi": 		["Najdi","q"]=0A=
	}=0A=
	, server_name: function(url)=0A=
	{=0A=
		var matches;=0A=
		var exp =3D new RegExp(/^([a-zA-Z]+:\/\/)(www\.)?([^\/]*)/);=0A=
		if (matches =3D exp.exec(url))=0A=
			return matches[3];=0A=
=0A=
		return "";=0A=
	}=0A=
	, get_browser: function()=0A=
	{=0A=
		with (reinvigorate.session)=0A=
		{=0A=
			// browser=0A=
			if (reinv_util.get_ua("konqueror"))=0A=
			{=0A=
				browser =3D "Konqueror";=0A=
				browser_ident =3D "konqueror";=0A=
			} else if (reinv_util.get_ua("chrome"))=0A=
			{=0A=
				browser =3D "Google Chrome";=0A=
				browser_ident =3D "chrome";=0A=
			} else if (reinv_util.get_ua("safari"))=0A=
			{=0A=
				browser =3D "Safari";=0A=
				browser_ident =3D "safari";=0A=
			} else if (reinv_util.get_ua("applewebkit"))=0A=
			{=0A=
				browser =3D "Safari";=0A=
				browser_ident =3D "applewebkit";=0A=
			}  else if (reinv_util.get_ua("opera"))=0A=
			{=0A=
				browser =3D "Opera";=0A=
				browser_ident =3D "opera";=0A=
			} else if (reinv_util.get_ua("webtv"))=0A=
			{=0A=
				browser =3D "WebTV";=0A=
				browser_ident =3D "webtv";=0A=
			} else if (reinv_util.get_ua("firefox"))=0A=
			{=0A=
				browser =3D "Firefox";=0A=
				browser_ident =3D "firefox";=0A=
			} else if (reinv_util.get_ua("msie"))=0A=
			{=0A=
				browser =3D "Internet Explorer";=0A=
				browser_ident =3D "msie";=0A=
			} else if (reinv_util.get_ua("omniweb"))=0A=
			{	=0A=
				browser =3D "OmniWeb";=0A=
				browser_ident =3D "omniweb";=0A=
			} else if (reinv_util.get_ua("netscape"))=0A=
			{=0A=
				browser =3D "Netscape";=0A=
				browser_ident =3D "netscape";=0A=
			} else=0A=
			{=0A=
				browser =3D "Unknown";=0A=
			}=0A=
=0A=
			// browser version=0A=
			var i, ua, b, cr;=0A=
			if (browser_ident =3D=3D "Netscape Navigator" && document.layers)=0A=
			{=0A=
				browser_version =3D 4;=0A=
			} else if (!((i =3D user_agent.indexOf(browser_ident+" ")) >=3D 0 || =
(i =3D user_agent.indexOf(browser_ident+"/")) >=3D 0))=0A=
			{=0A=
				browser_version =3D "";=0A=
			} else=0A=
			{=0A=
				ua =3D user_agent.substring(i + browser_ident.length + 1);=0A=
				if (ua.charAt(0) =3D=3D "v")=0A=
					ua =3D ua.substring(1);=0A=
				b =3D "";=0A=
				for (cnt=3D0;cnt<ua.length;cnt++)=0A=
				{=0A=
					cr =3D ua.charAt(cnt);=0A=
					if ((cr >=3D 0 && cr <=3D 9) || cr =3D=3D ".")=0A=
						b +=3D cr;=0A=
					else=0A=
						break;=0A=
				}=0A=
				browser_version =3D b;=0A=
			}=0A=
			=0A=
			if (browser_ident =3D=3D "opera" && browser_version =3D=3D "")=0A=
			{=0A=
				var exp =3D new RegExp(/^opera\/([0-9.]+)/);=0A=
				var matches;=0A=
				if ((matches =3D exp.exec(user_agent)) && matches.length =3D=3D 2)=0A=
					browser_version =3D matches[1];=0A=
			}=0A=
		}=0A=
	}=0A=
	, get_platform: function()=0A=
	{=0A=
		with (reinvigorate.session)=0A=
		{=0A=
			// platform=0A=
			if (reinv_util.get_ua("iphone"))=0A=
				platform =3D "iPhone";=0A=
			else if (reinv_util.get_ua("ipad"))=0A=
				platform =3D "iPad";=0A=
			else if (reinv_util.get_ua("sunos"))=0A=
				platform =3D "SunOS";=0A=
			else if (reinv_util.get_ua("freebsd") || reinv_util.get_ua("openbsd"))=0A=
				platform =3D "BSD";=0A=
			else if (reinv_util.get_ua("linux"))=0A=
				platform =3D "Linux";=0A=
			else if (reinv_util.get_ua("mac") || reinv_util.get_ua("ppc"))=0A=
				platform =3D "Mac";=0A=
			else if (reinv_util.get_ua("x11"))=0A=
				platform =3D "UNIX";=0A=
			else if (reinv_util.get_ua("win"))=0A=
				platform =3D "Windows";=0A=
			else if (reinv_util.get_ua("nintendo wii"))=0A=
				platform =3D "Nintendo Wii";=0A=
			else if (reinv_util.get_ua("playstation 3"))=0A=
				platform =3D "Playstation 3";=0A=
			else if (reinv_util.get_ua("playstation portable"))=0A=
				platform =3D "PlayStation Portable";=0A=
			else=0A=
				platform =3D "";=0A=
			=0A=
			// platform version=0A=
			var os =3D platform;=0A=
	=0A=
			if (os =3D=3D "Windows")=0A=
			{=0A=
				if (user_agent.indexOf("win3.11") !=3D -1 || =
user_agent.indexOf("windows 3.1") !=3D -1)=0A=
					platform_version =3D "3.1";=0A=
				else if (user_agent.indexOf("winnt3.51") !=3D -1)=0A=
					platform_version =3D "NT 3.11";=0A=
				else if (user_agent.indexOf("winnt4.0") !=3D -1)=0A=
					platform_version =3D "4.0";=0A=
				else if (user_agent.indexOf("win95") !=3D -1 || =
user_agent.indexOf("windows 95") !=3D -1)=0A=
					platform_version =3D "95";=0A=
				else if (user_agent.indexOf("win98") !=3D -1 || =
user_agent.indexOf("windows 98") !=3D -1)=0A=
					platform_version =3D "98";=0A=
				else if (user_agent.indexOf("win 9x 4.90") !=3D -1)=0A=
					platform_version =3D "Millennium Edition";=0A=
				else if (user_agent.indexOf("nt 5.0") !=3D -1 || =
user_agent.indexOf("windows 2000") !=3D -1)=0A=
					platform_version =3D "2000";=0A=
				else if (user_agent.indexOf("nt 5.1") !=3D -1)=0A=
					platform_version =3D "XP";=0A=
				else if (user_agent.indexOf("nt 5.2") !=3D -1)=0A=
					platform_version =3D "Server 2003 / XP Pro (x64 Edition)";=0A=
				else if (user_agent.indexOf("nt 6.0") !=3D -1)=0A=
					platform_version =3D "Vista";=0A=
				else if (user_agent.indexOf("nt 6.1") !=3D -1)=0A=
					platform_version =3D "7";=0A=
				else if (user_agent.indexOf("win32") !=3D -1)=0A=
					platform_version =3D "XP";=0A=
				else if (user_agent.indexOf("windows nt") !=3D -1)=0A=
					platform_version =3D "NT";=0A=
			} else if (os =3D=3D "Mac" || os =3D=3D "iPhone")=0A=
			{=0A=
				var exp =3D new RegExp(/os( x)? ([0-9._]+)/);=0A=
				var matches;=0A=
				if ((matches =3D exp.exec(user_agent)) && matches.length =3D=3D 3)=0A=
					platform_version =3D matches[2].replace(/_/g,".");=0A=
=0A=
			} else if (os =3D=3D "SunOS")=0A=
			{=0A=
				var exp =3D new RegExp(/sunos ([0-9.]+)/);=0A=
				var matches;=0A=
				if ((matches =3D exp.exec(user_agent)) && matches.length =3D=3D 2)=0A=
					platform_version =3D matches[1];=0A=
			}=0A=
		}=0A=
	}=0A=
};=0A=
=0A=
=0A=
reinvigorate.add(function()=0A=
{=0A=
	re_heatmap_click_cnt=3D0;=0A=
	var heatmap_click_event =3D function(e)=0A=
	{=0A=
		if(!e)=0A=
			e =3D window.event;=0A=
		var w =3D document.clientWidth !=3D=3D undefined ? =
document.clientWidth : window.innerWidth;=0A=
		var h =3D document.clientHeight !=3D=3D undefined ? =
document.clientHeight : window.innerHeight;=0A=
		var scrollx =3D window.pageXOffset =3D=3D=3D undefined ? =
document.scrollLeft : window.pageXOffset;=0A=
		var scrolly =3D window.pageYOffset =3D=3D=3D undefined ? =
document.scrollTop : window.pageYOffset;=0A=
		if(e.clientX > w || e.clientX < 0 || e.clientY > h || e.clientY < 0 || =
e.clientX =3D=3D "NaN" || scrollx =3D=3D "NaN" || w =3D=3D "NaN" || h =
=3D=3D "Nan")=0A=
			return;=0A=
		var node =3D false;=0A=
		if (e.target)=0A=
			node =3D e.target;=0A=
		else if (e.srcElement)=0A=
			node =3D e.srcElement;=0A=
		var ele_code =3D "";=0A=
		while (node)=0A=
		{=0A=
			ele_code +=3D node.tagName;=0A=
			if (typeof node.src !=3D "undefined")=0A=
				ele_code +=3D node.src;=0A=
			if (typeof node.name !=3D "undefined")=0A=
				ele_code +=3D node.name;=0A=
			if (typeof node.href !=3D "undefined")=0A=
				ele_code +=3D node.href;=0A=
			node =3D node.parentNode;=0A=
			if (typeof node.tagName =3D=3D "undefined")=0A=
				break;=0A=
		}=0A=
		=0A=
		var params =3D 'heatmap=3D1&wkey=3D' + =
encodeURIComponent(reinvigorate.wkey) + '&x=3D' + (e.clientX + scrollx) =
+ '&y=3D' + (e.clientY + scrolly) + '&w=3D' + w + '&h=3D' + h + =
'&url=3D' + =
encodeURIComponent(reinvigorate.url_filter(reinvigorate.session.url)) + =
'&title=3D' + encodeURIComponent((document.title && document.title !=3D =
'') ? document.title : 'Untitled') + "&elecode=3D" + =
encodeURIComponent(ele_code);=0A=
		if (((e.clientX + scrollx)+(e.clientY + scrolly))*w*h =3D=3D 0)=0A=
			return;=0A=
		var img =3D new Image(1,1);=0A=
		var proto =3D document.location.protocol =3D=3D "https:" ? "https" : =
"http";=0A=
		img.src =3D proto + '://' + reinvigorate.host + (reinvigorate.port =
=3D=3D 80 ? '' : (':'+reinvigorate.port)) + '/re_/ping?' + params;=0A=
	}=0A=
	if (document.addEventListener)=0A=
		document.addEventListener('mouseup', heatmap_click_event, false);=0A=
	else if (document.attachEvent)=0A=
		document.attachEvent('onmouseup', heatmap_click_event);=0A=
	return {};=0A=
});=0A=
=0A=
function log_region()=0A=
{=0A=
	var map =3D {};=0A=
	if (reinvigorate.session.unique)=0A=
	{=0A=
		map["tz"] =3D ((new Date()).getTimezoneOffset()/60)+"";=0A=
		if (navigator.language)=0A=
			map["lang"] =3D navigator.language.toLowerCase();=0A=
	}=0A=
	return map;=0A=
}=0A=
reinvigorate.add(log_region);=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
///// Legacy  ////////////////////////////////////////////////////=0A=
//////////////////////////////////////////////////////////////////=0A=
=0A=
=0A=
=0A=
var _re_script_v =3D 1.5;=0A=
=0A=
var re_host =3D "stats.reinvigorate.net";=0A=
=0A=
var re_u_expires =3D 86400;=0A=
var re_r_expires =3D 86400*365;=0A=
=0A=
=0A=
var re_unique =3D 0;=0A=
=0A=
var re_ua =3D navigator.userAgent.toLowerCase();=0A=
=0A=
var re_browser_ident =3D "";=0A=
=0A=
if (typeof(re_name_tag) =3D=3D "undefined")=0A=
	var re_name_tag =3D "";=0A=
if (typeof(re_context_tag) =3D=3D "undefined")=0A=
	var re_context_tag =3D "";=0A=
if (typeof(re_comment_tag) =3D=3D "undefined")=0A=
	var re_comment_tag =3D "";=0A=
if (typeof(re_new_user_tag) =3D=3D "undefined")=0A=
	var re_new_user_tag =3D "";=0A=
if (typeof(re_purchase_tag) =3D=3D "undefined")=0A=
	var re_purchase_tag =3D "";=0A=
=0A=
function re_ua_get(s)=0A=
{=0A=
	return re_ua.indexOf(s) + 1;=0A=
}=0A=
=0A=
function re_cookie_exists(n)=0A=
{=0A=
	return ((document.cookie.indexOf(n + "=3D") =3D=3D -1) ? false : true);=0A=
}=0A=
=0A=
function re_get_cookie(n)=0A=
{=0A=
	var b, e, n, t;=0A=
	=0A=
	if (document.cookie =3D=3D "")=0A=
		return false;=0A=
=0A=
	with (document.cookie)=0A=
	{=0A=
		if ((b =3D indexOf(n + "=3D")) =3D=3D -1)=0A=
			return false;=0A=
		if ((e =3D substring(b).indexOf(";")) =3D=3D -1)=0A=
			return unescape(substring(b + n.length + 1));=0A=
		t =3D substring(b + n.length + 1);=0A=
		return unescape(t.substring(0,t.indexOf(";")));=0A=
	}=0A=
	=0A=
	return  "";=0A=
}=0A=
=0A=
function re_set_cookie(name, value, expires, path, domain, secure)=0A=
{=0A=
	var whence =3D "";=0A=
	if (expires)=0A=
	{=0A=
		var the_date =3D new Date();=0A=
		the_date.setTime(the_date.getTime()+(expires*1000));=0A=
		whence =3D the_date.toGMTString();=0A=
	}=0A=
	=0A=
    var cook =3D name + "=3D" + escape(value) + (expires ? "; =
expires=3D" + whence : "") + (path ? "; path=3D" + path : "") + (domain =
? "; domain=3D" + domain : "") + (secure ? "secure" : "");=0A=
    document.cookie =3D cook;=0A=
}=0A=
=0A=
=0A=
function re_add_event(obj, evnt, func)=0A=
{=0A=
	var oldobj =3D obj[evnt];=0A=
	if (typeof oldfrm !=3D 'function')=0A=
	{=0A=
		obj[evnt] =3D func;=0A=
	} else=0A=
	{=0A=
		obj[evnt] =3D function()=0A=
		{=0A=
			oldfrm();=0A=
			func();=0A=
		}=0A=
	}=0A=
}=0A=
=0A=
function re_make_comment(name, email, url, comment)=0A=
{=0A=
	if (name =3D=3D "")=0A=
		name =3D "Anonymous";=0A=
	=0A=
	var context =3D url;=0A=
	if (context =3D=3D "")=0A=
		url =3D "mailto:" + email;=0A=
	=0A=
	if (name !=3D "Anonymous")=0A=
	{=0A=
		re_set_cookie("_reun",name,86400*365,"/");=0A=
		=0A=
		if (context !=3D "")=0A=
			re_set_cookie("_rectx",context,86400*365,"/");=0A=
	}=0A=
	=0A=
	comment =3D comment.substr(0,155);=0A=
	=0A=
	re_set_cookie("_recmt",comment,60*60*2,"/");=0A=
}=0A=
=0A=
function re_auto_tag(usernames, contexts)=0A=
{=0A=
	var nametag=3D"";=0A=
	for (var i=3D0;i<usernames.length;++i)=0A=
	{=0A=
		if (re_cookie_exists(usernames[i]) && re_get_cookie(usernames[i]) !=3D =
"")=0A=
		{=0A=
			nametag =3D re_get_cookie(usernames[i]);=0A=
			break;=0A=
		}=0A=
	}=0A=
=0A=
	var context=3D"";=0A=
	for (var i=3D0;i<contexts.length;++i)=0A=
	{=0A=
		if (re_cookie_exists(contexts[i]) && re_get_cookie(contexts[i]) !=3D =
"")=0A=
		{=0A=
			context =3D re_get_cookie(contexts[i]);=0A=
			break;=0A=
		}=0A=
	}=0A=
	=0A=
	=0A=
	//=0A=
	//re_name_tag =3D "n/a";=0A=
	//re_context_tag =3D "n/a";=0A=
	//re_comment_tag =3D "n/a";=0A=
	//=0A=
=0A=
	if (nametag !=3D "" && re_name_tag =3D=3D "")=0A=
		re_name_tag =3D nametag;=0A=
	=0A=
	if (context !=3D "" && re_context_tag =3D=3D "")=0A=
		re_context_tag =3D context;=0A=
=0A=
	=0A=
	if (re_cookie_exists("_recmt") && re_get_cookie("_recmt") !=3D "")=0A=
	{=0A=
		re_comment_tag =3D re_get_cookie("_recmt");=0A=
		re_set_cookie("_recmt","",0,"/");=0A=
	}=0A=
	=0A=
	//alert(re_name_tag + "\n" + re_context_tag + "\n" + re_comment_tag);=0A=
}=0A=
=0A=
function re_mt_platform() // Movable Type=0A=
{=0A=
	re_add_event(window, "onload", function()=0A=
		{=0A=
			var btn =3D document.getElementById("comment-post");=0A=
			var f =3D document.forms["comments_form"];=0A=
=0A=
			if (!btn && typeof f !=3D "undefined")=0A=
				return;=0A=
=0A=
			re_add_event(btn, "onclick", function()=0A=
				{=0A=
					re_make_comment(f["comment-author"].value, =
f["comment-email"].value, f["comment-url"].value, =
f["comment-text"].value);=0A=
				});=0A=
		} );=0A=
		=0A=
	re_auto_tag(new Array("_reun","mtcmtauth"), new =
Array("_rectx","mtcmthome","mtcmtmail"));=0A=
}=0A=
=0A=
function re_tt_platform() // Text Pattern=0A=
{=0A=
	re_add_event(window, "onload", function()=0A=
		{=0A=
			var f =3D document.getElementById("txpCommentInputForm");=0A=
			if (typeof f["submit"] =3D=3D "undefined")=0A=
				return;=0A=
			=0A=
			var msg =3D "";=0A=
			var a =3D f.getElementsByTagName("textarea");=0A=
			=0A=
			for (i=3D0;i<a.length;++i)=0A=
				if (a[i].className.match(/txpCommentInputMessage/))=0A=
					msg =3D a[i].value;=0A=
			=0A=
			re_add_event(f["submit"], "onclick", function() { =
re_make_comment(f.name.value, f.email.value, f.web.value, msg); });=0A=
		} );=0A=
		=0A=
		re_auto_tag(new Array("_reun"), new Array("_rectx"));=0A=
}=0A=
=0A=
function re_ee_platform() // Expression Engine=0A=
{=0A=
	re_add_event(window, "onload", function()=0A=
		{=0A=
			var f =3D document.getElementById("comment_form");=0A=
			if (f && f["submit"])=0A=
				re_add_event(f["submit"], "onclick", function() { =
re_make_comment(f.name.value, f.email.value, f.url.value, =
f.comment.value); });=0A=
		} );=0A=
=0A=
	re_auto_tag(new Array("_reun"), new Array("_rectx"));=0A=
}=0A=
=0A=
function re_wp_platform()=0A=
{=0A=
	=0A=
	re_add_event(window, "onload", function()=0A=
		{=0A=
			var f =3D document.getElementById("commentform");=0A=
			if (f && f["submit"])=0A=
				re_add_event(f["submit"], "onclick", function() { =
re_make_comment(f.author.value, f.email.value, f.url.value, =
f.comment.value); });=0A=
		} );=0A=
=0A=
	re_auto_tag(new Array("_reun"), new Array("_rectx"));=0A=
}=0A=
=0A=
function re_discover_platform()=0A=
{=0A=
	if (typeof(re_disc_plat_ran) !=3D "undefined")=0A=
		return;=0A=
=0A=
	re_disc_plat_ran =3D true;=0A=
=0A=
=0A=
	var metas =3D document.getElementsByName("generator");=0A=
	for (var i=3D0;i<metas.length;++i)=0A=
	{=0A=
		if ((metas[i].content + "").match(/movable type/i) || =
(metas[i].content + "").match(/typepad/i)) // Movable Type / Typepad=0A=
		{=0A=
			re_mt_platform();=0A=
			return;=0A=
		}=0A=
	}=0A=
	=0A=
	// Textpattern=0A=
	if (document.getElementById("txpCommentInputForm"))=0A=
	{=0A=
		re_tt_platform();=0A=
		return;=0A=
	}=0A=
=0A=
	=0A=
	// Expression Engine=0A=
	if (re_cookie_exists("exp_tracker"))=0A=
	{=0A=
		re_ee_platform();=0A=
		return;=0A=
	}=0A=
	=0A=
	// Wordress comments page=0A=
	var wp_tag =3D document.getElementById("commentform");=0A=
	if (wp_tag && wp_tag.action.match(/wp-comments-post/i))=0A=
	{=0A=
		re_wp_platform();=0A=
		return;=0A=
	}=0A=
	=0A=
	// Let name tags and comments work for unidentifable pages=0A=
	if (re_cookie_exists("_reun"))=0A=
		re_auto_tag(new Array("_reun"), new Array("_rectx"));=0A=
=0A=
}=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
=0A=
function re_os()=0A=
{=0A=
	if(re_ua_get("sunos"))=0A=
		return "SunOS";=0A=
	else if (re_ua_get("freebsd") || re_ua_get("openbsd"))=0A=
		return "BSD";=0A=
	else if (re_ua_get("linux"))=0A=
		return "Linux";=0A=
	else if (re_ua_get("mac") || re_ua_get("ppc"))=0A=
		return "Mac";=0A=
	else if (re_ua_get("x11"))=0A=
		return "UNIX";=0A=
	else if (re_ua_get("win"))=0A=
		return "Windows";=0A=
	else if (re_ua_get("nintendo wii"))=0A=
		return "Nintendo Wii";=0A=
	else if (re_ua_get("playstation 3"))=0A=
		return "Playstation 3";=0A=
	else if (re_ua_get("playstation portable"))=0A=
		return "PlayStation Portable";=0A=
	return "";=0A=
}=0A=
=0A=
=0A=
function re_os_version()=0A=
{=0A=
	var os =3D re_os();=0A=
	=0A=
	if (os =3D=3D "Windows")=0A=
	{=0A=
		if (re_ua.indexOf("win3.11") !=3D -1 || re_ua.indexOf("windows 3.1") =
!=3D -1)=0A=
			return "3.1";=0A=
		if (re_ua.indexOf("winnt3.51") !=3D -1)=0A=
			return "NT 3.11";=0A=
		if (re_ua.indexOf("winnt4.0") !=3D -1)=0A=
			return "4.0";=0A=
		if (re_ua.indexOf("win95") !=3D -1 || re_ua.indexOf("windows 95") !=3D =
-1)=0A=
			return "95";=0A=
		if (re_ua.indexOf("win98") !=3D -1 || re_ua.indexOf("windows 98") !=3D =
-1)=0A=
			return "98";=0A=
		if (re_ua.indexOf("win 9x 4.90") !=3D -1)=0A=
			return "Millennium Edition";=0A=
		if (re_ua.indexOf("nt 5.0") !=3D -1 || re_ua.indexOf("windows 2000") =
!=3D -1)=0A=
			return "2000";=0A=
		if (re_ua.indexOf("nt 5.1") !=3D -1)=0A=
			return "XP";=0A=
		if (re_ua.indexOf("nt 5.2") !=3D -1)=0A=
			return "Server 2003 / XP Pro (x64 Edition)";=0A=
		if (re_ua.indexOf("nt 6.0") !=3D -1)=0A=
			return "Vista";=0A=
		if (re_ua.indexOf("win32") !=3D -1)=0A=
			return "XP";=0A=
		if (re_ua.indexOf("windows nt") !=3D -1)=0A=
			return "NT";=0A=
			=0A=
	}=0A=
	=0A=
	if (os =3D=3D "Mac")=0A=
	{=0A=
		if (re_ua.indexOf("os x") !=3D -1 && re_ua.indexOf("intel") !=3D -1)=0A=
			return "OS X (Intel)";=0A=
		if (re_ua.indexOf("os x") !=3D -1 && re_ua.indexOf("ppc") !=3D -1)=0A=
			return "OS X (PowerPC)";=0A=
		if (re_ua.indexOf("mac") !=3D -1)=0A=
			return "MacOS";=0A=
	}=0A=
	=0A=
	if (os =3D=3D "SunOS")=0A=
	{=0A=
		var exp =3D new RegExp(/sunos ([0-9.]+)/);=0A=
		var matches;=0A=
		if ((matches =3D exp.exec(re_ua)) && matches.length =3D=3D 2)=0A=
			return matches[1];=0A=
	}=0A=
	=0A=
	return "";=0A=
}=0A=
=0A=
function re_get_browser_version()=0A=
{=0A=
	var i, ua, b, cr;=0A=
=0A=
	if (re_browser_ident =3D=3D "Netscape Navigator" && document.layers)=0A=
		return 4;=0A=
	if (!((i =3D re_ua.indexOf(re_browser_ident+" ")) >=3D 0 || (i =3D =
re_ua.indexOf(re_browser_ident+"/")) >=3D 0))=0A=
		return "";=0A=
	ua =3D re_ua.substring(i + re_browser_ident.length + 1);=0A=
	if (ua.charAt(0) =3D=3D "v")=0A=
		ua =3D ua.substring(1);=0A=
	b =3D "";=0A=
	for (cnt=3D0;cnt<ua.length;cnt++)=0A=
	{=0A=
		cr =3D ua.charAt(cnt);=0A=
		if ((cr >=3D 0 && cr <=3D 9) || cr =3D=3D ".")=0A=
			b +=3D cr;=0A=
		else=0A=
			break;=0A=
	}=0A=
	return b;=0A=
}=0A=
=0A=
function re_get_clr()=0A=
{=0A=
	var a =3D re_ua.split(".net clr ");=0A=
	var exp =3D new RegExp(/^([0-9.]+).*$/);=0A=
	var matches;=0A=
	=0A=
	var dotnet_v =3D new Array();=0A=
	for (var cnt=3D0;cnt<a.length;++cnt)=0A=
	{=0A=
		if ((matches =3D exp.exec(a[cnt])) && matches.length =3D=3D 2)=0A=
			dotnet_v.push(matches[1]);=0A=
	}=0A=
	=0A=
	if (dotnet_v.length > 0)=0A=
	{=0A=
		var big =3D dotnet_v[0];=0A=
		for (var cnt=3D0;cnt<dotnet_v.length;++cnt)=0A=
		{=0A=
			if (dotnet_v[cnt] > big)=0A=
				big =3D dotnet_v[cnt];=0A=
		}=0A=
=0A=
		return big;=0A=
	}=0A=
=0A=
	return "";=0A=
}=0A=
=0A=
function re_get_browser()=0A=
{=0A=
	var re_browser =3D "";=0A=
=0A=
	if (re_ua_get("konqueror"))=0A=
	{=0A=
		re_browser =3D "Konqueror";=0A=
		re_browser_ident =3D "konqueror";=0A=
	} else if (re_ua_get("safari"))=0A=
	{=0A=
		re_browser =3D "Safari";=0A=
		re_browser_ident =3D "safari";=0A=
	}  else if (re_ua_get("opera"))=0A=
	{=0A=
		re_browser =3D "Opera";=0A=
		re_browser_ident =3D "opera";=0A=
	} else if (re_ua_get("webtv"))=0A=
	{=0A=
		re_browser =3D "WebTV";=0A=
		re_browser_ident =3D "webtv";=0A=
	} else if (re_ua_get("firefox"))=0A=
	{=0A=
		re_browser =3D "FireFox";=0A=
		re_browser_ident =3D "firefox";=0A=
	} else if (re_ua_get("msie"))=0A=
	{=0A=
		re_browser =3D "Internet Explorer";=0A=
		re_browser_ident =3D "msie";=0A=
	} else if (re_ua_get("omniweb"))=0A=
	{	=0A=
		re_browser =3D "OmniWeb";=0A=
		re_browser_ident =3D "omniweb";=0A=
	} else if (re_ua_get("netscape"))=0A=
	{=0A=
		re_browser =3D "Netscape";=0A=
		re_browser_ident =3D "netscape";=0A=
	} else if (!re_ua_get("compatible"))=0A=
	{=0A=
		re_browser =3D "Netscape Navigator";=0A=
		re_browser_ident =3D "Netscape Navigator";=0A=
	}=0A=
	=0A=
	return re_browser;=0A=
}=0A=
=0A=
function primary_domain_name(url)=0A=
{=0A=
	var pos;=0A=
	if ((pos =3D url.indexOf(":\/\/")) >=3D 0)=0A=
		url =3D url.substr(pos);=0A=
	var domain =3D url.match(/(www\.)?([^\/:]+)/);=0A=
	if (!domain)=0A=
		return "";=0A=
	domain =3D domain[2];=0A=
	var top_levels =3D new =
Array("aero","biz","cat","com","coop","edu","gov","info","int","jobs","mi=
l","mobi","museum","name","net","org","travel");=0A=
	var name_list =3D domain.split(".");=0A=
	while (true)=0A=
	{=0A=
		var num_levels =3D name_list.length;=0A=
		var level =3D name_list[name_list.length-1];=0A=
		for (var cnt=3D0;cnt<top_levels.length;++cnt)=0A=
		{=0A=
			if (top_levels[cnt] =3D=3D level && name_list.length > 1)=0A=
			{=0A=
				name_list.pop();=0A=
				break;=0A=
			}=0A=
		}		=0A=
		if (name_list.length > 1 && name_list[name_list.length-1].length =
=3D=3D 2)=0A=
			name_list.pop();=0A=
		if (num_levels =3D=3D name_list.length)=0A=
			break;=0A=
	}=0A=
	return name_list.pop();=0A=
}=0A=
=0A=
function re_sid()=0A=
{=0A=
	var re_d =3D new Date();=0A=
	var chars =3D =
"qwertyuiopasdfghjklzxcvbnm1234567890QWERTYUIOPASDFGHJKLZXCVBNM";=0A=
	var buffer =3D "";=0A=
	for (var i=3D0;i<5;++i)=0A=
		buffer +=3D chars.charAt(Math.floor(Math.random()*chars.length));=0A=
	buffer +=3D "-" + Math.floor(Math.random()*214748364) + "" + =
re_d.getSeconds();=0A=
	return buffer;=0A=
}=0A=
=0A=
function re_localtime()=0A=
{=0A=
	var d =3D new Date();=0A=
	var hr =3D d.getHours()%12;=0A=
	return (hr =3D=3D 0 ? 12 : hr) + ":" + =
(d.getMinutes().toString().length =3D=3D 1 ? "0" : "") + d.getMinutes() =
+ " " + (d.getHours() < 12 ? "am" : "pm");=0A=
}=0A=
=0A=
=0A=
function re_(re_id)=0A=
{=0A=
	re_discover_platform();=0A=
=0A=
	var screen_res =3D 0;=0A=
	var inner_screen_res =3D 0;=0A=
	=0A=
	if (screen)=0A=
		screen_res =3D screen.width | screen.height << 16;=0A=
		=0A=
	if (window.innerWidth)=0A=
		inner_screen_res =3D window.innerWidth | window.innerHeight << 16;=0A=
	else if (document.body)=0A=
		inner_screen_res =3D document.body.clientWidth | =
document.body.clientHeight << 16;=0A=
=0A=
	if (!re_cookie_exists("re_ret"))=0A=
		re_set_cookie("re_ret",0,re_r_expires,"/");=0A=
	else if (!re_get_cookie("re_ses"))=0A=
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