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First Name: * Middle Name: Last Name: * Suffix:
CFA
CPA
DDS
DVM
Ed.D.
Esq.
II
III
IV
J.D.
Jr.
M.D.
M.Ed.
M.S.W.
MBA
Ph.D.
R.D.
R.N.
Ret.
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US Army, Ret.
US Navy, Ret.
USAF, Ret.
USCG, Ret.
USMC, Ret.
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OH
OK
OR
PA
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SC
SD
TN
TX
UT
VT
VA
WA
WV
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Mailing Address Zip: * Foreign Country:
ABU DHABI
ADEN
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANTARCTICA
ANTIGUA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH ANTARCTICA TERRITORY
BRITISH INDIAN OCEAN TERRITORY
BRITISH VIRGIN ISLANDS
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BRUNEI
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BURKINA FASO
BURUNDI
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CAMEROON
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CANAL ZONE
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CAYMAN ISLANDS
CEVLON
CHAD
CHANNEL ISLAND UK
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLAND
COLOMBIA
COMORO ISLANDS
CONGO
CONGO KINSHASA
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
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DAHOMEY
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
DUBAI
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ESTONIA
ETHIOPIA
FAEROE ISLANDS
FALKLAND ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GUADELOUPE
GUAM
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GUINEA
GUYANA
HAITI
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HONG KONG
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ICELAND
IFNI
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IRAQ
IRELAND
ISRAEL
ITALY
IVORY COAST
JAMAICA
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JORDAN
KAZAKHSTAN
KENYA
KOREA
KOREA, SOUTH
KUWAIT
KYRGYZSTAN
LAOS
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LESOTHO
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NIGERIA
NORFOLK ISLAND
NORWAY
OMAN
OTHER
PACIFIC ISLAND
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PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
PORTUGUESE TIMOR
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QATAR
REPUBLIC OF BELARUS
REPUBLIC OF SOUTH AFRICA
REUNION
ROMANIA
RUSSIA
RWANDA
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SABAH
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ZAMBIA
ZIMBABWE
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Foreign Time Zone:
(GMT-12:00) 7 Hours Behind
(GMT-11:00) 6 Hours Behind)
(GMT-10:00) 5 Hours Behind)
(GMT-9:00) 4 Hours Behind)
(GMT-8:00) 3 Hours Behind)
(GMT-7:00) 2 Hours Behind)
(GMT-6:00) 1 Hours Behind)
(GMT-5:00) EST-Same Time Zone)
(GMT-4:00) 1 Hour Ahead)
(GMT-3:30) 1 1/2 Hours Ahead)
(GMT-3:00) 2 Hours Ahead)
(GMT-2:00) 3 Hours Ahead)
(GMT-1:00) 4 Hours Ahead)
(GMT -0:00 5 Hours Ahead)
(GMT+1:00 6 Hours Ahead)
(GMT+2:00 7 Hours Ahead)
(GMT+3:00 8 Hours Ahead)
(GMT+3:30 8 1/2 Hours Ahead)
(GMT+4:00 9 Hours Ahead)
(GMT+4:30 9 1/2 Hours Ahead)
(GMT+5:00 10 Hours Ahead)
(GMT+5:30 10 1/2 Hours Ahead)
(GMT+5:45 10 3/4 Hours Ahead)
(GMT+6:00 11 Hours Ahead)
(GMT+7:00 12 Hours Ahead)
(GMT+8:00 13 Hours Ahead)
(GMT+9:00 14 Hours Ahead)
(GMT+9:30 14 1/2 Hours Ahead)
(GMT+10:00 15 Hours Ahead)
(GMT+11:00 16 Hours Ahead)
(GMT+12:00 17 Hours Ahead)
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Foreign Telephone Number: Foreign Telephone Extension: Foreign Fax Number: Type Of Event:
Amusement Park
Association-Local
Association-National
Association-Regional
Association-State
College-University
Corporate Function
Cruise Line
Fair-Festival
Fundraiser
High School
Performing Arts Center
Private Party
Public Free Event
Public Ticketed Event
Event Date: Budget Parameter: Start Time:
12:00 AM-MIDNIGHT
12:15AM
12:30AM
12:45AM
1:00AM
1:15AM
1:30AM
1:45AM
2:00AM
2:15AM
2:30AM
2:45AM
3:00AM
3:15AM
3:30AM
3:45AM
4:00AM
4:15AM
4:30AM
4:45AM
5:00AM
5:15AM
5:30AM
5:45AM
6:00AM
6:15AM
6:30AM
6:45AM
7:00AM
7:15AM
7:30AM
7:45AM
8:00AM
8:15AM
8:30AM
8:45AM
9:00AM
9:15AM
9:30AM
9:45AM
10:00AM
10:15AM
10:30AM
10:45AM
11:00AM
11:15AM
11:30AM
11:45AM
12:00PM-NOON
12:15PM
12:30PM
12:45PM
1:00PM
1:15PM
1:30PM
1:45PM
2:00PM
2:15PM
2:30PM
2:45PM
3:00PM
3:15PM
3:30PM
3:45PM
4:00PM
4:15PM
4:30PM
4:45PM
5:00PM
5:15PM
5:30PM
5:45PM
6:00PM
6:15PM
6:30PM
6:45PM
7:00PM
7:15PM
7:30PM
7:45PM
8:00PM
8:15PM
8:30PM
8:45PM
9:00PM
9:15PM
9:30PM
9:45PM
10:00PM
10:15PM
10:30PM
10:45PM
11:00PM
11:15PM
11:30PM
11:45PM
N/A
Event City: Event State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Event Country:
ABU DHABI
ADEN
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANTARCTICA
ANTIGUA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH ANTARCTICA TERRITORY
BRITISH INDIAN OCEAN TERRITORY
BRITISH VIRGIN ISLANDS
BRITISH WEST INDIES
BRUNEI
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CANAL ZONE
CANARY ISLAND
CAPE VERDI ISLANDS
CAYMAN ISLANDS
CEVLON
CHAD
CHANNEL ISLAND UK
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLAND
COLOMBIA
COMORO ISLANDS
CONGO
CONGO KINSHASA
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DAHOMEY
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
DUBAI
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ESTONIA
ETHIOPIA
FAEROE ISLANDS
FALKLAND ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GUADELOUPE
GUAM
GUATEMALA
GUINEA
GUYANA
HAITI
HONDURAS
HONG KONG
HUNGARY
ICELAND
IFNI
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KOREA
KOREA, SOUTH
KUWAIT
KYRGYZSTAN
LAOS
LATVIA
LEBANON
LEEWARD ISLANDS
LESOTHO
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARTINIQUE
MAURITANIA
MAURITIUS
MELANESIA
MEXICO
MOLDOVIA
MONACO
MONGOLIA
MOROCCO
MOZAMBIQUE
MYANAMAR
NAMIBIA
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NETHERLANDS ANTILLES NEUTRAL ZONE
NEW CALADONIA
NEW HEBRIDES
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NORFOLK ISLAND
NORWAY
OMAN
OTHER
PACIFIC ISLAND
PAKISTAN
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
PORTUGUESE TIMOR
PUERTO RICO
QATAR
REPUBLIC OF BELARUS
REPUBLIC OF SOUTH AFRICA
REUNION
ROMANIA
RUSSIA
RWANDA
RYUKYU ISLANDS
SABAH
SAN MARINO
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOMALILIAND
SOUTH AFRICA
SOUTH YEMEN
SPAIN
SPANISH SAHARA
SRI LANKA
ST. KITTS AND NEVIS
ST. LUCIA
SUDAN
SURINAM
SW AFRICA
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
TONGA
TRINIDAD
TUNISIA
TURKEY
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UPPER VOLTA
URUGUAY
US PACIFIC ISLAND
US VIRGIN ISLANDS
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIETNAM
WAKE ISLAND
WEST INDIES
WESTERN SAHARA
YEMEN
ZAIRE
ZAMBIA
ZIMBABWE
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