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First Name:
Last Name:
Street Address 1:
Street Address 2:
City:
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MB - Manitoba
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GU - Guam
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MP - Northern Mariana Islands
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AE - Armed Forces
AP - Armed Forces Pacific
Postal/Zip Code:
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United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
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Belarus
Belgium
Belize
Benin
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Bolivia
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Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
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Burkina Faso
Burundi
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Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
England
Equatorial Guinea
Eritrea
Estonia
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Fiji
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Former Czechoslovakia
Former USSR
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Jamaica
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Jordan
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Laos
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Madagascar
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North Korea
Norway
Occ. Palestinian Terr
Oman
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Portugal
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Qatar
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Saint Helena
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Scotland
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Western Sahara
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Phone Number:
Email:
Relationship:
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Faculty or Staff Member
Student
Parent
Friend
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