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First Name:
Last Name:
Street Address 1:
Street Address 2:
City:
Province/State:
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AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NL - Newfoundland and Labrador
NS - Nova Scotia
NT - Northwest Territories
NU - Nunavut
ON - Ontario
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SK - Saskatchewan
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AK - Alaska
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AR - Arkansas
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CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
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KY - Kentucky
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MD - Maryland
ME - Maine
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MS - Mississippi
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NM - New Mexico
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OH - Ohio
OK - Oklahoma
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PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
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VA - Virginia
VT - Vermont
WA - Washington
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WV - West Virginia
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AS - American Samoa
FM - Federated States of Micronesia
GU - Guam
MH - Marshall Islands
MP - Northern Mariana Islands
PR - Puerto Rico
PW - Palau
VI - Virgin Islands
AA - Armed Forces Americas
AE - Armed Forces
AP - Armed Forces Pacific
Postal/Zip Code:
Country/Region:
Canada
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
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
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
Former Czechoslovakia
Former USSR
France
French Guyana
French Southern Territories
Gabon
Gambia
Georgia
Germany
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Gibraltar
Great Britain
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Guam (USA)
Guatemala
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Guinea
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Guyana
Haiti
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Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast (Cote D'Ivoire)
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
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Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
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Luxembourg
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Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
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Martinique (French)
Mauritania
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Mayotte
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
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Nauru
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Netherlands
Netherlands Antilles
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Northern Ireland
Northern Mariana Islands
North Korea
Norway
Occ. Palestinian Terr
Oman
Pakistan
Palau
Panama
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Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion (French)
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts & Nevis Anguilla
Saint Lucia
Saint Pierre and Miquelon
Saint Tome (Sao Tome) and Principe
Saint Vincent & Grenadines
Samoa
San Marino
Saudi Arabia
Scotland
Senegal
Serbia
Seychelles
S. Georgia & S. Sandwich Isls.
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
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Spain
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Svalbard and Jan Mayen Islands
Swaziland
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Syria
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Taiwan
Tanzania
Thailand
Togo
Tokelau
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Tunisia
Turkey
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Tuvalu
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United Kingdom
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Venezuela
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Virgin Islands (British)
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Wales
Wallis and Futuna Islands
Western Sahara
Yemen
Zaire
Zambia
Zimbabwe
Phone Number:
Email:
Relationship:
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Faculty or Staff Member
Student
Parent
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