{"id":740,"date":"2018-07-24T20:17:53","date_gmt":"2018-07-24T20:17:53","guid":{"rendered":"https:\/\/www.usa-esta-visa.com\/en\/?page_id=740"},"modified":"2024-11-26T11:07:56","modified_gmt":"2024-11-26T10:07:56","slug":"esta-application-info","status":"publish","type":"page","link":"https:\/\/www.usa-esta-visa.com\/en\/esta-application-info\/","title":{"rendered":"Fill out ESTA Application"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"740\" class=\"elementor elementor-740\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ed30b74 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"ed30b74\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;b744cf5&quot;,&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7860d6ae\" data-id=\"7860d6ae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5e0f612a elementor-widget elementor-widget-heading\" data-id=\"5e0f612a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CREATE NEW ESTA APPLICATION<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-58df701 elementor-hidden-phone elementor-widget elementor-widget-text-editor\" data-id=\"58df701\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>You need ESTA electronic authorisation to travel to the United States for tourism, business or transit travel, for up to 90 days, without the need to apply for a visa.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d63a223 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d63a223\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;da2741a&quot;,&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-93257f2\" data-id=\"93257f2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8ff56b0 elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-text-editor\" data-id=\"8ff56b0\" data-element_type=\"widget\" data-settings=\"{&quot;_animation_mobile&quot;:&quot;fadeIn&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>You need <a href=\"https:\/\/www.usa-esta-visa.com\/en\/\">ESTA Electronic Authorisation<\/a> to travel to the United States for tourism, business or transit travel, for up to 90 days, without the need to apply for a visa.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fb1610f elementor-widget elementor-widget-heading\" data-id=\"fb1610f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Fill out the following <b>simplified form<\/b> to obtain your ESTA visa immediately<br><br>\n<small>Once your authorization has been processed and <b>approved<\/b>, we will send it to you by <b>email<\/b><\/small><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-eae778f elementor-hidden-phone elementor-widget elementor-widget-text-editor\" data-id=\"eae778f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p style=\"text-align: center;\">Processing at the<strong> Department of Homeland Security<\/strong> for the ESTA Authorization for tourism, business, or transit trips to the United States. If you have any questions while filling out the form, you can resolve them through the support chat or by sending an email to <a href=\"mailto:info@usa-esta-vista.com\" target=\"_new\">info@usa-esta-vista.com<\/a>.<\/p>\n<p style=\"text-align: center;\"><b>Error correction<\/b>. Once the form is completed,<strong> we will send your approved ESTA authorization to you by email<\/strong>.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64b5d7c elementor-widget elementor-widget-heading\" data-id=\"64b5d7c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">usa esta form<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-974df7e elementor-widget elementor-widget-shortcode\" data-id=\"974df7e\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_16' style='display:none'><div id='gf_16' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_16'  action='\/en\/wp-json\/wp\/v2\/pages\/740#gf_16' data-formid='16' novalidate>\n        <div id='gf_progressbar_wrapper_16' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_16_1' class='gform_page ' data-js='page-field-id-0' >\n                                    <div class='gform_page_fields'><div id='gform_fields_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_16_2\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_2\" ><h3>PASSPORT INFORMATION<\/h3>\n<\/div><div id=\"field_16_3\" mm-fa-icon=\"fa fa-info-circle\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible mm-enable-custom-icon\"  data-js-reload=\"field_16_3\" ><label class='gfield_label gform-field-label' for='input_16_3'>Surname<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_16_3' type='text' value='' class='large'  aria-describedby=\"gfield_description_16_3\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_16_3'>Write your two last names<\/div><div class='mm_tooltip_text' style='display:none'><p>In the <strong>Family Name field<\/strong>, enter your family name as the family name appears on your passport under the Family Name or Surname field. The family name is required to complete the application.<\/p><\/div><\/div><div id=\"field_16_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_4\" ><label class='gfield_label gform-field-label' for='input_16_4'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_16_4' type='text' value='' class='large'  aria-describedby=\"gfield_description_16_4\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_16_4'>If you have two first names, write both of them (as they appear on your passport)<\/div><div class='mm_tooltip_text' style='display:none'><p><span class=\"webkit-html-attribute-name\">data-original-title<\/span>=\"<span class=\"webkit-html-attribute-value\">In the First (Given) Name field, enter ALL names exactly as they appear on your passport in the First (Given) Name field. If a second or middle name is included in the First (Given) Name field on your passport, it must also be included here. This field is required to complete the application. If you have no first name, then enter the letters <strong>FNU<\/strong> which stands for First Name Unknown.<\/span>\"<\/p><\/div><\/div><div id=\"field_16_5\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_5\" ><label class='gfield_label gform-field-label' for='input_16_5'>Sex<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_16_5' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Choose your sex<\/option><option value='M' >Male<\/option><option value='F' >Female<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose your sex, as it appears on your passport. The sex is required to complete the application.<\/p><\/div><\/div><fieldset id=\"field_16_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_6\" ><legend class='gfield_label gform-field-label' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_16_6' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_16_6_2_container'><select name='input_6[]' id='input_16_6_2'   aria-required='true'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_16_6_1_container'><select name='input_6[]' id='input_16_6_1'   aria-required='true'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_16_6_3_container'><select name='input_6[]' id='input_16_6_3'   aria-required='true'  ><option value=''>YYYY<\/option><option value='2035' >2035<\/option><option value='2034' >2034<\/option><option value='2033' >2033<\/option><option value='2032' >2032<\/option><option value='2031' >2031<\/option><option value='2030' >2030<\/option><option value='2029' >2029<\/option><option value='2028' >2028<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_16_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_7\" ><label class='gfield_label gform-field-label' for='input_16_7'>City of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_16_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the city, town, village, or hamlet in which you were born. The city, town, village, or hamlet where you were born is required to complete the application. If you do not know the city in which you were born, enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_106\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_106\" ><label class='gfield_label gform-field-label' for='input_16_106'>Country of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_106' id='input_16_106' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AF' >AFGHANISTAN  (AFG)<\/option><option value='AX' >ALAND ISLANDS  (ALA)<\/option><option value='AL' >ALBANIA  (ALB)<\/option><option value='DZ' >ALGERIA  (DZA)<\/option><option value='AS' >AMERICAN SAMOA  (ASM)<\/option><option value='AD' >ANDORRA  (AND)<\/option><option value='AO' >ANGOLA  (AGO)<\/option><option value='AI' >ANGUILLA  (AIA)<\/option><option value='AQ' >ANTARCTICA  (ATA)<\/option><option value='AG' >ANTIGUA AND BARBUDA  (ATG)<\/option><option value='AR' >ARGENTINA  (ARG)<\/option><option value='AM' >ARMENIA  (ARM)<\/option><option value='AW' >ARUBA  (ABW)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='AZ' >AZERBAIJAN  (AZE)<\/option><option value='BS' >BAHAMAS  (BHS)<\/option><option value='BH' >BAHRAIN  (BHR)<\/option><option value='BD' >BANGLADESH  (BGD)<\/option><option value='BB' >BARBADOS  (BRB)<\/option><option value='BY' >BELARUS  (BLR)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BZ' >BELIZE  (BLZ)<\/option><option value='BJ' >BENIN  (BEN)<\/option><option value='BM' >BERMUDA  (BMU)<\/option><option value='BT' >BHUTAN  (BTN)<\/option><option value='BO' >BOLIVIA  (BOL)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA  (BES)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA  (BIH)<\/option><option value='BW' >BOTSWANA  (BWA)<\/option><option value='BV' >BOUVET ISLAND  (BVT)<\/option><option value='BR' >BRAZIL  (BRA)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY  (IOT)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='BG' >BULGARIA  (BGR)<\/option><option value='BF' >BURKINA FASO  (BFA)<\/option><option value='BU' >BURMA  (BUR)<\/option><option value='BI' >BURUNDI  (BDI)<\/option><option value='KH' >CAMBODIA  (KHM)<\/option><option value='CM' >CAMEROON  (CMR)<\/option><option value='CA' >CANADA  (CAN)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS  (CTE)<\/option><option value='CV' >CAPE VERDE  (CPV)<\/option><option value='KY' >CAYMAN ISLANDS  (CYM)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC  (CAF)<\/option><option value='TD' >CHAD  (TCD)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='CN' >CHINA  (CHN)<\/option><option value='CX' >CHRISTMAS ISLAND  (CXR)<\/option><option value='CC' >COCOS (KEELING) ISLANDS  (CCK)<\/option><option value='CO' >COLOMBIA  (COL)<\/option><option value='KM' >COMOROS  (COM)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF  (COD)<\/option><option value='CG' >CONGO, REPUBLIC OF  (COG)<\/option><option value='CK' >COOK ISLANDS  (COK)<\/option><option value='CR' >COSTA RICA  (CRI)<\/option><option value='CI' >COTE D&#039;IVOIRE  (CIV)<\/option><option value='HR' >CROATIA  (HRV)<\/option><option value='CU' >CUBA  (CUB)<\/option><option value='CW' >CURACAO  (CUW)<\/option><option value='CY' >CYPRUS  (CYP)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='YD' >DEMOCRATIC YEMEN  (YMD)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='DJ' >DJIBOUTI  (DJI)<\/option><option value='DM' >DOMINICA  (DMA)<\/option><option value='DO' >DOMINICAN REPUBLIC  (DOM)<\/option><option value='NQ' >DRONNING MAUD LAND  (DML)<\/option><option value='TP' >EAST TIMOR  (TMP)<\/option><option value='EC' >ECUADOR  (ECU)<\/option><option value='EG' >EGYPT  (EGY)<\/option><option value='SV' >EL SALVADOR  (SLV)<\/option><option value='GQ' >EQUATORIAL GUINEA  (GNQ)<\/option><option value='ER' >ERITREA  (ERI)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='ET' >ETHIOPIA  (ETH)<\/option><option value='FK' >FALKLAND ISLANDS  (FLK)<\/option><option value='FO' >FAROE ISLANDS  (FRO)<\/option><option value='FJ' >FIJI  (FJI)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='FX' >FRANCE METROPOLITAN  (FXX)<\/option><option value='GF' >FRENCH GUIANA  (GUF)<\/option><option value='PF' >FRENCH POLYNESIA  (PYF)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES  (ATF)<\/option><option value='GA' >GABON  (GAB)<\/option><option value='GM' >GAMBIA  (GMB)<\/option><option value='GE' >GEORGIA  (GEO)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GH' >GHANA  (GHA)<\/option><option value='GI' >GIBRALTAR  (GIB)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='GL' >GREENLAND  (GRL)<\/option><option value='GD' >GRENADA  (GRD)<\/option><option value='GP' >GUADELOUPE  (GLP)<\/option><option value='GU' >GUAM  (GUM)<\/option><option value='GT' >GUATEMALA  (GTM)<\/option><option value='GG' >GUERNSEY  (GGY)<\/option><option value='GN' >GUINEA  (GIN)<\/option><option value='GW' >GUINEA-BISSAU  (GNB)<\/option><option value='GY' >GUYANA  (GUY)<\/option><option value='HT' >HAITI  (HTI)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS  (HMD)<\/option><option value='HN' >HONDURAS  (HND)<\/option><option value='HK' >HONG KONG  (HKG)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IN' >INDIA  (IND)<\/option><option value='ID' >INDONESIA  (IDN)<\/option><option value='IR' >IRAN  (IRN)<\/option><option value='IQ' >IRAQ  (IRQ)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IM' >ISLE OF MAN  (IMN)<\/option><option value='IL' >ISRAEL  (ISR)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JM' >JAMAICA  (JAM)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='JE' >JERSEY  (JEY)<\/option><option value='JT' >JOHNSTON ISLAND  (JTN)<\/option><option value='JO' >JORDAN  (JOR)<\/option><option value='KZ' >KAZAKHSTAN  (KAZ)<\/option><option value='KE' >KENYA  (KEN)<\/option><option value='KI' >KIRIBATI  (KIR)<\/option><option value='KV' >KOSOVO  (KVV)<\/option><option value='KW' >KUWAIT  (KWT)<\/option><option value='KG' >KYRGYZSTAN  (KGZ)<\/option><option value='LA' >LAOS  (LAO)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LB' >LEBANON  (LBN)<\/option><option value='LS' >LESOTHO  (LSO)<\/option><option value='LR' >LIBERIA  (LBR)<\/option><option value='LY' >LIBYA  (LBY)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MO' >MACAU  (MAC)<\/option><option value='MK' >MACEDONIA  (MKD)<\/option><option value='MG' >MADAGASCAR  (MDG)<\/option><option value='MW' >MALAWI  (MWI)<\/option><option value='MY' >MALAYSIA  (MYS)<\/option><option value='MV' >MALDIVES  (MDV)<\/option><option value='ML' >MALI  (MLI)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MH' >MARSHALL ISLANDS  (MHL)<\/option><option value='MQ' >MARTINIQUE  (MTQ)<\/option><option value='MR' >MAURITANIA  (MRT)<\/option><option value='MU' >MAURITIUS  (MUS)<\/option><option value='YT' >MAYOTTE  (MYT)<\/option><option value='MX' >MEXICO  (MEX)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF  (FSM)<\/option><option value='MI' >MIDWAY ISLANDS  (MID)<\/option><option value='MD' >MOLDOVA  (MDA)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='MN' >MONGOLIA  (MNG)<\/option><option value='ME' >MONTENEGRO  (MNE)<\/option><option value='MS' >MONTSERRAT  (MSR)<\/option><option value='MA' >MOROCCO  (MAR)<\/option><option value='MZ' >MOZAMBIQUE  (MOZ)<\/option><option value='MM' >MYANMAR  (MMR)<\/option><option value='NA' >NAMIBIA  (NAM)<\/option><option value='NR' >NAURU  (NRU)<\/option><option value='NP' >NEPAL  (NPL)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='AN' >NETHERLANDS ANTILLES  (ANT)<\/option><option value='NT' >NEUTRAL ZONE  (NTZ)<\/option><option value='NC' >NEW CALEDONIA  (NCL)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NI' >NICARAGUA  (NIC)<\/option><option value='NE' >NIGER  (NER)<\/option><option value='NG' >NIGERIA  (NGA)<\/option><option value='NU' >NIUE  (NIU)<\/option><option value='NF' >NORFOLK ISLAND  (NFK)<\/option><option value='KP' >NORTH KOREA  (PRK)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS  (MNP)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='OM' >OMAN  (OMN)<\/option><option value='PK' >PAKISTAN  (PAK)<\/option><option value='PW' >PALAU  (PLW)<\/option><option value='PS' >PALESTINIAN TERRITORIES  (PSE)<\/option><option value='PA' >PANAMA  (PAN)<\/option><option value='PG' >PAPUA NEW GUINEA  (PNG)<\/option><option value='PY' >PARAGUAY  (PRY)<\/option><option value='PE' >PERU  (PER)<\/option><option value='PH' >PHILIPPINES  (PHL)<\/option><option value='PN' >PITCAIRN ISLANDS  (PCN)<\/option><option value='PL' >POLAND  (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='PR' >PUERTO RICO  (PRI)<\/option><option value='QA' >QATAR  (QAT)<\/option><option value='RE' >REUNION  (REU)<\/option><option value='RO' >ROMANIA  (ROM)<\/option><option value='RU' >RUSSIA  (RUS)<\/option><option value='RW' >RWANDA  (RWA)<\/option><option value='BL' >SAINT BARTHELEMY  (BLM)<\/option><option value='KN' >SAINT KITTS AND NEVIS  (KNA)<\/option><option value='LC' >SAINT LUCIA  (LCA)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART)  (MAF)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES  (VCT)<\/option><option value='WS' >SAMOA  (WSM)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='ST' >SAO TOME AND PRINCIPE  (STP)<\/option><option value='SA' >SAUDI ARABIA  (SAU)<\/option><option value='SN' >SENEGAL  (SEN)<\/option><option value='RS' >SERBIA  (SRB)<\/option><option value='CS' >SERBIA AND MONTENEGRO  (SCG)<\/option><option value='SC' >SEYCHELLES  (SYC)<\/option><option value='SL' >SIERRA LEONE  (SLE)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART)  (SXM)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='SB' >SOLOMON ISLANDS  (SLB)<\/option><option value='SO' >SOMALIA  (SOM)<\/option><option value='ZA' >SOUTH AFRICA  (ZAF)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS  (SGS)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='SS' >SOUTH SUDAN  (SSD)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='LK' >SRI LANKA  (LKA)<\/option><option value='SH' >ST. HELENA  (SHN)<\/option><option value='PM' >ST. PIERRE AND MIQUELON  (SPM)<\/option><option value='SD' >SUDAN  (SDN)<\/option><option value='SR' >SURINAME  (SUR)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS  (SJM)<\/option><option value='SZ' >SWAZILAND  (SWZ)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='SY' >SYRIA  (SYR)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='TJ' >TAJIKISTAN  (TJK)<\/option><option value='TZ' >TANZANIA  (TZA)<\/option><option value='TH' >THAILAND  (THA)<\/option><option value='TL' >TIMOR-LESTE  (TLS)<\/option><option value='TG' >TOGO  (TGO)<\/option><option value='TK' >TOKELAU  (TKL)<\/option><option value='TO' >TONGA  (TON)<\/option><option value='TT' >TRINIDAD AND TOBAGO  (TTO)<\/option><option value='TN' >TUNISIA  (TUN)<\/option><option value='TR' >TURKEY  (TUR)<\/option><option value='TM' >TURKMENISTAN  (TKM)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS  (TCA)<\/option><option value='TV' >TUVALU  (TUV)<\/option><option value='UG' >UGANDA  (UGA)<\/option><option value='UA' >UKRAINE  (UKR)<\/option><option value='AE' >UNITED ARAB EMIRATES  (ARE)<\/option><option value='GB' selected='selected'>UNITED KINGDOM  (GBR)<\/option><option value='US' >UNITED STATES  (USA)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS  (UMI)<\/option><option value='UY' >URUGUAY  (URY)<\/option><option value='UZ' >UZBEKISTAN  (UZB)<\/option><option value='VU' >VANUATU  (VUT)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE)  (VAT)<\/option><option value='VE' >VENEZUELA  (VEN)<\/option><option value='VN' >VIETNAM  (VNM)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH)  (VGB)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.)  (VIR)<\/option><option value='WK' >WAKE ISLAND  (WAK)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS  (WLF)<\/option><option value='EH' >WESTERN SAHARA  (ESH)<\/option><option value='YE' >YEMEN  (YEM)<\/option><option value='ZR' >ZAIRE  (ZAR)<\/option><option value='ZM' >ZAMBIA  (ZMB)<\/option><option value='ZW' >ZIMBABWE  (ZWE)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Country of Birth<\/p><\/div><\/div><div id=\"field_16_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_13\" ><label class='gfield_label gform-field-label' for='input_16_13'>Country of Citizenship \/ Nationality<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_16_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AD' >ANDORRA  (AND)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='HR' >CROATIA (HRV)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='GB' selected='selected'>UK - BRITISH CITIZEN  (GBR)<\/option><option value='G3' >UK - BRITISH DTC  (GBD)<\/option><option value='G4' >UK - BRITISH NATIONAL (O)  (GBN)<\/option><option value='G2' >UK - BRITISH OVERSEAS  (GBO)<\/option><option value='G5' >UK - BRITISH SUBJECT  (GBS)<\/option><option value='G1' >UK - PROTECTED PERSON  (GBP)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose the country of citizenship, as it appears on your passport.<\/p><\/div><\/div><div id=\"field_16_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_12\" ><label class='gfield_label gform-field-label' for='input_16_12'>Passport Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_16_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your passport number as it appears on your passport. The passport number may contain numbers and\/or characters. <em>Please closely distinguish between the number zero and the letter O<\/em>. The passport number is required to complete the application or to check the status of your application.<\/p><\/div><\/div><div id=\"field_16_16\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_16\" ><label class='gfield_label gform-field-label' for='input_16_16'>Passport Issuing country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_16_16' class='large gfield_select'  aria-describedby=\"gfield_description_16_16\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='AD' >ANDORRA  (AND)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='HR' >CROATIA (HRV)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='PL' >POLAND (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='GB' selected='selected'>UK - BRITISH CITIZEN  (GBR)<\/option><option value='G3' >UK - BRITISH DTC  (GBD)<\/option><option value='G4' >UK - BRITISH NATIONAL (O)  (GBN)<\/option><option value='G2' >UK - BRITISH OVERSEAS  (GBO)<\/option><option value='G5' >UK - BRITISH SUBJECT  (GBS)<\/option><option value='G1' >UK - PROTECTED PERSON  (GBP)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_16_16'><strong>\u00a1Attention!<\/strong> You can only apply for ESTA if the issuing country of your passport is on the list.<\/div><div class='mm_tooltip_text' style='display:none'><p>Please select the issuing country of your passport.<\/p><\/div><\/div><fieldset id=\"field_16_15\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_15\" ><legend class='gfield_label gform-field-label' >Passport Issuance Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_16_15' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_16_15_2_container'><select name='input_15[]' id='input_16_15_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_16_15_1_container'><select name='input_15[]' id='input_16_15_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_16_15_3_container'><select name='input_15[]' id='input_16_15_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2035' >2035<\/option><option value='2034' >2034<\/option><option value='2033' >2033<\/option><option value='2032' >2032<\/option><option value='2031' >2031<\/option><option value='2030' >2030<\/option><option value='2029' >2029<\/option><option value='2028' >2028<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose the day, month and year on which your passport was issued.<\/p><\/div><\/fieldset><fieldset id=\"field_16_17\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_17\" ><legend class='gfield_label gform-field-label' >Passport Expiration Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_16_17' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_16_17_2_container'><select name='input_17[]' id='input_16_17_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_16_17_1_container'><select name='input_17[]' id='input_16_17_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_16_17_3_container'><select name='input_17[]' id='input_16_17_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2035' >2035<\/option><option value='2034' >2034<\/option><option value='2033' >2033<\/option><option value='2032' >2032<\/option><option value='2031' >2031<\/option><option value='2030' >2030<\/option><option value='2029' >2029<\/option><option value='2028' >2028<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose the day, month and year on which your passport expires.<\/p><\/div><\/fieldset><div id=\"field_16_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_14\" ><label class='gfield_label gform-field-label' for='input_16_14'>National Identification Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_16_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the number on your identity document, other than a passport, issued by your country. The National Identification Number, if issued to you, is required to complete the application.<\/p><\/div><\/div><fieldset id=\"field_16_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_18\" ><legend class='gfield_label gform-field-label' >Have you ever been issued a passport or national identity card for travel by any other country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_18'>\n\t\t\t<div class='gchoice gchoice_16_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Y'  id='choice_16_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_18_0' id='label_16_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='N'  id='choice_16_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_18_1' id='label_16_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><p>If you have never been issued any one of these documents by any other country answer \"No\" to this question. If you have been issued one of these documents from another country, but you do not remember the passport number or national identification card number and the year of expiration answer \"<strong>UNKNOWN<\/strong>\" in the passport number field and four zeros \"<strong>0000<\/strong>\" in the year of expiration field.<\/p><\/div><\/fieldset><div id=\"field_16_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_19\" ><label class='gfield_label gform-field-label' for='input_16_19'>Issuing Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_16_19' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AF' >AFGHANISTAN  (AFG)<\/option><option value='AX' >ALAND ISLANDS  (ALA)<\/option><option value='AL' >ALBANIA  (ALB)<\/option><option value='DZ' >ALGERIA  (DZA)<\/option><option value='AS' >AMERICAN SAMOA  (ASM)<\/option><option value='AD' >ANDORRA  (AND)<\/option><option value='AO' >ANGOLA  (AGO)<\/option><option value='AI' >ANGUILLA  (AIA)<\/option><option value='AQ' >ANTARCTICA  (ATA)<\/option><option value='AG' >ANTIGUA AND BARBUDA  (ATG)<\/option><option value='AR' >ARGENTINA  (ARG)<\/option><option value='AM' >ARMENIA  (ARM)<\/option><option value='AW' >ARUBA  (ABW)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='AZ' >AZERBAIJAN  (AZE)<\/option><option value='BS' >BAHAMAS  (BHS)<\/option><option value='BH' >BAHRAIN  (BHR)<\/option><option value='BD' >BANGLADESH  (BGD)<\/option><option value='BB' >BARBADOS  (BRB)<\/option><option value='BY' >BELARUS  (BLR)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BZ' >BELIZE  (BLZ)<\/option><option value='BJ' >BENIN  (BEN)<\/option><option value='BM' >BERMUDA  (BMU)<\/option><option value='BT' >BHUTAN  (BTN)<\/option><option value='BO' >BOLIVIA  (BOL)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA  (BES)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA  (BIH)<\/option><option value='BW' >BOTSWANA  (BWA)<\/option><option value='BV' >BOUVET ISLAND  (BVT)<\/option><option value='BR' >BRAZIL  (BRA)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY  (IOT)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='BG' >BULGARIA  (BGR)<\/option><option value='BF' >BURKINA FASO  (BFA)<\/option><option value='BU' >BURMA  (BUR)<\/option><option value='BI' >BURUNDI  (BDI)<\/option><option value='KH' >CAMBODIA  (KHM)<\/option><option value='CM' >CAMEROON  (CMR)<\/option><option value='CA' >CANADA  (CAN)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS  (CTE)<\/option><option value='CV' >CAPE VERDE  (CPV)<\/option><option value='KY' >CAYMAN ISLANDS  (CYM)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC  (CAF)<\/option><option value='TD' >CHAD  (TCD)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='CN' >CHINA  (CHN)<\/option><option value='CX' >CHRISTMAS ISLAND  (CXR)<\/option><option value='CC' >COCOS (KEELING) ISLANDS  (CCK)<\/option><option value='CO' >COLOMBIA  (COL)<\/option><option value='KM' >COMOROS  (COM)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF  (COD)<\/option><option value='CG' >CONGO, REPUBLIC OF  (COG)<\/option><option value='CK' >COOK ISLANDS  (COK)<\/option><option value='CR' >COSTA RICA  (CRI)<\/option><option value='CI' >COTE D&#039;IVOIRE  (CIV)<\/option><option value='HR' >CROATIA  (HRV)<\/option><option value='CU' >CUBA  (CUB)<\/option><option value='CW' >CURACAO  (CUW)<\/option><option value='CY' >CYPRUS  (CYP)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='YD' >DEMOCRATIC YEMEN  (YMD)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='DJ' >DJIBOUTI  (DJI)<\/option><option value='DM' >DOMINICA  (DMA)<\/option><option value='DO' >DOMINICAN REPUBLIC  (DOM)<\/option><option value='NQ' >DRONNING MAUD LAND  (DML)<\/option><option value='TP' >EAST TIMOR  (TMP)<\/option><option value='EC' >ECUADOR  (ECU)<\/option><option value='EG' >EGYPT  (EGY)<\/option><option value='SV' >EL SALVADOR  (SLV)<\/option><option value='GQ' >EQUATORIAL GUINEA  (GNQ)<\/option><option value='ER' >ERITREA  (ERI)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='ET' >ETHIOPIA  (ETH)<\/option><option value='FK' >FALKLAND ISLANDS  (FLK)<\/option><option value='FO' >FAROE ISLANDS  (FRO)<\/option><option value='FJ' >FIJI  (FJI)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='FX' >FRANCE METROPOLITAN  (FXX)<\/option><option value='GF' >FRENCH GUIANA  (GUF)<\/option><option value='PF' >FRENCH POLYNESIA  (PYF)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES  (ATF)<\/option><option value='GA' >GABON  (GAB)<\/option><option value='GM' >GAMBIA  (GMB)<\/option><option value='GE' >GEORGIA  (GEO)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GH' >GHANA  (GHA)<\/option><option value='GI' >GIBRALTAR  (GIB)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='GL' >GREENLAND  (GRL)<\/option><option value='GD' >GRENADA  (GRD)<\/option><option value='GP' >GUADELOUPE  (GLP)<\/option><option value='GU' >GUAM  (GUM)<\/option><option value='GT' >GUATEMALA  (GTM)<\/option><option value='GG' >GUERNSEY  (GGY)<\/option><option value='GN' >GUINEA  (GIN)<\/option><option value='GW' >GUINEA-BISSAU  (GNB)<\/option><option value='GY' >GUYANA  (GUY)<\/option><option value='HT' >HAITI  (HTI)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS  (HMD)<\/option><option value='HN' >HONDURAS  (HND)<\/option><option value='HK' >HONG KONG  (HKG)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IN' >INDIA  (IND)<\/option><option value='ID' >INDONESIA  (IDN)<\/option><option value='IR' >IRAN  (IRN)<\/option><option value='IQ' >IRAQ  (IRQ)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IM' >ISLE OF MAN  (IMN)<\/option><option value='IL' >ISRAEL  (ISR)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JM' >JAMAICA  (JAM)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='JE' >JERSEY  (JEY)<\/option><option value='JT' >JOHNSTON ISLAND  (JTN)<\/option><option value='JO' >JORDAN  (JOR)<\/option><option value='KZ' >KAZAKHSTAN  (KAZ)<\/option><option value='KE' >KENYA  (KEN)<\/option><option value='KI' >KIRIBATI  (KIR)<\/option><option value='KV' >KOSOVO  (KVV)<\/option><option value='KW' >KUWAIT  (KWT)<\/option><option value='KG' >KYRGYZSTAN  (KGZ)<\/option><option value='LA' >LAOS  (LAO)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LB' >LEBANON  (LBN)<\/option><option value='LS' >LESOTHO  (LSO)<\/option><option value='LR' >LIBERIA  (LBR)<\/option><option value='LY' >LIBYA  (LBY)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MO' >MACAU  (MAC)<\/option><option value='MK' >MACEDONIA  (MKD)<\/option><option value='MG' >MADAGASCAR  (MDG)<\/option><option value='MW' >MALAWI  (MWI)<\/option><option value='MY' >MALAYSIA  (MYS)<\/option><option value='MV' >MALDIVES  (MDV)<\/option><option value='ML' >MALI  (MLI)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MH' >MARSHALL ISLANDS  (MHL)<\/option><option value='MQ' >MARTINIQUE  (MTQ)<\/option><option value='MR' >MAURITANIA  (MRT)<\/option><option value='MU' >MAURITIUS  (MUS)<\/option><option value='YT' >MAYOTTE  (MYT)<\/option><option value='MX' >MEXICO  (MEX)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF  (FSM)<\/option><option value='MI' >MIDWAY ISLANDS  (MID)<\/option><option value='MD' >MOLDOVA  (MDA)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='MN' >MONGOLIA  (MNG)<\/option><option value='ME' >MONTENEGRO  (MNE)<\/option><option value='MS' >MONTSERRAT  (MSR)<\/option><option value='MA' >MOROCCO  (MAR)<\/option><option value='MZ' >MOZAMBIQUE  (MOZ)<\/option><option value='MM' >MYANMAR  (MMR)<\/option><option value='NA' >NAMIBIA  (NAM)<\/option><option value='NR' >NAURU  (NRU)<\/option><option value='NP' >NEPAL  (NPL)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='AN' >NETHERLANDS ANTILLES  (ANT)<\/option><option value='NT' >NEUTRAL ZONE  (NTZ)<\/option><option value='NC' >NEW CALEDONIA  (NCL)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NI' >NICARAGUA  (NIC)<\/option><option value='NE' >NIGER  (NER)<\/option><option value='NG' >NIGERIA  (NGA)<\/option><option value='NU' >NIUE  (NIU)<\/option><option value='NF' >NORFOLK ISLAND  (NFK)<\/option><option value='KP' >NORTH KOREA  (PRK)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS  (MNP)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='OM' >OMAN  (OMN)<\/option><option value='PK' >PAKISTAN  (PAK)<\/option><option value='PW' >PALAU  (PLW)<\/option><option value='PS' >PALESTINIAN TERRITORIES  (PSE)<\/option><option value='PA' >PANAMA  (PAN)<\/option><option value='PG' >PAPUA NEW GUINEA  (PNG)<\/option><option value='PY' >PARAGUAY  (PRY)<\/option><option value='PE' >PERU  (PER)<\/option><option value='PH' >PHILIPPINES  (PHL)<\/option><option value='PN' >PITCAIRN ISLANDS  (PCN)<\/option><option value='PL' >POLAND  (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='PR' >PUERTO RICO  (PRI)<\/option><option value='QA' >QATAR  (QAT)<\/option><option value='RE' >REUNION  (REU)<\/option><option value='RO' >ROMANIA  (ROM)<\/option><option value='RU' >RUSSIA  (RUS)<\/option><option value='RW' >RWANDA  (RWA)<\/option><option value='BL' >SAINT BARTHELEMY  (BLM)<\/option><option value='KN' >SAINT KITTS AND NEVIS  (KNA)<\/option><option value='LC' >SAINT LUCIA  (LCA)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART)  (MAF)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES  (VCT)<\/option><option value='WS' >SAMOA  (WSM)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='ST' >SAO TOME AND PRINCIPE  (STP)<\/option><option value='SA' >SAUDI ARABIA  (SAU)<\/option><option value='SN' >SENEGAL  (SEN)<\/option><option value='RS' >SERBIA  (SRB)<\/option><option value='CS' >SERBIA AND MONTENEGRO  (SCG)<\/option><option value='SC' >SEYCHELLES  (SYC)<\/option><option value='SL' >SIERRA LEONE  (SLE)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART)  (SXM)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='SB' >SOLOMON ISLANDS  (SLB)<\/option><option value='SO' >SOMALIA  (SOM)<\/option><option value='ZA' >SOUTH AFRICA  (ZAF)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS  (SGS)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='SS' >SOUTH SUDAN  (SSD)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='LK' >SRI LANKA  (LKA)<\/option><option value='SH' >ST. HELENA  (SHN)<\/option><option value='PM' >ST. PIERRE AND MIQUELON  (SPM)<\/option><option value='SD' >SUDAN  (SDN)<\/option><option value='SR' >SURINAME  (SUR)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS  (SJM)<\/option><option value='SZ' >SWAZILAND  (SWZ)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='SY' >SYRIA  (SYR)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='TJ' >TAJIKISTAN  (TJK)<\/option><option value='TZ' >TANZANIA  (TZA)<\/option><option value='TH' >THAILAND  (THA)<\/option><option value='TL' >TIMOR-LESTE  (TLS)<\/option><option value='TG' >TOGO  (TGO)<\/option><option value='TK' >TOKELAU  (TKL)<\/option><option value='TO' >TONGA  (TON)<\/option><option value='TT' >TRINIDAD AND TOBAGO  (TTO)<\/option><option value='TN' >TUNISIA  (TUN)<\/option><option value='TR' >TURKEY  (TUR)<\/option><option value='TM' >TURKMENISTAN  (TKM)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS  (TCA)<\/option><option value='TV' >TUVALU  (TUV)<\/option><option value='UG' >UGANDA  (UGA)<\/option><option value='UA' >UKRAINE  (UKR)<\/option><option value='AE' >UNITED ARAB EMIRATES  (ARE)<\/option><option value='GB' >UNITED KINGDOM  (GBR)<\/option><option value='US' >UNITED STATES  (USA)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS  (UMI)<\/option><option value='UY' >URUGUAY  (URY)<\/option><option value='UZ' >UZBEKISTAN  (UZB)<\/option><option value='VU' >VANUATU  (VUT)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE)  (VAT)<\/option><option value='VE' >VENEZUELA  (VEN)<\/option><option value='VN' >VIETNAM  (VNM)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH)  (VGB)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.)  (VIR)<\/option><option value='WK' >WAKE ISLAND  (WAK)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS  (WLF)<\/option><option value='EH' >WESTERN SAHARA  (ESH)<\/option><option value='YE' >YEMEN  (YEM)<\/option><option value='ZR' >ZAIRE  (ZAR)<\/option><option value='ZM' >ZAMBIA  (ZMB)<\/option><option value='ZW' >ZIMBABWE  (ZWE)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.<\/p><\/div><\/div><div id=\"field_16_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_20\" ><label class='gfield_label gform-field-label' for='input_16_20'>Document Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_16_20' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Select the travel document type<\/option><option value='P' >Passport Number<\/option><option value='NID' >National Identity Card Number<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Please select the travel document type issued by another country.<\/p><\/div><\/div><div id=\"field_16_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_21\" ><label class='gfield_label gform-field-label' for='input_16_21'>Document Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_16_21' type='text' value='' class='medium'  aria-describedby=\"gfield_description_16_21\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_16_21'>If you do not remember the passport number or national identification card number, answer \"<strong>UNKNOWN<\/strong>\" in the passport number field.<\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your document number as it appears on your travel document. The travel document may contain numbers and\/or characters.<em> Please closely distinguish between the number zero and the letter O<\/em>.<\/p><\/div><\/div><div id=\"field_16_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_22\" ><label class='gfield_label gform-field-label' for='input_16_22'>Expiration year<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_16_22' type='text' value='' class='medium'  aria-describedby=\"gfield_description_16_22\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_16_22'>If you do not remember the year of expiration, answer four zeros \"<strong>0000<\/strong>\" in the year of expiration field.<\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your document expiration year as it appears on your travel document.<\/p><\/div><\/div><div id=\"field_16_133\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_133\" ><h3>UPLOAD A PHOTO OF YOUR PASSPORT<\/h3>\n<p>You must upload your passport to continue with your ESTA application.<\/p><\/div><div id=\"field_16_134\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_134\" ><div id=\"instrucciones\">\n\n<div class=\"columna\">\n<h4>PASSPORT EXAMPLE<\/h4>\n<img decoding=\"async\" class=\"ejemplo-pasaporte\" src=\"https:\/\/www.usa-esta-visa.com\/img\/ejemplo_pasaporte.png\">\n\n<span class=\"mrz\">The MRZ code (highlighted in yellow in the example) is the most important information on the passport. Make sure it is fully visible and perfectly horizontal.<\/span>\n\n<\/div>\n\n\n\n<div class=\"columna\">\n<h4>HOW TO TAKE A PASSPORT PHOTO?<\/h4>\n<ul>\n<li>Take the photo in landscape mode (not portrait).<\/i>\n<li>Make sure the photo is focused and not blurry or shaky.<\/li>\n<li>Take the photo in a well-lit environment, but without flash or direct light shining on the passport to avoid glare.<\/li>\n\n<\/ul>\n<\/div>\n\n<div class=\"columna\">\n<h4>EDIT THE PHOTO ONCE UPLOADED<\/h4>\n<span>Once you upload the photo, you will have a very simple editor to::<\/span>\n<ul>\n<li>Rotate the photo left or right and make it horizontal (icons above the photo).<\/li>\n<li>Adjust the four black dots to fit the corners of the passport and crop it perfectly.<\/li>\n<li>If the photo is not perfectly horizontal, you can adjust it using the scale below the photo, under Rotation.<\/li>\n<\/ul>\n<span>Finally, click the yellow button labeled <span class=\"finalizado\">Done<\/span> (on mobile <span class=\"finalizado\">&check;<\/span> ) at the top right corner.<\/span>\n<\/div>\n<\/div><\/div><div id=\"field_16_135\" class=\"gfield gfield--type-image_hopper gfield--input-type-image_hopper gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_135\" ><label class='gfield_label gform-field-label' for='gform_browse_button_16_135'>Upload a photo of your passport<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_image_hopper gform-theme__no-reset--children'><input\n\t\tname='input_135'\n\t\tid='input_16_135'\n\t\ttype='file'\n\t\tdata-image-resize-target-height='760'\n\t\tdata-image-resize-target-width='1000'\n\t\tdata-max-files='1'\n\t\tdata-max-file-size='5MB'\n\t\tdata-image-preview-max-file-size='5MB'\n\t\tdata-image-transform-output-quality='90'\n\t\tdata-allow-image-crop='false'\n\t\t\n\t\tdata-image-resize-upscale='false'\n\t\tdata-image-validate-size-min-width='1'\n\t\tdata-image-validate-size-min-height='1'\n\t\tclass=' '\n\t\t\n\t\t\n\t\taria-required=\"true\"\n\t\taria-invalid=\"false\"\n\t\tdata-form-id='16'\n\t\tdata-field-id='135'\n\t\tdata-files=''\n\t\tdata-nonce='3e5a7ab58e'\n\t\tdata-min-image-warning=''\n\t\tdata-min-image-warning-width=''\n\t\tdata-min-image-warning-height=''\n\t\tdata-editor='{&quot;enableEditor&quot;:true,&quot;instantEdit&quot;:true,&quot;cropToSize&quot;:&quot;&quot;,&quot;upscaleImageToCropSize&quot;:&quot;&quot;,&quot;defaultEditorView&quot;:&quot;field_crop&quot;,&quot;defaultFilter&quot;:&quot;field_mono&quot;,&quot;editorAppearance&quot;:&quot;auto&quot;,&quot;enabledFeatures&quot;:{&quot;field_crop&quot;:true,&quot;field_rotate_left&quot;:true,&quot;field_rotate_right&quot;:true,&quot;field_manual_rotation&quot;:true,&quot;field_color&quot;:false,&quot;field_contrast&quot;:false,&quot;field_brightness&quot;:false,&quot;field_saturation&quot;:false,&quot;field_exposure&quot;:false,&quot;field_temperature&quot;:false,&quot;field_gamma&quot;:false,&quot;field_clarity&quot;:false,&quot;field_vignette&quot;:false}}' \/><\/div><\/div><div id=\"field_16_24\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_24\" ><h3>ANOTHER CITIZENSHIP \/ NATIONALITY<\/h3><\/div><div id=\"field_16_25\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_25\" ><label class='gfield_label gform-field-label' for='input_16_25'>Are you now, a citizen or national of any other country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_16_25' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Y' >Yes<\/option><option value='N' >No<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>If Yes, select the country first, then select how you acquired the citizenship\/nationality.<\/p><\/div><\/div><div id=\"field_16_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_26\" ><label class='gfield_label gform-field-label' for='input_16_26'>Country of Citizenship \/ Nationality<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_16_26' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AF' >AFGHANISTAN  (AFG)<\/option><option value='AX' >ALAND ISLANDS  (ALA)<\/option><option value='AL' >ALBANIA  (ALB)<\/option><option value='DZ' >ALGERIA  (DZA)<\/option><option value='AS' >AMERICAN SAMOA  (ASM)<\/option><option value='AD' >ANDORRA  (AND)<\/option><option value='AO' >ANGOLA  (AGO)<\/option><option value='AI' >ANGUILLA  (AIA)<\/option><option value='AQ' >ANTARCTICA  (ATA)<\/option><option value='AG' >ANTIGUA AND BARBUDA  (ATG)<\/option><option value='AR' >ARGENTINA  (ARG)<\/option><option value='AM' >ARMENIA  (ARM)<\/option><option value='AW' >ARUBA  (ABW)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='AZ' >AZERBAIJAN  (AZE)<\/option><option value='BS' >BAHAMAS  (BHS)<\/option><option value='BH' >BAHRAIN  (BHR)<\/option><option value='BD' >BANGLADESH  (BGD)<\/option><option value='BB' >BARBADOS  (BRB)<\/option><option value='BY' >BELARUS  (BLR)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BZ' >BELIZE  (BLZ)<\/option><option value='BJ' >BENIN  (BEN)<\/option><option value='BM' >BERMUDA  (BMU)<\/option><option value='BT' >BHUTAN  (BTN)<\/option><option value='BO' >BOLIVIA  (BOL)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA  (BES)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA  (BIH)<\/option><option value='BW' >BOTSWANA  (BWA)<\/option><option value='BV' >BOUVET ISLAND  (BVT)<\/option><option value='BR' >BRAZIL  (BRA)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY  (IOT)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='BG' >BULGARIA  (BGR)<\/option><option value='BF' >BURKINA FASO  (BFA)<\/option><option value='BU' >BURMA  (BUR)<\/option><option value='BI' >BURUNDI  (BDI)<\/option><option value='KH' >CAMBODIA  (KHM)<\/option><option value='CM' >CAMEROON  (CMR)<\/option><option value='CA' >CANADA  (CAN)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS  (CTE)<\/option><option value='CV' >CAPE VERDE  (CPV)<\/option><option value='KY' >CAYMAN ISLANDS  (CYM)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC  (CAF)<\/option><option value='TD' >CHAD  (TCD)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='CN' >CHINA  (CHN)<\/option><option value='CX' >CHRISTMAS ISLAND  (CXR)<\/option><option value='CC' >COCOS (KEELING) ISLANDS  (CCK)<\/option><option value='CO' >COLOMBIA  (COL)<\/option><option value='KM' >COMOROS  (COM)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF  (COD)<\/option><option value='CG' >CONGO, REPUBLIC OF  (COG)<\/option><option value='CK' >COOK ISLANDS  (COK)<\/option><option value='CR' >COSTA RICA  (CRI)<\/option><option value='CI' >COTE D&#039;IVOIRE  (CIV)<\/option><option value='HR' >CROATIA  (HRV)<\/option><option value='CU' >CUBA  (CUB)<\/option><option value='CW' >CURACAO  (CUW)<\/option><option value='CY' >CYPRUS  (CYP)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='YD' >DEMOCRATIC YEMEN  (YMD)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='DJ' >DJIBOUTI  (DJI)<\/option><option value='DM' >DOMINICA  (DMA)<\/option><option value='DO' >DOMINICAN REPUBLIC  (DOM)<\/option><option value='NQ' >DRONNING MAUD LAND  (DML)<\/option><option value='TP' >EAST TIMOR  (TMP)<\/option><option value='EC' >ECUADOR  (ECU)<\/option><option value='EG' >EGYPT  (EGY)<\/option><option value='SV' >EL SALVADOR  (SLV)<\/option><option value='GQ' >EQUATORIAL GUINEA  (GNQ)<\/option><option value='ER' >ERITREA  (ERI)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='ET' >ETHIOPIA  (ETH)<\/option><option value='FK' >FALKLAND ISLANDS  (FLK)<\/option><option value='FO' >FAROE ISLANDS  (FRO)<\/option><option value='FJ' >FIJI  (FJI)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='FX' >FRANCE METROPOLITAN  (FXX)<\/option><option value='GF' >FRENCH GUIANA  (GUF)<\/option><option value='PF' >FRENCH POLYNESIA  (PYF)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES  (ATF)<\/option><option value='GA' >GABON  (GAB)<\/option><option value='GM' >GAMBIA  (GMB)<\/option><option value='GE' >GEORGIA  (GEO)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GH' >GHANA  (GHA)<\/option><option value='GI' >GIBRALTAR  (GIB)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='GL' >GREENLAND  (GRL)<\/option><option value='GD' >GRENADA  (GRD)<\/option><option value='GP' >GUADELOUPE  (GLP)<\/option><option value='GU' >GUAM  (GUM)<\/option><option value='GT' >GUATEMALA  (GTM)<\/option><option value='GG' >GUERNSEY  (GGY)<\/option><option value='GN' >GUINEA  (GIN)<\/option><option value='GW' >GUINEA-BISSAU  (GNB)<\/option><option value='GY' >GUYANA  (GUY)<\/option><option value='HT' >HAITI  (HTI)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS  (HMD)<\/option><option value='HN' >HONDURAS  (HND)<\/option><option value='HK' >HONG KONG  (HKG)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IN' >INDIA  (IND)<\/option><option value='ID' >INDONESIA  (IDN)<\/option><option value='IR' >IRAN  (IRN)<\/option><option value='IQ' >IRAQ  (IRQ)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IM' >ISLE OF MAN  (IMN)<\/option><option value='IL' >ISRAEL  (ISR)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JM' >JAMAICA  (JAM)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='JE' >JERSEY  (JEY)<\/option><option value='JT' >JOHNSTON ISLAND  (JTN)<\/option><option value='JO' >JORDAN  (JOR)<\/option><option value='KZ' >KAZAKHSTAN  (KAZ)<\/option><option value='KE' >KENYA  (KEN)<\/option><option value='KI' >KIRIBATI  (KIR)<\/option><option value='KV' >KOSOVO  (KVV)<\/option><option value='KW' >KUWAIT  (KWT)<\/option><option value='KG' >KYRGYZSTAN  (KGZ)<\/option><option value='LA' >LAOS  (LAO)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LB' >LEBANON  (LBN)<\/option><option value='LS' >LESOTHO  (LSO)<\/option><option value='LR' >LIBERIA  (LBR)<\/option><option value='LY' >LIBYA  (LBY)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MO' >MACAU  (MAC)<\/option><option value='MK' >MACEDONIA  (MKD)<\/option><option value='MG' >MADAGASCAR  (MDG)<\/option><option value='MW' >MALAWI  (MWI)<\/option><option value='MY' >MALAYSIA  (MYS)<\/option><option value='MV' >MALDIVES  (MDV)<\/option><option value='ML' >MALI  (MLI)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MH' >MARSHALL ISLANDS  (MHL)<\/option><option value='MQ' >MARTINIQUE  (MTQ)<\/option><option value='MR' >MAURITANIA  (MRT)<\/option><option value='MU' >MAURITIUS  (MUS)<\/option><option value='YT' >MAYOTTE  (MYT)<\/option><option value='MX' >MEXICO  (MEX)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF  (FSM)<\/option><option value='MI' >MIDWAY ISLANDS  (MID)<\/option><option value='MD' >MOLDOVA  (MDA)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='MN' >MONGOLIA  (MNG)<\/option><option value='ME' >MONTENEGRO  (MNE)<\/option><option value='MS' >MONTSERRAT  (MSR)<\/option><option value='MA' >MOROCCO  (MAR)<\/option><option value='MZ' >MOZAMBIQUE  (MOZ)<\/option><option value='MM' >MYANMAR  (MMR)<\/option><option value='NA' >NAMIBIA  (NAM)<\/option><option value='NR' >NAURU  (NRU)<\/option><option value='NP' >NEPAL  (NPL)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='AN' >NETHERLANDS ANTILLES  (ANT)<\/option><option value='NT' >NEUTRAL ZONE  (NTZ)<\/option><option value='NC' >NEW CALEDONIA  (NCL)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NI' >NICARAGUA  (NIC)<\/option><option value='NE' >NIGER  (NER)<\/option><option value='NG' >NIGERIA  (NGA)<\/option><option value='NU' >NIUE  (NIU)<\/option><option value='NF' >NORFOLK ISLAND  (NFK)<\/option><option value='KP' >NORTH KOREA  (PRK)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS  (MNP)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='OM' >OMAN  (OMN)<\/option><option value='PK' >PAKISTAN  (PAK)<\/option><option value='PW' >PALAU  (PLW)<\/option><option value='PS' >PALESTINIAN TERRITORIES  (PSE)<\/option><option value='PA' >PANAMA  (PAN)<\/option><option value='PG' >PAPUA NEW GUINEA  (PNG)<\/option><option value='PY' >PARAGUAY  (PRY)<\/option><option value='PE' >PERU  (PER)<\/option><option value='PH' >PHILIPPINES  (PHL)<\/option><option value='PN' >PITCAIRN ISLANDS  (PCN)<\/option><option value='PL' >POLAND  (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='PR' >PUERTO RICO  (PRI)<\/option><option value='QA' >QATAR  (QAT)<\/option><option value='RE' >REUNION  (REU)<\/option><option value='RO' >ROMANIA  (ROM)<\/option><option value='RU' >RUSSIA  (RUS)<\/option><option value='RW' >RWANDA  (RWA)<\/option><option value='BL' >SAINT BARTHELEMY  (BLM)<\/option><option value='KN' >SAINT KITTS AND NEVIS  (KNA)<\/option><option value='LC' >SAINT LUCIA  (LCA)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART)  (MAF)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES  (VCT)<\/option><option value='WS' >SAMOA  (WSM)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='ST' >SAO TOME AND PRINCIPE  (STP)<\/option><option value='SA' >SAUDI ARABIA  (SAU)<\/option><option value='SN' >SENEGAL  (SEN)<\/option><option value='RS' >SERBIA  (SRB)<\/option><option value='CS' >SERBIA AND MONTENEGRO  (SCG)<\/option><option value='SC' >SEYCHELLES  (SYC)<\/option><option value='SL' >SIERRA LEONE  (SLE)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART)  (SXM)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='SB' >SOLOMON ISLANDS  (SLB)<\/option><option value='SO' >SOMALIA  (SOM)<\/option><option value='ZA' >SOUTH AFRICA  (ZAF)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS  (SGS)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='SS' >SOUTH SUDAN  (SSD)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='LK' >SRI LANKA  (LKA)<\/option><option value='SH' >ST. HELENA  (SHN)<\/option><option value='PM' >ST. PIERRE AND MIQUELON  (SPM)<\/option><option value='SD' >SUDAN  (SDN)<\/option><option value='SR' >SURINAME  (SUR)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS  (SJM)<\/option><option value='SZ' >SWAZILAND  (SWZ)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='SY' >SYRIA  (SYR)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='TJ' >TAJIKISTAN  (TJK)<\/option><option value='TZ' >TANZANIA  (TZA)<\/option><option value='TH' >THAILAND  (THA)<\/option><option value='TL' >TIMOR-LESTE  (TLS)<\/option><option value='TG' >TOGO  (TGO)<\/option><option value='TK' >TOKELAU  (TKL)<\/option><option value='TO' >TONGA  (TON)<\/option><option value='TT' >TRINIDAD AND TOBAGO  (TTO)<\/option><option value='TN' >TUNISIA  (TUN)<\/option><option value='TR' >TURKEY  (TUR)<\/option><option value='TM' >TURKMENISTAN  (TKM)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS  (TCA)<\/option><option value='TV' >TUVALU  (TUV)<\/option><option value='UG' >UGANDA  (UGA)<\/option><option value='UA' >UKRAINE  (UKR)<\/option><option value='AE' >UNITED ARAB EMIRATES  (ARE)<\/option><option value='GB' >UNITED KINGDOM  (GBR)<\/option><option value='US' >UNITED STATES  (USA)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS  (UMI)<\/option><option value='UY' >URUGUAY  (URY)<\/option><option value='UZ' >UZBEKISTAN  (UZB)<\/option><option value='VU' >VANUATU  (VUT)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE)  (VAT)<\/option><option value='VE' >VENEZUELA  (VEN)<\/option><option value='VN' >VIETNAM  (VNM)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH)  (VGB)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.)  (VIR)<\/option><option value='WK' >WAKE ISLAND  (WAK)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS  (WLF)<\/option><option value='EH' >WESTERN SAHARA  (ESH)<\/option><option value='YE' >YEMEN  (YEM)<\/option><option value='ZR' >ZAIRE  (ZAR)<\/option><option value='ZM' >ZAMBIA  (ZMB)<\/option><option value='ZW' >ZIMBABWE  (ZWE)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Country field, choose the country of your other citizenship(s). If you answered yes above, the country is required to complete your application.<\/p><\/div><\/div><fieldset id=\"field_16_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-two-thirds gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_28\" ><legend class='gfield_label gform-field-label' >How did you acquire citizenship \/ nationality from this country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_28'>\n\t\t\t<div class='gchoice gchoice_16_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='1'  id='choice_16_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_28_0' id='label_16_28_0' class='gform-field-label gform-field-label--type-inline'>By birth<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='2'  id='choice_16_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_28_1' id='label_16_28_1' class='gform-field-label gform-field-label--type-inline'>Through parents<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='3'  id='choice_16_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_28_2' id='label_16_28_2' class='gform-field-label gform-field-label--type-inline'>Naturalized<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gf_other_choice'  id='choice_16_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_28_3' id='label_16_28_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_16_28_other' class='gchoice_other_control' name='input_28_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><p>Please indicate whether you acquired citizenship\/nationality by birth, through parents, as a national of another country (born in the territory or possession of another country), or by other means.<\/p><\/div><\/fieldset><div id=\"field_16_29\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_29\" ><label class='gfield_label gform-field-label' for='input_16_29'>Have you ever been a citizen or national of any other country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_29' id='input_16_29' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Y' >Yes<\/option><option value='N' >No<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>\"Previous\" means at any time in the past, <strong>without limitation<\/strong>.<\/p><\/div><\/div><div id=\"field_16_30\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_30\" ><label class='gfield_label gform-field-label' for='input_16_30'>Country of Citizenship \/ Nationality<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_16_30' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AF' >AFGHANISTAN  (AFG)<\/option><option value='AX' >ALAND ISLANDS  (ALA)<\/option><option value='AL' >ALBANIA  (ALB)<\/option><option value='DZ' >ALGERIA  (DZA)<\/option><option value='AS' >AMERICAN SAMOA  (ASM)<\/option><option value='AD' >ANDORRA  (AND)<\/option><option value='AO' >ANGOLA  (AGO)<\/option><option value='AI' >ANGUILLA  (AIA)<\/option><option value='AQ' >ANTARCTICA  (ATA)<\/option><option value='AG' >ANTIGUA AND BARBUDA  (ATG)<\/option><option value='AR' >ARGENTINA  (ARG)<\/option><option value='AM' >ARMENIA  (ARM)<\/option><option value='AW' >ARUBA  (ABW)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='AZ' >AZERBAIJAN  (AZE)<\/option><option value='BS' >BAHAMAS  (BHS)<\/option><option value='BH' >BAHRAIN  (BHR)<\/option><option value='BD' >BANGLADESH  (BGD)<\/option><option value='BB' >BARBADOS  (BRB)<\/option><option value='BY' >BELARUS  (BLR)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BZ' >BELIZE  (BLZ)<\/option><option value='BJ' >BENIN  (BEN)<\/option><option value='BM' >BERMUDA  (BMU)<\/option><option value='BT' >BHUTAN  (BTN)<\/option><option value='BO' >BOLIVIA  (BOL)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA  (BES)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA  (BIH)<\/option><option value='BW' >BOTSWANA  (BWA)<\/option><option value='BV' >BOUVET ISLAND  (BVT)<\/option><option value='BR' >BRAZIL  (BRA)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY  (IOT)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='BG' >BULGARIA  (BGR)<\/option><option value='BF' >BURKINA FASO  (BFA)<\/option><option value='BU' >BURMA  (BUR)<\/option><option value='BI' >BURUNDI  (BDI)<\/option><option value='KH' >CAMBODIA  (KHM)<\/option><option value='CM' >CAMEROON  (CMR)<\/option><option value='CA' >CANADA  (CAN)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS  (CTE)<\/option><option value='CV' >CAPE VERDE  (CPV)<\/option><option value='KY' >CAYMAN ISLANDS  (CYM)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC  (CAF)<\/option><option value='TD' >CHAD  (TCD)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='CN' >CHINA  (CHN)<\/option><option value='CX' >CHRISTMAS ISLAND  (CXR)<\/option><option value='CC' >COCOS (KEELING) ISLANDS  (CCK)<\/option><option value='CO' >COLOMBIA  (COL)<\/option><option value='KM' >COMOROS  (COM)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF  (COD)<\/option><option value='CG' >CONGO, REPUBLIC OF  (COG)<\/option><option value='CK' >COOK ISLANDS  (COK)<\/option><option value='CR' >COSTA RICA  (CRI)<\/option><option value='CI' >COTE D&#039;IVOIRE  (CIV)<\/option><option value='HR' >CROATIA  (HRV)<\/option><option value='CU' >CUBA  (CUB)<\/option><option value='CW' >CURACAO  (CUW)<\/option><option value='CY' >CYPRUS  (CYP)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='YD' >DEMOCRATIC YEMEN  (YMD)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='DJ' >DJIBOUTI  (DJI)<\/option><option value='DM' >DOMINICA  (DMA)<\/option><option value='DO' >DOMINICAN REPUBLIC  (DOM)<\/option><option value='NQ' >DRONNING MAUD LAND  (DML)<\/option><option value='TP' >EAST TIMOR  (TMP)<\/option><option value='EC' >ECUADOR  (ECU)<\/option><option value='EG' >EGYPT  (EGY)<\/option><option value='SV' >EL SALVADOR  (SLV)<\/option><option value='GQ' >EQUATORIAL GUINEA  (GNQ)<\/option><option value='ER' >ERITREA  (ERI)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='ET' >ETHIOPIA  (ETH)<\/option><option value='FK' >FALKLAND ISLANDS  (FLK)<\/option><option value='FO' >FAROE ISLANDS  (FRO)<\/option><option value='FJ' >FIJI  (FJI)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='FX' >FRANCE METROPOLITAN  (FXX)<\/option><option value='GF' >FRENCH GUIANA  (GUF)<\/option><option value='PF' >FRENCH POLYNESIA  (PYF)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES  (ATF)<\/option><option value='GA' >GABON  (GAB)<\/option><option value='GM' >GAMBIA  (GMB)<\/option><option value='GE' >GEORGIA  (GEO)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GH' >GHANA  (GHA)<\/option><option value='GI' >GIBRALTAR  (GIB)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='GL' >GREENLAND  (GRL)<\/option><option value='GD' >GRENADA  (GRD)<\/option><option value='GP' >GUADELOUPE  (GLP)<\/option><option value='GU' >GUAM  (GUM)<\/option><option value='GT' >GUATEMALA  (GTM)<\/option><option value='GG' >GUERNSEY  (GGY)<\/option><option value='GN' >GUINEA  (GIN)<\/option><option value='GW' >GUINEA-BISSAU  (GNB)<\/option><option value='GY' >GUYANA  (GUY)<\/option><option value='HT' >HAITI  (HTI)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS  (HMD)<\/option><option value='HN' >HONDURAS  (HND)<\/option><option value='HK' >HONG KONG  (HKG)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IN' >INDIA  (IND)<\/option><option value='ID' >INDONESIA  (IDN)<\/option><option value='IR' >IRAN  (IRN)<\/option><option value='IQ' >IRAQ  (IRQ)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IM' >ISLE OF MAN  (IMN)<\/option><option value='IL' >ISRAEL  (ISR)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JM' >JAMAICA  (JAM)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='JE' >JERSEY  (JEY)<\/option><option value='JT' >JOHNSTON ISLAND  (JTN)<\/option><option value='JO' >JORDAN  (JOR)<\/option><option value='KZ' >KAZAKHSTAN  (KAZ)<\/option><option value='KE' >KENYA  (KEN)<\/option><option value='KI' >KIRIBATI  (KIR)<\/option><option value='KV' >KOSOVO  (KVV)<\/option><option value='KW' >KUWAIT  (KWT)<\/option><option value='KG' >KYRGYZSTAN  (KGZ)<\/option><option value='LA' >LAOS  (LAO)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LB' >LEBANON  (LBN)<\/option><option value='LS' >LESOTHO  (LSO)<\/option><option value='LR' >LIBERIA  (LBR)<\/option><option value='LY' >LIBYA  (LBY)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MO' >MACAU  (MAC)<\/option><option value='MK' >MACEDONIA  (MKD)<\/option><option value='MG' >MADAGASCAR  (MDG)<\/option><option value='MW' >MALAWI  (MWI)<\/option><option value='MY' >MALAYSIA  (MYS)<\/option><option value='MV' >MALDIVES  (MDV)<\/option><option value='ML' >MALI  (MLI)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MH' >MARSHALL ISLANDS  (MHL)<\/option><option value='MQ' >MARTINIQUE  (MTQ)<\/option><option value='MR' >MAURITANIA  (MRT)<\/option><option value='MU' >MAURITIUS  (MUS)<\/option><option value='YT' >MAYOTTE  (MYT)<\/option><option value='MX' >MEXICO  (MEX)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF  (FSM)<\/option><option value='MI' >MIDWAY ISLANDS  (MID)<\/option><option value='MD' >MOLDOVA  (MDA)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='MN' >MONGOLIA  (MNG)<\/option><option value='ME' >MONTENEGRO  (MNE)<\/option><option value='MS' >MONTSERRAT  (MSR)<\/option><option value='MA' >MOROCCO  (MAR)<\/option><option value='MZ' >MOZAMBIQUE  (MOZ)<\/option><option value='MM' >MYANMAR  (MMR)<\/option><option value='NA' >NAMIBIA  (NAM)<\/option><option value='NR' >NAURU  (NRU)<\/option><option value='NP' >NEPAL  (NPL)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='AN' >NETHERLANDS ANTILLES  (ANT)<\/option><option value='NT' >NEUTRAL ZONE  (NTZ)<\/option><option value='NC' >NEW CALEDONIA  (NCL)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NI' >NICARAGUA  (NIC)<\/option><option value='NE' >NIGER  (NER)<\/option><option value='NG' >NIGERIA  (NGA)<\/option><option value='NU' >NIUE  (NIU)<\/option><option value='NF' >NORFOLK ISLAND  (NFK)<\/option><option value='KP' >NORTH KOREA  (PRK)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS  (MNP)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='OM' >OMAN  (OMN)<\/option><option value='PK' >PAKISTAN  (PAK)<\/option><option value='PW' >PALAU  (PLW)<\/option><option value='PS' >PALESTINIAN TERRITORIES  (PSE)<\/option><option value='PA' >PANAMA  (PAN)<\/option><option value='PG' >PAPUA NEW GUINEA  (PNG)<\/option><option value='PY' >PARAGUAY  (PRY)<\/option><option value='PE' >PERU  (PER)<\/option><option value='PH' >PHILIPPINES  (PHL)<\/option><option value='PN' >PITCAIRN ISLANDS  (PCN)<\/option><option value='PL' >POLAND  (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='PR' >PUERTO RICO  (PRI)<\/option><option value='QA' >QATAR  (QAT)<\/option><option value='RE' >REUNION  (REU)<\/option><option value='RO' >ROMANIA  (ROM)<\/option><option value='RU' >RUSSIA  (RUS)<\/option><option value='RW' >RWANDA  (RWA)<\/option><option value='BL' >SAINT BARTHELEMY  (BLM)<\/option><option value='KN' >SAINT KITTS AND NEVIS  (KNA)<\/option><option value='LC' >SAINT LUCIA  (LCA)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART)  (MAF)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES  (VCT)<\/option><option value='WS' >SAMOA  (WSM)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='ST' >SAO TOME AND PRINCIPE  (STP)<\/option><option value='SA' >SAUDI ARABIA  (SAU)<\/option><option value='SN' >SENEGAL  (SEN)<\/option><option value='RS' >SERBIA  (SRB)<\/option><option value='CS' >SERBIA AND MONTENEGRO  (SCG)<\/option><option value='SC' >SEYCHELLES  (SYC)<\/option><option value='SL' >SIERRA LEONE  (SLE)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART)  (SXM)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='SB' >SOLOMON ISLANDS  (SLB)<\/option><option value='SO' >SOMALIA  (SOM)<\/option><option value='ZA' >SOUTH AFRICA  (ZAF)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS  (SGS)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='SS' >SOUTH SUDAN  (SSD)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='LK' >SRI LANKA  (LKA)<\/option><option value='SH' >ST. HELENA  (SHN)<\/option><option value='PM' >ST. PIERRE AND MIQUELON  (SPM)<\/option><option value='SD' >SUDAN  (SDN)<\/option><option value='SR' >SURINAME  (SUR)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS  (SJM)<\/option><option value='SZ' >SWAZILAND  (SWZ)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='SY' >SYRIA  (SYR)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='TJ' >TAJIKISTAN  (TJK)<\/option><option value='TZ' >TANZANIA  (TZA)<\/option><option value='TH' >THAILAND  (THA)<\/option><option value='TL' >TIMOR-LESTE  (TLS)<\/option><option value='TG' >TOGO  (TGO)<\/option><option value='TK' >TOKELAU  (TKL)<\/option><option value='TO' >TONGA  (TON)<\/option><option value='TT' >TRINIDAD AND TOBAGO  (TTO)<\/option><option value='TN' >TUNISIA  (TUN)<\/option><option value='TR' >TURKEY  (TUR)<\/option><option value='TM' >TURKMENISTAN  (TKM)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS  (TCA)<\/option><option value='TV' >TUVALU  (TUV)<\/option><option value='UG' >UGANDA  (UGA)<\/option><option value='UA' >UKRAINE  (UKR)<\/option><option value='AE' >UNITED ARAB EMIRATES  (ARE)<\/option><option value='GB' >UNITED KINGDOM  (GBR)<\/option><option value='US' >UNITED STATES  (USA)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS  (UMI)<\/option><option value='UY' >URUGUAY  (URY)<\/option><option value='UZ' >UZBEKISTAN  (UZB)<\/option><option value='VU' >VANUATU  (VUT)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE)  (VAT)<\/option><option value='VE' >VENEZUELA  (VEN)<\/option><option value='VN' >VIETNAM  (VNM)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH)  (VGB)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.)  (VIR)<\/option><option value='WK' >WAKE ISLAND  (WAK)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS  (WLF)<\/option><option value='EH' >WESTERN SAHARA  (ESH)<\/option><option value='YE' >YEMEN  (YEM)<\/option><option value='ZR' >ZAIRE  (ZAR)<\/option><option value='ZM' >ZAMBIA  (ZMB)<\/option><option value='ZW' >ZIMBABWE  (ZWE)<\/option><\/select><\/div><\/div><div id=\"field_16_31\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_31\" ><h3>PARENTS<\/h3><\/div><div id=\"field_16_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_32\" ><label class='gfield_label gform-field-label' for='input_16_32'>First parent Surname<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_16_32' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Surname field, enter your parent's family name. The Surname is required to complete the application. If you do not know one or both of your parents, enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_33\" ><label class='gfield_label gform-field-label' for='input_16_33'>First parent First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_16_33' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the First Name field, enter your parent's first name. Do not include the middle name in this field. The first name is required to complete the application. If your parent has no first name, or if you do not know one or both of your parents, enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_35\" ><label class='gfield_label gform-field-label' for='input_16_35'>Second parent Surname<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_16_35' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Surname field, enter your parent's family name. The Surname is required to complete the application. If you do not know one or both of your parents, enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_36\" ><label class='gfield_label gform-field-label' for='input_16_36'>Second parent First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_16_36' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the First Name field, enter your parent's first name. Do not include the middle name in this field. The first name is required to complete the application. If your parent has no first name, or if you do not know one or both of your parents, enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_37\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_37\" ><h3>YOUR CONTACT INFORMATION<\/h3>\n<p>Please, enter your contact information below<\/p><\/div><div id=\"field_16_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_39\" ><label class='gfield_label gform-field-label' for='input_16_39'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_16_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the number and street of the location of your home address. Do not include the city and state in this field. Address is required to complete the application.<\/p><\/div><\/div><div id=\"field_16_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_41\" ><label class='gfield_label gform-field-label' for='input_16_41'>Apartment Number<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_16_41' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field.\u00a0<\/p><\/div><\/div><div id=\"field_16_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_42\" ><label class='gfield_label gform-field-label' for='input_16_42'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_16_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the city, town, village, or hamlet.<\/p><\/div><\/div><div id=\"field_16_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_43\" ><label class='gfield_label gform-field-label' for='input_16_43'>State\/Province\/Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_16_43' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the state, province, or region.\u00a0<\/p><\/div><\/div><div id=\"field_16_44\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_44\" ><label class='gfield_label gform-field-label' for='input_16_44'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_44' id='input_16_44' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AF' >AFGHANISTAN  (AFG)<\/option><option value='AX' >ALAND ISLANDS  (ALA)<\/option><option value='AL' >ALBANIA  (ALB)<\/option><option value='DZ' >ALGERIA  (DZA)<\/option><option value='AS' >AMERICAN SAMOA  (ASM)<\/option><option value='AD' >ANDORRA  (AND)<\/option><option value='AO' >ANGOLA  (AGO)<\/option><option value='AI' >ANGUILLA  (AIA)<\/option><option value='AQ' >ANTARCTICA  (ATA)<\/option><option value='AG' >ANTIGUA AND BARBUDA  (ATG)<\/option><option value='AR' >ARGENTINA  (ARG)<\/option><option value='AM' >ARMENIA  (ARM)<\/option><option value='AW' >ARUBA  (ABW)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='AZ' >AZERBAIJAN  (AZE)<\/option><option value='BS' >BAHAMAS  (BHS)<\/option><option value='BH' >BAHRAIN  (BHR)<\/option><option value='BD' >BANGLADESH  (BGD)<\/option><option value='BB' >BARBADOS  (BRB)<\/option><option value='BY' >BELARUS  (BLR)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BZ' >BELIZE  (BLZ)<\/option><option value='BJ' >BENIN  (BEN)<\/option><option value='BM' >BERMUDA  (BMU)<\/option><option value='BT' >BHUTAN  (BTN)<\/option><option value='BO' >BOLIVIA  (BOL)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA  (BES)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA  (BIH)<\/option><option value='BW' >BOTSWANA  (BWA)<\/option><option value='BV' >BOUVET ISLAND  (BVT)<\/option><option value='BR' >BRAZIL  (BRA)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY  (IOT)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='BG' >BULGARIA  (BGR)<\/option><option value='BF' >BURKINA FASO  (BFA)<\/option><option value='BU' >BURMA  (BUR)<\/option><option value='BI' >BURUNDI  (BDI)<\/option><option value='KH' >CAMBODIA  (KHM)<\/option><option value='CM' >CAMEROON  (CMR)<\/option><option value='CA' >CANADA  (CAN)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS  (CTE)<\/option><option value='CV' >CAPE VERDE  (CPV)<\/option><option value='KY' >CAYMAN ISLANDS  (CYM)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC  (CAF)<\/option><option value='TD' >CHAD  (TCD)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='CN' >CHINA  (CHN)<\/option><option value='CX' >CHRISTMAS ISLAND  (CXR)<\/option><option value='CC' >COCOS (KEELING) ISLANDS  (CCK)<\/option><option value='CO' >COLOMBIA  (COL)<\/option><option value='KM' >COMOROS  (COM)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF  (COD)<\/option><option value='CG' >CONGO, REPUBLIC OF  (COG)<\/option><option value='CK' >COOK ISLANDS  (COK)<\/option><option value='CR' >COSTA RICA  (CRI)<\/option><option value='CI' >COTE D&#039;IVOIRE  (CIV)<\/option><option value='HR' >CROATIA  (HRV)<\/option><option value='CU' >CUBA  (CUB)<\/option><option value='CW' >CURACAO  (CUW)<\/option><option value='CY' >CYPRUS  (CYP)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='YD' >DEMOCRATIC YEMEN  (YMD)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='DJ' >DJIBOUTI  (DJI)<\/option><option value='DM' >DOMINICA  (DMA)<\/option><option value='DO' >DOMINICAN REPUBLIC  (DOM)<\/option><option value='NQ' >DRONNING MAUD LAND  (DML)<\/option><option value='TP' >EAST TIMOR  (TMP)<\/option><option value='EC' >ECUADOR  (ECU)<\/option><option value='EG' >EGYPT  (EGY)<\/option><option value='SV' >EL SALVADOR  (SLV)<\/option><option value='GQ' >EQUATORIAL GUINEA  (GNQ)<\/option><option value='ER' >ERITREA  (ERI)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='ET' >ETHIOPIA  (ETH)<\/option><option value='FK' >FALKLAND ISLANDS  (FLK)<\/option><option value='FO' >FAROE ISLANDS  (FRO)<\/option><option value='FJ' >FIJI  (FJI)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='FX' >FRANCE METROPOLITAN  (FXX)<\/option><option value='GF' >FRENCH GUIANA  (GUF)<\/option><option value='PF' >FRENCH POLYNESIA  (PYF)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES  (ATF)<\/option><option value='GA' >GABON  (GAB)<\/option><option value='GM' >GAMBIA  (GMB)<\/option><option value='GE' >GEORGIA  (GEO)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GH' >GHANA  (GHA)<\/option><option value='GI' >GIBRALTAR  (GIB)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='GL' >GREENLAND  (GRL)<\/option><option value='GD' >GRENADA  (GRD)<\/option><option value='GP' >GUADELOUPE  (GLP)<\/option><option value='GU' >GUAM  (GUM)<\/option><option value='GT' >GUATEMALA  (GTM)<\/option><option value='GG' >GUERNSEY  (GGY)<\/option><option value='GN' >GUINEA  (GIN)<\/option><option value='GW' >GUINEA-BISSAU  (GNB)<\/option><option value='GY' >GUYANA  (GUY)<\/option><option value='HT' >HAITI  (HTI)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS  (HMD)<\/option><option value='HN' >HONDURAS  (HND)<\/option><option value='HK' >HONG KONG  (HKG)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IN' >INDIA  (IND)<\/option><option value='ID' >INDONESIA  (IDN)<\/option><option value='IR' >IRAN  (IRN)<\/option><option value='IQ' >IRAQ  (IRQ)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IM' >ISLE OF MAN  (IMN)<\/option><option value='IL' >ISRAEL  (ISR)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JM' >JAMAICA  (JAM)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='JE' >JERSEY  (JEY)<\/option><option value='JT' >JOHNSTON ISLAND  (JTN)<\/option><option value='JO' >JORDAN  (JOR)<\/option><option value='KZ' >KAZAKHSTAN  (KAZ)<\/option><option value='KE' >KENYA  (KEN)<\/option><option value='KI' >KIRIBATI  (KIR)<\/option><option value='KV' >KOSOVO  (KVV)<\/option><option value='KW' >KUWAIT  (KWT)<\/option><option value='KG' >KYRGYZSTAN  (KGZ)<\/option><option value='LA' >LAOS  (LAO)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LB' >LEBANON  (LBN)<\/option><option value='LS' >LESOTHO  (LSO)<\/option><option value='LR' >LIBERIA  (LBR)<\/option><option value='LY' >LIBYA  (LBY)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MO' >MACAU  (MAC)<\/option><option value='MK' >MACEDONIA  (MKD)<\/option><option value='MG' >MADAGASCAR  (MDG)<\/option><option value='MW' >MALAWI  (MWI)<\/option><option value='MY' >MALAYSIA  (MYS)<\/option><option value='MV' >MALDIVES  (MDV)<\/option><option value='ML' >MALI  (MLI)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MH' >MARSHALL ISLANDS  (MHL)<\/option><option value='MQ' >MARTINIQUE  (MTQ)<\/option><option value='MR' >MAURITANIA  (MRT)<\/option><option value='MU' >MAURITIUS  (MUS)<\/option><option value='YT' >MAYOTTE  (MYT)<\/option><option value='MX' >MEXICO  (MEX)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF  (FSM)<\/option><option value='MI' >MIDWAY ISLANDS  (MID)<\/option><option value='MD' >MOLDOVA  (MDA)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='MN' >MONGOLIA  (MNG)<\/option><option value='ME' >MONTENEGRO  (MNE)<\/option><option value='MS' >MONTSERRAT  (MSR)<\/option><option value='MA' >MOROCCO  (MAR)<\/option><option value='MZ' >MOZAMBIQUE  (MOZ)<\/option><option value='MM' >MYANMAR  (MMR)<\/option><option value='NA' >NAMIBIA  (NAM)<\/option><option value='NR' >NAURU  (NRU)<\/option><option value='NP' >NEPAL  (NPL)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='AN' >NETHERLANDS ANTILLES  (ANT)<\/option><option value='NT' >NEUTRAL ZONE  (NTZ)<\/option><option value='NC' >NEW CALEDONIA  (NCL)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NI' >NICARAGUA  (NIC)<\/option><option value='NE' >NIGER  (NER)<\/option><option value='NG' >NIGERIA  (NGA)<\/option><option value='NU' >NIUE  (NIU)<\/option><option value='NF' >NORFOLK ISLAND  (NFK)<\/option><option value='KP' >NORTH KOREA  (PRK)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS  (MNP)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='OM' >OMAN  (OMN)<\/option><option value='PK' >PAKISTAN  (PAK)<\/option><option value='PW' >PALAU  (PLW)<\/option><option value='PS' >PALESTINIAN TERRITORIES  (PSE)<\/option><option value='PA' >PANAMA  (PAN)<\/option><option value='PG' >PAPUA NEW GUINEA  (PNG)<\/option><option value='PY' >PARAGUAY  (PRY)<\/option><option value='PE' >PERU  (PER)<\/option><option value='PH' >PHILIPPINES  (PHL)<\/option><option value='PN' >PITCAIRN ISLANDS  (PCN)<\/option><option value='PL' >POLAND  (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='PR' >PUERTO RICO  (PRI)<\/option><option value='QA' >QATAR  (QAT)<\/option><option value='RE' >REUNION  (REU)<\/option><option value='RO' >ROMANIA  (ROM)<\/option><option value='RU' >RUSSIA  (RUS)<\/option><option value='RW' >RWANDA  (RWA)<\/option><option value='BL' >SAINT BARTHELEMY  (BLM)<\/option><option value='KN' >SAINT KITTS AND NEVIS  (KNA)<\/option><option value='LC' >SAINT LUCIA  (LCA)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART)  (MAF)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES  (VCT)<\/option><option value='WS' >SAMOA  (WSM)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='ST' >SAO TOME AND PRINCIPE  (STP)<\/option><option value='SA' >SAUDI ARABIA  (SAU)<\/option><option value='SN' >SENEGAL  (SEN)<\/option><option value='RS' >SERBIA  (SRB)<\/option><option value='CS' >SERBIA AND MONTENEGRO  (SCG)<\/option><option value='SC' >SEYCHELLES  (SYC)<\/option><option value='SL' >SIERRA LEONE  (SLE)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART)  (SXM)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='SB' >SOLOMON ISLANDS  (SLB)<\/option><option value='SO' >SOMALIA  (SOM)<\/option><option value='ZA' >SOUTH AFRICA  (ZAF)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS  (SGS)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='SS' >SOUTH SUDAN  (SSD)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='LK' >SRI LANKA  (LKA)<\/option><option value='SH' >ST. HELENA  (SHN)<\/option><option value='PM' >ST. PIERRE AND MIQUELON  (SPM)<\/option><option value='SD' >SUDAN  (SDN)<\/option><option value='SR' >SURINAME  (SUR)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS  (SJM)<\/option><option value='SZ' >SWAZILAND  (SWZ)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='SY' >SYRIA  (SYR)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='TJ' >TAJIKISTAN  (TJK)<\/option><option value='TZ' >TANZANIA  (TZA)<\/option><option value='TH' >THAILAND  (THA)<\/option><option value='TL' >TIMOR-LESTE  (TLS)<\/option><option value='TG' >TOGO  (TGO)<\/option><option value='TK' >TOKELAU  (TKL)<\/option><option value='TO' >TONGA  (TON)<\/option><option value='TT' >TRINIDAD AND TOBAGO  (TTO)<\/option><option value='TN' >TUNISIA  (TUN)<\/option><option value='TR' >TURKEY  (TUR)<\/option><option value='TM' >TURKMENISTAN  (TKM)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS  (TCA)<\/option><option value='TV' >TUVALU  (TUV)<\/option><option value='UG' >UGANDA  (UGA)<\/option><option value='UA' >UKRAINE  (UKR)<\/option><option value='AE' >UNITED ARAB EMIRATES  (ARE)<\/option><option value='GB' selected='selected'>UNITED KINGDOM  (GBR)<\/option><option value='US' >UNITED STATES  (USA)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS  (UMI)<\/option><option value='UY' >URUGUAY  (URY)<\/option><option value='UZ' >UZBEKISTAN  (UZB)<\/option><option value='VU' >VANUATU  (VUT)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE)  (VAT)<\/option><option value='VE' >VENEZUELA  (VEN)<\/option><option value='VN' >VIETNAM  (VNM)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH)  (VGB)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.)  (VIR)<\/option><option value='WK' >WAKE ISLAND  (WAK)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS  (WLF)<\/option><option value='EH' >WESTERN SAHARA  (ESH)<\/option><option value='YE' >YEMEN  (YEM)<\/option><option value='ZR' >ZAIRE  (ZAR)<\/option><option value='ZM' >ZAMBIA  (ZMB)<\/option><option value='ZW' >ZIMBABWE  (ZWE)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose the country.<\/p><\/div><\/div><div id=\"field_16_110\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_110\" ><p><b>Write down your phone and email information.<\/b><\/p><\/div><div id=\"field_16_107\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_107\" ><label class='gfield_label gform-field-label' for='input_16_107'>Telephone Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_107' id='input_16_107' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='P:HOME' >Home<\/option><option value='P:WORK' >Work<\/option><option value='P:MOBILE' >Mobile<\/option><option value='P:OTHER' >Other<\/option><\/select><\/div><\/div><div id=\"field_16_129\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_129\" ><label class='gfield_label gform-field-label' for='input_16_129'>Country Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_16_129' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Elige pa\u00eds' >Elige pa\u00eds<\/option><option value='AF' >AFGHANISTAN (AFG) (+93)<\/option><option value='AX' >ALAND ISLANDS (ALA) (+358)<\/option><option value='AL' >ALBANIA (ALB) (+355)<\/option><option value='DZ' >ALGERIA (DZA) (+213)<\/option><option value='AS' >AMERICAN SAMOA (ASM) (+1)<\/option><option value='AD' >ANDORRA (AND) (+376)<\/option><option value='AO' >ANGOLA (AGO) (+244)<\/option><option value='AI' >ANGUILLA (AIA) (+1)<\/option><option value='AQ' >ANTARCTICA (ATA) (+672)<\/option><option value='AG' >ANTIGUA AND BARBUDA (ATG) (+1)<\/option><option value='AR' >ARGENTINA (ARG) (+54)<\/option><option value='AM' >ARMENIA (ARM) (+374)<\/option><option value='AW' >ARUBA (ABW) (+297)<\/option><option value='AU' >AUSTRALIA (AUS) (+61)<\/option><option value='AT' >AUSTRIA (AUT) (+43)<\/option><option value='AZ' >AZERBAIJAN (AZE) (+994)<\/option><option value='BS' >BAHAMAS (BHS) (+1)<\/option><option value='BH' >BAHRAIN (BHR) (+973)<\/option><option value='BD' >BANGLADESH (BGD) (+880)<\/option><option value='BB' >BARBADOS (BRB) (+1)<\/option><option value='BY' >BELARUS (BLR) (+375)<\/option><option value='BE' >BELGIUM (BEL) (+32)<\/option><option value='BZ' >BELIZE (BLZ) (+501)<\/option><option value='BJ' >BENIN (BEN) (+229)<\/option><option value='BM' >BERMUDA (BMU) (+1)<\/option><option value='BT' >BHUTAN (BTN) (+975)<\/option><option value='BO' >BOLIVIA (BOL) (+591)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA (BIH) (+387)<\/option><option value='BW' >BOTSWANA (BWA) (+267)<\/option><option value='BV' >BOUVET ISLAND (BVT) (+55)<\/option><option value='BR' >BRAZIL (BRA) (+55)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)<\/option><option value='BN' >BRUNEI (BRN) (+673)<\/option><option value='BG' >BULGARIA (BGR) (+359)<\/option><option value='BF' >BURKINA FASO (BFA) (+226)<\/option><option value='BU' >BURMA (BUR) (+95)<\/option><option value='BI' >BURUNDI (BDI) (+257)<\/option><option value='KH' >CAMBODIA (KHM) (+855)<\/option><option value='CM' >CAMEROON (CMR) (+237)<\/option><option value='CA' >CANADA (CAN) (+1)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS (CTE) (+686)<\/option><option value='CV' >CAPE VERDE (CPV) (+238)<\/option><option value='KY' >CAYMAN ISLANDS (CYM) (+1)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC (CAF) (+236)<\/option><option value='TD' >CHAD (TCD) (+235)<\/option><option value='CL' >CHILE (CHL) (+56)<\/option><option value='CN' >CHINA (CHN) (+86)<\/option><option value='CX' >CHRISTMAS ISLAND (CXR) (+61)<\/option><option value='CC' >COCOS (KEELING) ISLANDS (CCK) (+61)<\/option><option value='CO' >COLOMBIA (COL) (+57)<\/option><option value='KM' >COMOROS (COM) (+269)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)<\/option><option value='CG' >CONGO, REPUBLIC OF (COG) (+242)<\/option><option value='CK' >COOK ISLANDS (COK) (+682)<\/option><option value='CR' >COSTA RICA (CRI) (+506)<\/option><option value='CI' >COTE D&#039;IVOIRE (CIV) (+225)<\/option><option value='HR' >CROATIA (HRV) (+385)<\/option><option value='CU' >CUBA (CUB) (+53)<\/option><option value='CW' >CURACAO (CUW) (+599)<\/option><option value='CY' >CYPRUS (CYP) (+357)<\/option><option value='CZ' >CZECH REPUBLIC (CZE) (+420)<\/option><option value='YD' >DEMOCRATIC YEMEN (YMD) (+967)<\/option><option value='DK' >DENMARK (DNK) (+45)<\/option><option value='DJ' >DJIBOUTI (DJI) (+253)<\/option><option value='DM' >DOMINICA (DMA) (+1)<\/option><option value='DO' >DOMINICAN REPUBLIC (DOM) (+1)<\/option><option value='TP' >EAST TIMOR (TMP) (+670)<\/option><option value='EC' >ECUADOR (ECU) (+593)<\/option><option value='EG' >EGYPT (EGY) (+20)<\/option><option value='SV' >EL SALVADOR (SLV) (+503)<\/option><option value='GQ' >EQUATORIAL GUINEA (GNQ) (+240)<\/option><option value='ER' >ERITREA (ERI) (+291)<\/option><option value='EE' >ESTONIA (EST) (+372)<\/option><option value='ET' >ETHIOPIA (ETH) (+251)<\/option><option value='FK' >FALKLAND ISLANDS (FLK) (+500)<\/option><option value='FO' >FAROE ISLANDS (FRO) (+298)<\/option><option value='FJ' >FIJI (FJI) (+679)<\/option><option value='FI' >FINLAND (FIN) (+358)<\/option><option value='FR' >FRANCE (FRA) (+33)<\/option><option value='FX' >FRANCE METROPOLITAN (FXX) (+33)<\/option><option value='GF' >FRENCH GUIANA (GUF) (+594)<\/option><option value='PF' >FRENCH POLYNESIA (PYF) (+689)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES (ATF) (+262)<\/option><option value='GA' >GABON (GAB) (+241)<\/option><option value='GM' >GAMBIA (GMB) (+220)<\/option><option value='GE' >GEORGIA (GEO) (+995)<\/option><option value='DE' >GERMANY (DEU) (+49)<\/option><option value='GH' >GHANA (GHA) (+233)<\/option><option value='GI' >GIBRALTAR (GIB) (+350)<\/option><option value='GR' >GREECE (GRC) (+30)<\/option><option value='GL' >GREENLAND (GRL) (+299)<\/option><option value='GD' >GRENADA (GRD) (+1)<\/option><option value='GP' >GUADELOUPE (GLP) (+590)<\/option><option value='GU' >GUAM (GUM) (+1)<\/option><option value='GT' >GUATEMALA (GTM) (+502)<\/option><option value='GG' >GUERNSEY (GGY) (+44)<\/option><option value='GN' >GUINEA (GIN) (+224)<\/option><option value='GW' >GUINEA-BISSAU (GNB) (+245)<\/option><option value='GY' >GUYANA (GUY) (+592)<\/option><option value='HT' >HAITI (HTI) (+509)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS (HMD) (+0)<\/option><option value='HN' >HONDURAS (HND) (+504)<\/option><option value='HK' >HONG KONG (HKG) (+852)<\/option><option value='HU' >HUNGARY (HUN) (+36)<\/option><option value='IS' >ICELAND (ISL) (+354)<\/option><option value='IN' >INDIA (IND) (+91)<\/option><option value='ID' >INDONESIA (IDN) (+62)<\/option><option value='IR' >IRAN (IRN) (+98)<\/option><option value='IQ' >IRAQ (IRQ) (+964)<\/option><option value='IE' >IRELAND (IRL) (+353)<\/option><option value='IM' >ISLE OF MAN (IMN) (+44)<\/option><option value='IL' >ISRAEL (ISR) (+972)<\/option><option value='IT' >ITALY (ITA) (+39)<\/option><option value='JM' >JAMAICA (JAM) (+1)<\/option><option value='JP' >JAPAN (JPN) (+81)<\/option><option value='JE' >JERSEY (JEY) (+44)<\/option><option value='JT' >JOHNSTON ISLAND (JTN) (+1)<\/option><option value='JO' >JORDAN (JOR) (+962)<\/option><option value='KZ' >KAZAKHSTAN (KAZ) (+7)<\/option><option value='KE' >KENYA (KEN) (+254)<\/option><option value='KI' >KIRIBATI (KIR) (+686)<\/option><option value='KV' >KOSOVO (KVV) (+383)<\/option><option value='KW' >KUWAIT (KWT) (+965)<\/option><option value='KG' >KYRGYZSTAN (KGZ) (+996)<\/option><option value='LA' >LAOS (LAO) (+856)<\/option><option value='LV' >LATVIA (LVA) (+371)<\/option><option value='LB' >LEBANON (LBN) (+961)<\/option><option value='LS' >LESOTHO (LSO) (+266)<\/option><option value='LR' >LIBERIA (LBR) (+231)<\/option><option value='LY' >LIBYA (LBY) (+218)<\/option><option value='LI' >LIECHTENSTEIN (LIE) (+423)<\/option><option value='LT' >LITHUANIA (LTU) (+370)<\/option><option value='LU' >LUXEMBOURG (LUX) (+352)<\/option><option value='MO' >MACAU (MAC) (+853)<\/option><option value='MK' >MACEDONIA (MKD) (+389)<\/option><option value='MG' >MADAGASCAR (MDG) (+261)<\/option><option value='MW' >MALAWI (MWI) (+265)<\/option><option value='MY' >MALAYSIA (MYS) (+60)<\/option><option value='MV' >MALDIVES (MDV) (+960)<\/option><option value='ML' >MALI (MLI) (+223)<\/option><option value='MT' >MALTA (MLT) (+356)<\/option><option value='MH' >MARSHALL ISLANDS (MHL) (+692)<\/option><option value='MQ' >MARTINIQUE (MTQ) (+596)<\/option><option value='MR' >MAURITANIA (MRT) (+222)<\/option><option value='MU' >MAURITIUS (MUS) (+230)<\/option><option value='YT' >MAYOTTE (MYT) (+262)<\/option><option value='MX' >MEXICO (MEX) (+52)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF (FSM) (+691)<\/option><option value='MI' >MIDWAY ISLANDS (MID) (+1)<\/option><option value='MD' >MOLDOVA (MDA) (+373)<\/option><option value='MC' >MONACO (MCO) (+377)<\/option><option value='MN' >MONGOLIA (MNG) (+976)<\/option><option value='ME' >MONTENEGRO (MNE) (+382)<\/option><option value='MS' >MONTSERRAT (MSR) (+1)<\/option><option value='MA' >MOROCCO (MAR) (+212)<\/option><option value='MZ' >MOZAMBIQUE (MOZ) (+258)<\/option><option value='MM' >MYANMAR (MMR) (+95)<\/option><option value='NA' >NAMIBIA (NAM) (+264)<\/option><option value='NR' >NAURU (NRU) (+674)<\/option><option value='NP' >NEPAL (NPL) (+977)<\/option><option value='NL' >NETHERLANDS (NLD) (+31)<\/option><option value='AN' >NETHERLANDS ANTILLES (ANT) (+599)<\/option><option value='NC' >NEW CALEDONIA (NCL) (+687)<\/option><option value='NZ' >NEW ZEALAND (NZL) (+64)<\/option><option value='NI' >NICARAGUA (NIC) (+505)<\/option><option value='NE' >NIGER (NER) (+227)<\/option><option value='NG' >NIGERIA (NGA) (+234)<\/option><option value='NU' >NIUE (NIU) (+683)<\/option><option value='NF' >NORFOLK ISLAND (NFK) (+672)<\/option><option value='KP' >NORTH KOREA (PRK) (+850)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS (MNP) (+1)<\/option><option value='NO' >NORWAY (NOR) (+47)<\/option><option value='OM' >OMAN (OMN) (+968)<\/option><option value='PK' >PAKISTAN (PAK) (+92)<\/option><option value='PW' >PALAU (PLW) (+680)<\/option><option value='PS' >PALESTINIAN TERRITORIES (PSE) (+970)<\/option><option value='PA' >PANAMA (PAN) (+507)<\/option><option value='PG' >PAPUA NEW GUINEA (PNG) (+675)<\/option><option value='PY' >PARAGUAY (PRY) (+595)<\/option><option value='PE' >PERU (PER) (+51)<\/option><option value='PH' >PHILIPPINES (PHL) (+63)<\/option><option value='PN' >PITCAIRN ISLANDS (PCN) (+64)<\/option><option value='PL' >POLAND (POL) (+48)<\/option><option value='PT' >PORTUGAL (PRT) (+351)<\/option><option value='PR' >PUERTO RICO (PRI) (+1)<\/option><option value='QA' >QATAR (QAT) (+974)<\/option><option value='RE' >REUNION (REU) (+262)<\/option><option value='RO' >ROMANIA (ROM) (+40)<\/option><option value='RU' >RUSSIA (RUS) (+7)<\/option><option value='RW' >RWANDA (RWA) (+250)<\/option><option value='BL' >SAINT BARTHELEMY (BLM) (+590)<\/option><option value='KN' >SAINT KITTS AND NEVIS (KNA) (+1)<\/option><option value='LC' >SAINT LUCIA (LCA) (+1)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART) (MAF) (+590)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES (VCT) (+1)<\/option><option value='WS' >SAMOA (WSM) (+685)<\/option><option value='SM' >SAN MARINO (SMR) (+378)<\/option><option value='ST' >SAO TOME AND PRINCIPE (STP) (+239)<\/option><option value='SA' >SAUDI ARABIA (SAU) (+966)<\/option><option value='SN' >SENEGAL (SEN) (+221)<\/option><option value='RS' >SERBIA (SRB) (+381)<\/option><option value='CS' >SERBIA AND MONTENEGRO (SCG) (+381)<\/option><option value='SC' >SEYCHELLES (SYC) (+248)<\/option><option value='SL' >SIERRA LEONE (SLE) (+232)<\/option><option value='SG' >SINGAPORE (SGP) (+65)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART) (SXM) (+1)<\/option><option value='SK' >SLOVAKIA (SVK) (+421)<\/option><option value='SI' >SLOVENIA (SVN) (+386)<\/option><option value='SB' >SOLOMON ISLANDS (SLB) (+677)<\/option><option value='SO' >SOMALIA (SOM) (+252)<\/option><option value='ZA' >SOUTH AFRICA (ZAF) (+27)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)<\/option><option value='KR' >SOUTH KOREA (KOR) (+82)<\/option><option value='SS' >SOUTH SUDAN (SSD) (+211)<\/option><option value='ES' >SPAIN (ESP) (+34)<\/option><option value='LK' >SRI LANKA (LKA) (+94)<\/option><option value='SH' >ST. HELENA (SHN) (+290)<\/option><option value='PM' >ST. PIERRE AND MIQUELON (SPM) (+508)<\/option><option value='SD' >SUDAN (SDN) (+249)<\/option><option value='SR' >SURINAME (SUR) (+597)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)<\/option><option value='SZ' >SWAZILAND (SWZ) (+268)<\/option><option value='SE' >SWEDEN (SWE) (+46)<\/option><option value='CH' >SWITZERLAND (CHE) (+41)<\/option><option value='SY' >SYRIA (SYR) (+963)<\/option><option value='TW' >TAIWAN (TWN) (+886)<\/option><option value='TJ' >TAJIKISTAN (TJK) (+992)<\/option><option value='TZ' >TANZANIA (TZA) (+255)<\/option><option value='TH' >THAILAND (THA) (+66)<\/option><option value='TL' >TIMOR-LESTE (TLS) (+670)<\/option><option value='TG' >TOGO (TGO) (+228)<\/option><option value='TK' >TOKELAU (TKL) (+690)<\/option><option value='TO' >TONGA (TON) (+676)<\/option><option value='TT' >TRINIDAD AND TOBAGO (TTO) (+1)<\/option><option value='TN' >TUNISIA (TUN) (+216)<\/option><option value='TR' >TURKEY (TUR) (+90)<\/option><option value='TM' >TURKMENISTAN (TKM) (+993)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS (TCA) (+1)<\/option><option value='TV' >TUVALU (TUV) (+688)<\/option><option value='UG' >UGANDA (UGA) (+256)<\/option><option value='UA' >UKRAINE (UKR) (+380)<\/option><option value='AE' >UNITED ARAB EMIRATES (ARE) (+971)<\/option><option value='GB' selected='selected'>UNITED KINGDOM (GBR) (+44)<\/option><option value='US' >UNITED STATES (USA) (+1)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)<\/option><option value='UY' >URUGUAY (URY) (+598)<\/option><option value='UZ' >UZBEKISTAN (UZB) (+998)<\/option><option value='VU' >VANUATU (VUT) (+678)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE) (VAT) (+379)<\/option><option value='VE' >VENEZUELA (VEN) (+58)<\/option><option value='VN' >VIETNAM (VNM) (+84)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH) (VGB) (+1)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.) (VIR) (+1)<\/option><option value='WK' >WAKE ISLAND (WAK) (+808)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS (WLF) (+681)<\/option><option value='EH' >WESTERN SAHARA (ESH) (+212)<\/option><option value='YE' >YEMEN (YEM) (+967)<\/option><option value='ZR' >ZAIRE (ZAR) (+243)<\/option><option value='ZM' >ZAMBIA (ZMB) (+260)<\/option><option value='ZW' >ZIMBABWE (ZWE) (+263)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>At least one telephone number is required to complete the application. If you do not have a telephone number, you may provide an alternative third-party telephone number belonging to a point of contact (e.g. a family member, friend, or business associate). In the Country Code field, enter the country code of the telephone number where you may be contacted.\u00a0<\/p><\/div><\/div><div id=\"field_16_109\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_109\" ><label class='gfield_label gform-field-label' for='input_16_109'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_109' id='input_16_109' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>At least one telephone number is required to complete the application. If you do not have a telephone number, you may provide an alternative third-party telephone number belonging to a point of contact (e.g. a family member, friend, or business associate).<\/p><\/div><\/div><fieldset id=\"field_16_46\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_46\" ><legend class='gfield_label gform-field-label' >E-mail Adress<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_16_46_container'>\n                                <span id='input_16_46_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_46' id='input_16_46' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_16_46' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_16_46_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_46_2' id='input_16_46_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_16_46_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the email address at which you can be contacted. If you do not have an email, you may provide an alternative third-party email address belonging to a point of contact (e.g. a family member, friend or business associate.)<\/p><\/div><\/fieldset><div id=\"field_16_48\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_48\" ><h3>EMPLOYMENT INFORMATION<\/h3><\/div><div id=\"field_16_50\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_50\" ><label class='gfield_label gform-field-label' for='input_16_50'>Do you have a current or previous employer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_50' id='input_16_50' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Y' >Yes<\/option><option value='N' >No<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Indicate whether you have a current or previous employer by selecting yes or no.<\/p><\/div><\/div><div id=\"field_16_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_51\" ><label class='gfield_label gform-field-label' for='input_16_51'>Job Title<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_16_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the job title of your current or previous employment. Job title is optional to complete this application.<\/p><\/div><\/div><div id=\"field_16_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_52\" ><label class='gfield_label gform-field-label' for='input_16_52'>Employer Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_16_52' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the name of your current employer (the company or organization for whom you work). If you are not currently employed, enter the name of your previous employer. Employer name is required to complete the application. You may also enter SELF-EMPLOYED, STUDENT, CHILD, HOMEMAKER, STAY-AT-HOME PARENT, or any other word to describe your employment status.<\/p><\/div><\/div><div id=\"field_16_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_53\" ><label class='gfield_label gform-field-label' for='input_16_53'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_16_53' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the number and street of the location of the employer you listed. If you do not know the address of the employer you listed you may enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_54\" ><label class='gfield_label gform-field-label' for='input_16_54'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_16_54' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the City field, enter the city, town, village, or hamlet.\u00a0 If you do not know the city you may enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_55\" ><label class='gfield_label gform-field-label' for='input_16_55'>State\/Province\/Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_16_55' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter the state, province, or region. The state\/province\/region is required to complete the application. If you do not know the state\/province\/region you may enter <strong>UNKNOWN<\/strong>.<\/p><\/div><\/div><div id=\"field_16_58\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_58\" ><label class='gfield_label gform-field-label' for='input_16_58'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_58' id='input_16_58' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AF' >AFGHANISTAN  (AFG)<\/option><option value='AX' >ALAND ISLANDS  (ALA)<\/option><option value='AL' >ALBANIA  (ALB)<\/option><option value='DZ' >ALGERIA  (DZA)<\/option><option value='AS' >AMERICAN SAMOA  (ASM)<\/option><option value='AD' >ANDORRA  (AND)<\/option><option value='AO' >ANGOLA  (AGO)<\/option><option value='AI' >ANGUILLA  (AIA)<\/option><option value='AQ' >ANTARCTICA  (ATA)<\/option><option value='AG' >ANTIGUA AND BARBUDA  (ATG)<\/option><option value='AR' >ARGENTINA  (ARG)<\/option><option value='AM' >ARMENIA  (ARM)<\/option><option value='AW' >ARUBA  (ABW)<\/option><option value='AU' >AUSTRALIA  (AUS)<\/option><option value='AT' >AUSTRIA  (AUT)<\/option><option value='AZ' >AZERBAIJAN  (AZE)<\/option><option value='BS' >BAHAMAS  (BHS)<\/option><option value='BH' >BAHRAIN  (BHR)<\/option><option value='BD' >BANGLADESH  (BGD)<\/option><option value='BB' >BARBADOS  (BRB)<\/option><option value='BY' >BELARUS  (BLR)<\/option><option value='BE' >BELGIUM  (BEL)<\/option><option value='BZ' >BELIZE  (BLZ)<\/option><option value='BJ' >BENIN  (BEN)<\/option><option value='BM' >BERMUDA  (BMU)<\/option><option value='BT' >BHUTAN  (BTN)<\/option><option value='BO' >BOLIVIA  (BOL)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA  (BES)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA  (BIH)<\/option><option value='BW' >BOTSWANA  (BWA)<\/option><option value='BV' >BOUVET ISLAND  (BVT)<\/option><option value='BR' >BRAZIL  (BRA)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY  (IOT)<\/option><option value='BN' >BRUNEI  (BRN)<\/option><option value='BG' >BULGARIA  (BGR)<\/option><option value='BF' >BURKINA FASO  (BFA)<\/option><option value='BU' >BURMA  (BUR)<\/option><option value='BI' >BURUNDI  (BDI)<\/option><option value='KH' >CAMBODIA  (KHM)<\/option><option value='CM' >CAMEROON  (CMR)<\/option><option value='CA' >CANADA  (CAN)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS  (CTE)<\/option><option value='CV' >CAPE VERDE  (CPV)<\/option><option value='KY' >CAYMAN ISLANDS  (CYM)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC  (CAF)<\/option><option value='TD' >CHAD  (TCD)<\/option><option value='CL' >CHILE  (CHL)<\/option><option value='CN' >CHINA  (CHN)<\/option><option value='CX' >CHRISTMAS ISLAND  (CXR)<\/option><option value='CC' >COCOS (KEELING) ISLANDS  (CCK)<\/option><option value='CO' >COLOMBIA  (COL)<\/option><option value='KM' >COMOROS  (COM)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF  (COD)<\/option><option value='CG' >CONGO, REPUBLIC OF  (COG)<\/option><option value='CK' >COOK ISLANDS  (COK)<\/option><option value='CR' >COSTA RICA  (CRI)<\/option><option value='CI' >COTE D&#039;IVOIRE  (CIV)<\/option><option value='HR' >CROATIA  (HRV)<\/option><option value='CU' >CUBA  (CUB)<\/option><option value='CW' >CURACAO  (CUW)<\/option><option value='CY' >CYPRUS  (CYP)<\/option><option value='CZ' >CZECH REPUBLIC  (CZE)<\/option><option value='YD' >DEMOCRATIC YEMEN  (YMD)<\/option><option value='DK' >DENMARK  (DNK)<\/option><option value='DJ' >DJIBOUTI  (DJI)<\/option><option value='DM' >DOMINICA  (DMA)<\/option><option value='DO' >DOMINICAN REPUBLIC  (DOM)<\/option><option value='NQ' >DRONNING MAUD LAND  (DML)<\/option><option value='TP' >EAST TIMOR  (TMP)<\/option><option value='EC' >ECUADOR  (ECU)<\/option><option value='EG' >EGYPT  (EGY)<\/option><option value='SV' >EL SALVADOR  (SLV)<\/option><option value='GQ' >EQUATORIAL GUINEA  (GNQ)<\/option><option value='ER' >ERITREA  (ERI)<\/option><option value='EE' >ESTONIA  (EST)<\/option><option value='ET' >ETHIOPIA  (ETH)<\/option><option value='FK' >FALKLAND ISLANDS  (FLK)<\/option><option value='FO' >FAROE ISLANDS  (FRO)<\/option><option value='FJ' >FIJI  (FJI)<\/option><option value='FI' >FINLAND  (FIN)<\/option><option value='FR' >FRANCE  (FRA)<\/option><option value='FX' >FRANCE METROPOLITAN  (FXX)<\/option><option value='GF' >FRENCH GUIANA  (GUF)<\/option><option value='PF' >FRENCH POLYNESIA  (PYF)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES  (ATF)<\/option><option value='GA' >GABON  (GAB)<\/option><option value='GM' >GAMBIA  (GMB)<\/option><option value='GE' >GEORGIA  (GEO)<\/option><option value='DE' >GERMANY  (DEU)<\/option><option value='GH' >GHANA  (GHA)<\/option><option value='GI' >GIBRALTAR  (GIB)<\/option><option value='GR' >GREECE  (GRC)<\/option><option value='GL' >GREENLAND  (GRL)<\/option><option value='GD' >GRENADA  (GRD)<\/option><option value='GP' >GUADELOUPE  (GLP)<\/option><option value='GU' >GUAM  (GUM)<\/option><option value='GT' >GUATEMALA  (GTM)<\/option><option value='GG' >GUERNSEY  (GGY)<\/option><option value='GN' >GUINEA  (GIN)<\/option><option value='GW' >GUINEA-BISSAU  (GNB)<\/option><option value='GY' >GUYANA  (GUY)<\/option><option value='HT' >HAITI  (HTI)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS  (HMD)<\/option><option value='HN' >HONDURAS  (HND)<\/option><option value='HK' >HONG KONG  (HKG)<\/option><option value='HU' >HUNGARY  (HUN)<\/option><option value='IS' >ICELAND  (ISL)<\/option><option value='IN' >INDIA  (IND)<\/option><option value='ID' >INDONESIA  (IDN)<\/option><option value='IR' >IRAN  (IRN)<\/option><option value='IQ' >IRAQ  (IRQ)<\/option><option value='IE' >IRELAND  (IRL)<\/option><option value='IM' >ISLE OF MAN  (IMN)<\/option><option value='IL' >ISRAEL  (ISR)<\/option><option value='IT' >ITALY  (ITA)<\/option><option value='JM' >JAMAICA  (JAM)<\/option><option value='JP' >JAPAN  (JPN)<\/option><option value='JE' >JERSEY  (JEY)<\/option><option value='JT' >JOHNSTON ISLAND  (JTN)<\/option><option value='JO' >JORDAN  (JOR)<\/option><option value='KZ' >KAZAKHSTAN  (KAZ)<\/option><option value='KE' >KENYA  (KEN)<\/option><option value='KI' >KIRIBATI  (KIR)<\/option><option value='KV' >KOSOVO  (KVV)<\/option><option value='KW' >KUWAIT  (KWT)<\/option><option value='KG' >KYRGYZSTAN  (KGZ)<\/option><option value='LA' >LAOS  (LAO)<\/option><option value='LV' >LATVIA  (LVA)<\/option><option value='LB' >LEBANON  (LBN)<\/option><option value='LS' >LESOTHO  (LSO)<\/option><option value='LR' >LIBERIA  (LBR)<\/option><option value='LY' >LIBYA  (LBY)<\/option><option value='LI' >LIECHTENSTEIN  (LIE)<\/option><option value='LT' >LITHUANIA  (LTU)<\/option><option value='LU' >LUXEMBOURG  (LUX)<\/option><option value='MO' >MACAU  (MAC)<\/option><option value='MK' >MACEDONIA  (MKD)<\/option><option value='MG' >MADAGASCAR  (MDG)<\/option><option value='MW' >MALAWI  (MWI)<\/option><option value='MY' >MALAYSIA  (MYS)<\/option><option value='MV' >MALDIVES  (MDV)<\/option><option value='ML' >MALI  (MLI)<\/option><option value='MT' >MALTA  (MLT)<\/option><option value='MH' >MARSHALL ISLANDS  (MHL)<\/option><option value='MQ' >MARTINIQUE  (MTQ)<\/option><option value='MR' >MAURITANIA  (MRT)<\/option><option value='MU' >MAURITIUS  (MUS)<\/option><option value='YT' >MAYOTTE  (MYT)<\/option><option value='MX' >MEXICO  (MEX)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF  (FSM)<\/option><option value='MI' >MIDWAY ISLANDS  (MID)<\/option><option value='MD' >MOLDOVA  (MDA)<\/option><option value='MC' >MONACO  (MCO)<\/option><option value='MN' >MONGOLIA  (MNG)<\/option><option value='ME' >MONTENEGRO  (MNE)<\/option><option value='MS' >MONTSERRAT  (MSR)<\/option><option value='MA' >MOROCCO  (MAR)<\/option><option value='MZ' >MOZAMBIQUE  (MOZ)<\/option><option value='MM' >MYANMAR  (MMR)<\/option><option value='NA' >NAMIBIA  (NAM)<\/option><option value='NR' >NAURU  (NRU)<\/option><option value='NP' >NEPAL  (NPL)<\/option><option value='NL' >NETHERLANDS  (NLD)<\/option><option value='AN' >NETHERLANDS ANTILLES  (ANT)<\/option><option value='NT' >NEUTRAL ZONE  (NTZ)<\/option><option value='NC' >NEW CALEDONIA  (NCL)<\/option><option value='NZ' >NEW ZEALAND  (NZL)<\/option><option value='NI' >NICARAGUA  (NIC)<\/option><option value='NE' >NIGER  (NER)<\/option><option value='NG' >NIGERIA  (NGA)<\/option><option value='NU' >NIUE  (NIU)<\/option><option value='NF' >NORFOLK ISLAND  (NFK)<\/option><option value='KP' >NORTH KOREA  (PRK)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS  (MNP)<\/option><option value='NO' >NORWAY  (NOR)<\/option><option value='OM' >OMAN  (OMN)<\/option><option value='PK' >PAKISTAN  (PAK)<\/option><option value='PW' >PALAU  (PLW)<\/option><option value='PS' >PALESTINIAN TERRITORIES  (PSE)<\/option><option value='PA' >PANAMA  (PAN)<\/option><option value='PG' >PAPUA NEW GUINEA  (PNG)<\/option><option value='PY' >PARAGUAY  (PRY)<\/option><option value='PE' >PERU  (PER)<\/option><option value='PH' >PHILIPPINES  (PHL)<\/option><option value='PN' >PITCAIRN ISLANDS  (PCN)<\/option><option value='PL' >POLAND  (POL)<\/option><option value='PT' >PORTUGAL  (PRT)<\/option><option value='PR' >PUERTO RICO  (PRI)<\/option><option value='QA' >QATAR  (QAT)<\/option><option value='RE' >REUNION  (REU)<\/option><option value='RO' >ROMANIA  (ROM)<\/option><option value='RU' >RUSSIA  (RUS)<\/option><option value='RW' >RWANDA  (RWA)<\/option><option value='BL' >SAINT BARTHELEMY  (BLM)<\/option><option value='KN' >SAINT KITTS AND NEVIS  (KNA)<\/option><option value='LC' >SAINT LUCIA  (LCA)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART)  (MAF)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES  (VCT)<\/option><option value='WS' >SAMOA  (WSM)<\/option><option value='SM' >SAN MARINO  (SMR)<\/option><option value='ST' >SAO TOME AND PRINCIPE  (STP)<\/option><option value='SA' >SAUDI ARABIA  (SAU)<\/option><option value='SN' >SENEGAL  (SEN)<\/option><option value='RS' >SERBIA  (SRB)<\/option><option value='CS' >SERBIA AND MONTENEGRO  (SCG)<\/option><option value='SC' >SEYCHELLES  (SYC)<\/option><option value='SL' >SIERRA LEONE  (SLE)<\/option><option value='SG' >SINGAPORE  (SGP)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART)  (SXM)<\/option><option value='SK' >SLOVAKIA  (SVK)<\/option><option value='SI' >SLOVENIA  (SVN)<\/option><option value='SB' >SOLOMON ISLANDS  (SLB)<\/option><option value='SO' >SOMALIA  (SOM)<\/option><option value='ZA' >SOUTH AFRICA  (ZAF)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS  (SGS)<\/option><option value='KR' >SOUTH KOREA  (KOR)<\/option><option value='SS' >SOUTH SUDAN  (SSD)<\/option><option value='ES' >SPAIN  (ESP)<\/option><option value='LK' >SRI LANKA  (LKA)<\/option><option value='SH' >ST. HELENA  (SHN)<\/option><option value='PM' >ST. PIERRE AND MIQUELON  (SPM)<\/option><option value='SD' >SUDAN  (SDN)<\/option><option value='SR' >SURINAME  (SUR)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS  (SJM)<\/option><option value='SZ' >SWAZILAND  (SWZ)<\/option><option value='SE' >SWEDEN  (SWE)<\/option><option value='CH' >SWITZERLAND  (CHE)<\/option><option value='SY' >SYRIA  (SYR)<\/option><option value='TW' >TAIWAN  (TWN)<\/option><option value='TJ' >TAJIKISTAN  (TJK)<\/option><option value='TZ' >TANZANIA  (TZA)<\/option><option value='TH' >THAILAND  (THA)<\/option><option value='TL' >TIMOR-LESTE  (TLS)<\/option><option value='TG' >TOGO  (TGO)<\/option><option value='TK' >TOKELAU  (TKL)<\/option><option value='TO' >TONGA  (TON)<\/option><option value='TT' >TRINIDAD AND TOBAGO  (TTO)<\/option><option value='TN' >TUNISIA  (TUN)<\/option><option value='TR' >TURKEY  (TUR)<\/option><option value='TM' >TURKMENISTAN  (TKM)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS  (TCA)<\/option><option value='TV' >TUVALU  (TUV)<\/option><option value='UG' >UGANDA  (UGA)<\/option><option value='UA' >UKRAINE  (UKR)<\/option><option value='AE' >UNITED ARAB EMIRATES  (ARE)<\/option><option value='GB' selected='selected'>UNITED KINGDOM  (GBR)<\/option><option value='US' >UNITED STATES  (USA)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS  (UMI)<\/option><option value='UY' >URUGUAY  (URY)<\/option><option value='UZ' >UZBEKISTAN  (UZB)<\/option><option value='VU' >VANUATU  (VUT)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE)  (VAT)<\/option><option value='VE' >VENEZUELA  (VEN)<\/option><option value='VN' >VIETNAM  (VNM)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH)  (VGB)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.)  (VIR)<\/option><option value='WK' >WAKE ISLAND  (WAK)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS  (WLF)<\/option><option value='EH' >WESTERN SAHARA  (ESH)<\/option><option value='YE' >YEMEN  (YEM)<\/option><option value='ZR' >ZAIRE  (ZAR)<\/option><option value='ZM' >ZAMBIA  (ZMB)<\/option><option value='ZW' >ZIMBABWE  (ZWE)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>Choose the country.<\/p><\/div><\/div><div id=\"field_16_130\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_16_130\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_16_130'>Country Telephone Code<\/label><div class='ginput_container ginput_container_select'><select name='input_130' id='input_16_130' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Choose Conutry Code' >Choose Country Code<\/option><option value='AF' >AFGHANISTAN (AFG) (+93)<\/option><option value='AX' >ALAND ISLANDS (ALA) (+358)<\/option><option value='AL' >ALBANIA (ALB) (+355)<\/option><option value='DZ' >ALGERIA (DZA) (+213)<\/option><option value='AS' >AMERICAN SAMOA (ASM) (+1)<\/option><option value='AD' >ANDORRA (AND) (+376)<\/option><option value='AO' >ANGOLA (AGO) (+244)<\/option><option value='AI' >ANGUILLA (AIA) (+1)<\/option><option value='AQ' >ANTARCTICA (ATA) (+672)<\/option><option value='AG' >ANTIGUA AND BARBUDA (ATG) (+1)<\/option><option value='AR' >ARGENTINA (ARG) (+54)<\/option><option value='AM' >ARMENIA (ARM) (+374)<\/option><option value='AW' >ARUBA (ABW) (+297)<\/option><option value='AU' >AUSTRALIA (AUS) (+61)<\/option><option value='AT' >AUSTRIA (AUT) (+43)<\/option><option value='AZ' >AZERBAIJAN (AZE) (+994)<\/option><option value='BS' >BAHAMAS (BHS) (+1)<\/option><option value='BH' >BAHRAIN (BHR) (+973)<\/option><option value='BD' >BANGLADESH (BGD) (+880)<\/option><option value='BB' >BARBADOS (BRB) (+1)<\/option><option value='BY' >BELARUS (BLR) (+375)<\/option><option value='BE' >BELGIUM (BEL) (+32)<\/option><option value='BZ' >BELIZE (BLZ) (+501)<\/option><option value='BJ' >BENIN (BEN) (+229)<\/option><option value='BM' >BERMUDA (BMU) (+1)<\/option><option value='BT' >BHUTAN (BTN) (+975)<\/option><option value='BO' >BOLIVIA (BOL) (+591)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA (BIH) (+387)<\/option><option value='BW' >BOTSWANA (BWA) (+267)<\/option><option value='BV' >BOUVET ISLAND (BVT) (+55)<\/option><option value='BR' >BRAZIL (BRA) (+55)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)<\/option><option value='BN' >BRUNEI (BRN) (+673)<\/option><option value='BG' >BULGARIA (BGR) (+359)<\/option><option value='BF' >BURKINA FASO (BFA) (+226)<\/option><option value='BU' >BURMA (BUR) (+95)<\/option><option value='BI' >BURUNDI (BDI) (+257)<\/option><option value='KH' >CAMBODIA (KHM) (+855)<\/option><option value='CM' >CAMEROON (CMR) (+237)<\/option><option value='CA' >CANADA (CAN) (+1)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS (CTE) (+686)<\/option><option value='CV' >CAPE VERDE (CPV) (+238)<\/option><option value='KY' >CAYMAN ISLANDS (CYM) (+1)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC (CAF) (+236)<\/option><option value='TD' >CHAD (TCD) (+235)<\/option><option value='CL' >CHILE (CHL) (+56)<\/option><option value='CN' >CHINA (CHN) (+86)<\/option><option value='CX' >CHRISTMAS ISLAND (CXR) (+61)<\/option><option value='CC' >COCOS (KEELING) ISLANDS (CCK) (+61)<\/option><option value='CO' >COLOMBIA (COL) (+57)<\/option><option value='KM' >COMOROS (COM) (+269)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)<\/option><option value='CG' >CONGO, REPUBLIC OF (COG) (+242)<\/option><option value='CK' >COOK ISLANDS (COK) (+682)<\/option><option value='CR' >COSTA RICA (CRI) (+506)<\/option><option value='CI' >COTE D&#039;IVOIRE (CIV) (+225)<\/option><option value='HR' >CROATIA (HRV) (+385)<\/option><option value='CU' >CUBA (CUB) (+53)<\/option><option value='CW' >CURACAO (CUW) (+599)<\/option><option value='CY' >CYPRUS (CYP) (+357)<\/option><option value='CZ' >CZECH REPUBLIC (CZE) (+420)<\/option><option value='YD' >DEMOCRATIC YEMEN (YMD) (+967)<\/option><option value='DK' >DENMARK (DNK) (+45)<\/option><option value='DJ' >DJIBOUTI (DJI) (+253)<\/option><option value='DM' >DOMINICA (DMA) (+1)<\/option><option value='DO' >DOMINICAN REPUBLIC (DOM) (+1)<\/option><option value='TP' >EAST TIMOR (TMP) (+670)<\/option><option value='EC' >ECUADOR (ECU) (+593)<\/option><option value='EG' >EGYPT (EGY) (+20)<\/option><option value='SV' >EL SALVADOR (SLV) (+503)<\/option><option value='GQ' >EQUATORIAL GUINEA (GNQ) (+240)<\/option><option value='ER' >ERITREA (ERI) (+291)<\/option><option value='EE' >ESTONIA (EST) (+372)<\/option><option value='ET' >ETHIOPIA (ETH) (+251)<\/option><option value='FK' >FALKLAND ISLANDS (FLK) (+500)<\/option><option value='FO' >FAROE ISLANDS (FRO) (+298)<\/option><option value='FJ' >FIJI (FJI) (+679)<\/option><option value='FI' >FINLAND (FIN) (+358)<\/option><option value='FR' >FRANCE (FRA) (+33)<\/option><option value='FX' >FRANCE METROPOLITAN (FXX) (+33)<\/option><option value='GF' >FRENCH GUIANA (GUF) (+594)<\/option><option value='PF' >FRENCH POLYNESIA (PYF) (+689)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES (ATF) (+262)<\/option><option value='GA' >GABON (GAB) (+241)<\/option><option value='GM' >GAMBIA (GMB) (+220)<\/option><option value='GE' >GEORGIA (GEO) (+995)<\/option><option value='DE' >GERMANY (DEU) (+49)<\/option><option value='GH' >GHANA (GHA) (+233)<\/option><option value='GI' >GIBRALTAR (GIB) (+350)<\/option><option value='GR' >GREECE (GRC) (+30)<\/option><option value='GL' >GREENLAND (GRL) (+299)<\/option><option value='GD' >GRENADA (GRD) (+1)<\/option><option value='GP' >GUADELOUPE (GLP) (+590)<\/option><option value='GU' >GUAM (GUM) (+1)<\/option><option value='GT' >GUATEMALA (GTM) (+502)<\/option><option value='GG' >GUERNSEY (GGY) (+44)<\/option><option value='GN' >GUINEA (GIN) (+224)<\/option><option value='GW' >GUINEA-BISSAU (GNB) (+245)<\/option><option value='GY' >GUYANA (GUY) (+592)<\/option><option value='HT' >HAITI (HTI) (+509)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS (HMD) (+0)<\/option><option value='HN' >HONDURAS (HND) (+504)<\/option><option value='HK' >HONG KONG (HKG) (+852)<\/option><option value='HU' >HUNGARY (HUN) (+36)<\/option><option value='IS' >ICELAND (ISL) (+354)<\/option><option value='IN' >INDIA (IND) (+91)<\/option><option value='ID' >INDONESIA (IDN) (+62)<\/option><option value='IR' >IRAN (IRN) (+98)<\/option><option value='IQ' >IRAQ (IRQ) (+964)<\/option><option value='IE' >IRELAND (IRL) (+353)<\/option><option value='IM' >ISLE OF MAN (IMN) (+44)<\/option><option value='IL' >ISRAEL (ISR) (+972)<\/option><option value='IT' >ITALY (ITA) (+39)<\/option><option value='JM' >JAMAICA (JAM) (+1)<\/option><option value='JP' >JAPAN (JPN) (+81)<\/option><option value='JE' >JERSEY (JEY) (+44)<\/option><option value='JT' >JOHNSTON ISLAND (JTN) (+1)<\/option><option value='JO' >JORDAN (JOR) (+962)<\/option><option value='KZ' >KAZAKHSTAN (KAZ) (+7)<\/option><option value='KE' >KENYA (KEN) (+254)<\/option><option value='KI' >KIRIBATI (KIR) (+686)<\/option><option value='KV' >KOSOVO (KVV) (+383)<\/option><option value='KW' >KUWAIT (KWT) (+965)<\/option><option value='KG' >KYRGYZSTAN (KGZ) (+996)<\/option><option value='LA' >LAOS (LAO) (+856)<\/option><option value='LV' >LATVIA (LVA) (+371)<\/option><option value='LB' >LEBANON (LBN) (+961)<\/option><option value='LS' >LESOTHO (LSO) (+266)<\/option><option value='LR' >LIBERIA (LBR) (+231)<\/option><option value='LY' >LIBYA (LBY) (+218)<\/option><option value='LI' >LIECHTENSTEIN (LIE) (+423)<\/option><option value='LT' >LITHUANIA (LTU) (+370)<\/option><option value='LU' >LUXEMBOURG (LUX) (+352)<\/option><option value='MO' >MACAU (MAC) (+853)<\/option><option value='MK' >MACEDONIA (MKD) (+389)<\/option><option value='MG' >MADAGASCAR (MDG) (+261)<\/option><option value='MW' >MALAWI (MWI) (+265)<\/option><option value='MY' >MALAYSIA (MYS) (+60)<\/option><option value='MV' >MALDIVES (MDV) (+960)<\/option><option value='ML' >MALI (MLI) (+223)<\/option><option value='MT' >MALTA (MLT) (+356)<\/option><option value='MH' >MARSHALL ISLANDS (MHL) (+692)<\/option><option value='MQ' >MARTINIQUE (MTQ) (+596)<\/option><option value='MR' >MAURITANIA (MRT) (+222)<\/option><option value='MU' >MAURITIUS (MUS) (+230)<\/option><option value='YT' >MAYOTTE (MYT) (+262)<\/option><option value='MX' >MEXICO (MEX) (+52)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF (FSM) (+691)<\/option><option value='MI' >MIDWAY ISLANDS (MID) (+1)<\/option><option value='MD' >MOLDOVA (MDA) (+373)<\/option><option value='MC' >MONACO (MCO) (+377)<\/option><option value='MN' >MONGOLIA (MNG) (+976)<\/option><option value='ME' >MONTENEGRO (MNE) (+382)<\/option><option value='MS' >MONTSERRAT (MSR) (+1)<\/option><option value='MA' >MOROCCO (MAR) (+212)<\/option><option value='MZ' >MOZAMBIQUE (MOZ) (+258)<\/option><option value='MM' >MYANMAR (MMR) (+95)<\/option><option value='NA' >NAMIBIA (NAM) (+264)<\/option><option value='NR' >NAURU (NRU) (+674)<\/option><option value='NP' >NEPAL (NPL) (+977)<\/option><option value='NL' >NETHERLANDS (NLD) (+31)<\/option><option value='AN' >NETHERLANDS ANTILLES (ANT) (+599)<\/option><option value='NC' >NEW CALEDONIA (NCL) (+687)<\/option><option value='NZ' >NEW ZEALAND (NZL) (+64)<\/option><option value='NI' >NICARAGUA (NIC) (+505)<\/option><option value='NE' >NIGER (NER) (+227)<\/option><option value='NG' >NIGERIA (NGA) (+234)<\/option><option value='NU' >NIUE (NIU) (+683)<\/option><option value='NF' >NORFOLK ISLAND (NFK) (+672)<\/option><option value='KP' >NORTH KOREA (PRK) (+850)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS (MNP) (+1)<\/option><option value='NO' >NORWAY (NOR) (+47)<\/option><option value='OM' >OMAN (OMN) (+968)<\/option><option value='PK' >PAKISTAN (PAK) (+92)<\/option><option value='PW' >PALAU (PLW) (+680)<\/option><option value='PS' >PALESTINIAN TERRITORIES (PSE) (+970)<\/option><option value='PA' >PANAMA (PAN) (+507)<\/option><option value='PG' >PAPUA NEW GUINEA (PNG) (+675)<\/option><option value='PY' >PARAGUAY (PRY) (+595)<\/option><option value='PE' >PERU (PER) (+51)<\/option><option value='PH' >PHILIPPINES (PHL) (+63)<\/option><option value='PN' >PITCAIRN ISLANDS (PCN) (+64)<\/option><option value='PL' >POLAND (POL) (+48)<\/option><option value='PT' >PORTUGAL (PRT) (+351)<\/option><option value='PR' >PUERTO RICO (PRI) (+1)<\/option><option value='QA' >QATAR (QAT) (+974)<\/option><option value='RE' >REUNION (REU) (+262)<\/option><option value='RO' >ROMANIA (ROM) (+40)<\/option><option value='RU' >RUSSIA (RUS) (+7)<\/option><option value='RW' >RWANDA (RWA) (+250)<\/option><option value='BL' >SAINT BARTHELEMY (BLM) (+590)<\/option><option value='KN' >SAINT KITTS AND NEVIS (KNA) (+1)<\/option><option value='LC' >SAINT LUCIA (LCA) (+1)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART) (MAF) (+590)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES (VCT) (+1)<\/option><option value='WS' >SAMOA (WSM) (+685)<\/option><option value='SM' >SAN MARINO (SMR) (+378)<\/option><option value='ST' >SAO TOME AND PRINCIPE (STP) (+239)<\/option><option value='SA' >SAUDI ARABIA (SAU) (+966)<\/option><option value='SN' >SENEGAL (SEN) (+221)<\/option><option value='RS' >SERBIA (SRB) (+381)<\/option><option value='CS' >SERBIA AND MONTENEGRO (SCG) (+381)<\/option><option value='SC' >SEYCHELLES (SYC) (+248)<\/option><option value='SL' >SIERRA LEONE (SLE) (+232)<\/option><option value='SG' >SINGAPORE (SGP) (+65)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART) (SXM) (+1)<\/option><option value='SK' >SLOVAKIA (SVK) (+421)<\/option><option value='SI' >SLOVENIA (SVN) (+386)<\/option><option value='SB' >SOLOMON ISLANDS (SLB) (+677)<\/option><option value='SO' >SOMALIA (SOM) (+252)<\/option><option value='ZA' >SOUTH AFRICA (ZAF) (+27)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)<\/option><option value='KR' >SOUTH KOREA (KOR) (+82)<\/option><option value='SS' >SOUTH SUDAN (SSD) (+211)<\/option><option value='ES' >SPAIN (ESP) (+34)<\/option><option value='LK' >SRI LANKA (LKA) (+94)<\/option><option value='SH' >ST. HELENA (SHN) (+290)<\/option><option value='PM' >ST. PIERRE AND MIQUELON (SPM) (+508)<\/option><option value='SD' >SUDAN (SDN) (+249)<\/option><option value='SR' >SURINAME (SUR) (+597)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)<\/option><option value='SZ' >SWAZILAND (SWZ) (+268)<\/option><option value='SE' >SWEDEN (SWE) (+46)<\/option><option value='CH' >SWITZERLAND (CHE) (+41)<\/option><option value='SY' >SYRIA (SYR) (+963)<\/option><option value='TW' >TAIWAN (TWN) (+886)<\/option><option value='TJ' >TAJIKISTAN (TJK) (+992)<\/option><option value='TZ' >TANZANIA (TZA) (+255)<\/option><option value='TH' >THAILAND (THA) (+66)<\/option><option value='TL' >TIMOR-LESTE (TLS) (+670)<\/option><option value='TG' >TOGO (TGO) (+228)<\/option><option value='TK' >TOKELAU (TKL) (+690)<\/option><option value='TO' >TONGA (TON) (+676)<\/option><option value='TT' >TRINIDAD AND TOBAGO (TTO) (+1)<\/option><option value='TN' >TUNISIA (TUN) (+216)<\/option><option value='TR' >TURKEY (TUR) (+90)<\/option><option value='TM' >TURKMENISTAN (TKM) (+993)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS (TCA) (+1)<\/option><option value='TV' >TUVALU (TUV) (+688)<\/option><option value='UG' >UGANDA (UGA) (+256)<\/option><option value='UA' >UKRAINE (UKR) (+380)<\/option><option value='AE' >UNITED ARAB EMIRATES (ARE) (+971)<\/option><option value='GB' selected='selected'>UNITED KINGDOM (GBR) (+44)<\/option><option value='US' >UNITED STATES (USA) (+1)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)<\/option><option value='UY' >URUGUAY (URY) (+598)<\/option><option value='UZ' >UZBEKISTAN (UZB) (+998)<\/option><option value='VU' >VANUATU (VUT) (+678)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE) (VAT) (+379)<\/option><option value='VE' >VENEZUELA (VEN) (+58)<\/option><option value='VN' >VIETNAM (VNM) (+84)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH) (VGB) (+1)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.) (VIR) (+1)<\/option><option value='WK' >WAKE ISLAND (WAK) (+808)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS (WLF) (+681)<\/option><option value='EH' >WESTERN SAHARA (ESH) (+212)<\/option><option value='YE' >YEMEN (YEM) (+967)<\/option><option value='ZR' >ZAIRE (ZAR) (+243)<\/option><option value='ZM' >ZAMBIA (ZMB) (+260)<\/option><option value='ZW' >ZIMBABWE (ZWE) (+263)<\/option><\/select><\/div><\/div><div id=\"field_16_59\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_16_59\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_16_59'>Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_59' id='input_16_59' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Country Telephone Code field, enter the country code of your employer's telephone number. In the Phone field, enter your employer's telephone number. The telephone number is optional to complete the application.<\/p><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_16_138' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this)' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_16_2' class='gform_page' data-js='page-field-id-138' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_16_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_16_114\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_114\" ><div class='ginput_container ginput_container_text'><input name='input_114' id='input_16_114' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='******************************************************************' \/><\/div><\/div><div id=\"field_16_62\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_62\" ><h3>ENTER TRAVEL INFORMATION<\/h3><\/div><div id=\"field_16_61\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_61\" ><label class='gfield_label gform-field-label' for='input_16_61'>Is your travel to the US occurring in transit to another country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_16_61' class='small gfield_select'  aria-describedby=\"gfield_description_16_61\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Y' >Yes<\/option><option value='N' >No<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_16_61'>If \"YES,\" it would imply that your travel plans include a layover or stopover in the US (Puerto Rico is considered part of the US for travel and immigration purposes) before continuing your journey to another country. This indicates that the purpose of your visit to the US is not the final destination but rather a transit point on your way to another destination. <\/div><div class='mm_tooltip_text' style='display:none'><p>Indicate whether your travel to the U.S. is occurring in transit to another country by selecting yes or no. A trip is considered as transit to the United States when the traveler is only passing through the country without staying for a prolonged period of time. This includes layovers or connecting flights where the traveler does not leave the airport or remains in the international transit area.<\/p><\/div><\/div><div id=\"field_16_136\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full titulo-seccion-formulario gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_136\" ><h4><b>TRAVEL INFO<\/b> | U.S. POINT OF CONTACT INFORMATION<\/h4><\/div><div id=\"field_16_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_63\" ><label class='gfield_label gform-field-label' for='input_16_63'>Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_16_63' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>A U.S. point of contact may be a friend, relative, or business associate. If you do not have a U.S. point of contact, please enter the name, address and telephone number of the location where you will be staying (e.g. a hotel name). You may also enter UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-two-thirds gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_64\" ><label class='gfield_label gform-field-label' for='input_16_64'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_16_64' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Address Line 1 field, enter the number and street of your U.S. Point of Contact's address. Do not include the city and state in this field. Address line 1 is required to complete the application. If you do not know the address of the employer you listed you may enter UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_65\" ><label class='gfield_label gform-field-label' for='input_16_65'>Apartment Number<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_16_65' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field. Apartment number is optional to complete the application.<\/p><\/div><\/div><div id=\"field_16_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_66\" ><label class='gfield_label gform-field-label' for='input_16_66'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_16_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the City field, enter the city. The city is required to complete the application. You may also enter UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_127\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_127\" ><label class='gfield_label gform-field-label' for='input_16_127'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_127' id='input_16_127' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='AL' >ALABAMA<\/option><option value='AK' >ALASKA<\/option><option value='AQ' >AMERICAN SAMOA<\/option><option value='AZ' >ARIZONA<\/option><option value='AR' >ARKANSAS<\/option><option value='CA' >CALIFORNIA<\/option><option value='CO' >COLORADO<\/option><option value='CT' >CONNECTICUT<\/option><option value='DE' >DELAWARE<\/option><option value='DC' >DISTRICT OF COLUMBIA<\/option><option value='FL' >FLORIDA<\/option><option value='GA' >GEORGIA<\/option><option value='GU' >GUAM<\/option><option value='HI' >HAWAII<\/option><option value='ID' >IDAHO<\/option><option value='IL' >ILLINOIS<\/option><option value='IN' >INDIANA<\/option><option value='IA' >IOWA<\/option><option value='KS' >KANSAS<\/option><option value='KY' >KENTUCKY<\/option><option value='LA' >LOUISIANA<\/option><option value='ME' >MAINE<\/option><option value='MD' >MARYLAND<\/option><option value='MA' >MASSACHUSETTS<\/option><option value='MI' >MICHIGAN<\/option><option value='MN' >MINNESOTA<\/option><option value='MS' >MISSISSIPPI<\/option><option value='MO' >MISSOURI<\/option><option value='MT' >MONTANA<\/option><option value='NE' >NEBRASKA<\/option><option value='NV' >NEVADA<\/option><option value='NH' >NEW HAMPSHIRE<\/option><option value='NJ' >NEW JERSEY<\/option><option value='NM' >NEW MEXICO<\/option><option value='NY' >NEW YORK<\/option><option value='NC' >NORTH CAROLINA<\/option><option value='ND' >NORTH DAKOTA<\/option><option value='CQ' >NORTH MARIANA ISL<\/option><option value='OH' >OHIO<\/option><option value='OK' >OKLAHOMA<\/option><option value='OR' >OREGON<\/option><option value='PA' >PENNSYLVANIA<\/option><option value='PR' >PUERTO RICO<\/option><option value='RI' >RHODE ISLAND<\/option><option value='SC' >SOUTH CAROLINA<\/option><option value='SD' >SOUTH DAKOTA<\/option><option value='TN' >TENNESSEE<\/option><option value='TX' >TEXAS<\/option><option value='UT' >UTAH<\/option><option value='VT' >VERMONT<\/option><option value='VQ' >VIRGIN ISLANDS<\/option><option value='VA' >VIRGINIA<\/option><option value='WA' >WASHINGTON<\/option><option value='WV' >WEST VIRGINIA<\/option><option value='WI' >WISCONSIN<\/option><option value='WY' >WYOMING<\/option><option value='XX' >UNKNOWN<\/option><option value='' ><\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>In the State field, choose the state. The state is required to complete the application. You may also select UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_80\" ><label class='gfield_label gform-field-label' for='input_16_80'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_16_80' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your U.S. point of contact's telephone number. The number is required to complete the application. If you do not have a point of contact telephone number you may enter zeros.<\/p><\/div><\/div><div id=\"field_16_68\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_68\" ><h4>U.S. POINT OF CONTACT INFORMATION<\/h4><p>The address where you will be staying in the U.S. is optional to complete the application. If multiple locations are planned, enter the first address. If the complete address is not known, enter the name of the hotel or location you will visit.<\/p><\/div><fieldset id=\"field_16_81\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_81\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Estad\u00eda<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_16_81'><div class='gchoice gchoice_16_81_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='Y' checked='checked' id='choice_16_81_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_16_81_1' id='label_16_81_1' class='gform-field-label gform-field-label--type-inline'>My stay will be the same as I have written previously in Point of Contact.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_16_82\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_82\" ><label class='gfield_label gform-field-label' for='input_16_82'>Address (stay)<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_16_82' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Address Line 1 field, enter the number and street of the location where you will stay while in the United States. Do not include the city and state in this field. Address line 1 is optional to complete the application.<\/p><\/div><\/div><div id=\"field_16_83\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_83\" ><label class='gfield_label gform-field-label' for='input_16_83'>Apartment Number<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_16_83' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field. Apartment number is optional to complete the application.<\/p><\/div><\/div><div id=\"field_16_70\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_70\" ><label class='gfield_label gform-field-label' for='input_16_70'>Citiy (stay)<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_16_70' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the City field, enter the city. The city is optional to complete the application.<\/p><\/div><\/div><div id=\"field_16_128\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_128\" ><label class='gfield_label gform-field-label' for='input_16_128'>State (stay)<\/label><div class='ginput_container ginput_container_select'><select name='input_128' id='input_16_128' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' >Choose State<\/option><option value='AL' >ALABAMA<\/option><option value='AK' >ALASKA<\/option><option value='AQ' >AMERICAN SAMOA<\/option><option value='AZ' >ARIZONA<\/option><option value='AR' >ARKANSAS<\/option><option value='CA' >CALIFORNIA<\/option><option value='CO' >COLORADO<\/option><option value='CT' >CONNECTICUT<\/option><option value='DE' >DELAWARE<\/option><option value='DC' >DISTRICT OF COLUMBIA<\/option><option value='FL' >FLORIDA<\/option><option value='GA' >GEORGIA<\/option><option value='GU' >GUAM<\/option><option value='HI' >HAWAII<\/option><option value='ID' >IDAHO<\/option><option value='IL' >ILLINOIS<\/option><option value='IN' >INDIANA<\/option><option value='IA' >IOWA<\/option><option value='KS' >KANSAS<\/option><option value='KY' >KENTUCKY<\/option><option value='LA' >LOUISIANA<\/option><option value='ME' >MAINE<\/option><option value='MD' >MARYLAND<\/option><option value='MA' >MASSACHUSETTS<\/option><option value='MI' >MICHIGAN<\/option><option value='MN' >MINNESOTA<\/option><option value='MS' >MISSISSIPPI<\/option><option value='MO' >MISSOURI<\/option><option value='MT' >MONTANA<\/option><option value='NE' >NEBRASKA<\/option><option value='NV' >NEVADA<\/option><option value='NH' >NEW HAMPSHIRE<\/option><option value='NJ' >NEW JERSEY<\/option><option value='NM' >NEW MEXICO<\/option><option value='NY' >NEW YORK<\/option><option value='NC' >NORTH CAROLINA<\/option><option value='ND' >NORTH DAKOTA<\/option><option value='CQ' >NORTH MARIANA ISL<\/option><option value='OH' >OHIO<\/option><option value='OK' >OKLAHOMA<\/option><option value='OR' >OREGON<\/option><option value='PA' >PENNSYLVANIA<\/option><option value='PR' >PUERTO RICO<\/option><option value='RI' >RHODE ISLAND<\/option><option value='SC' >SOUTH CAROLINA<\/option><option value='SD' >SOUTH DAKOTA<\/option><option value='TN' >TENNESSEE<\/option><option value='TX' >TEXAS<\/option><option value='UT' >UTAH<\/option><option value='VT' >VERMONT<\/option><option value='VQ' >VIRGIN ISLANDS<\/option><option value='VA' >VIRGINIA<\/option><option value='WA' >WASHINGTON<\/option><option value='WV' >WEST VIRGINIA<\/option><option value='WI' >WISCONSIN<\/option><option value='WY' >WYOMING<\/option><option value='XX' >UNKNOWN<\/option><option value='' ><\/option><\/select><\/div><\/div><div id=\"field_16_74\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_74\" ><h3>EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.<\/h3><\/div><div id=\"field_16_75\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_75\" ><label class='gfield_label gform-field-label' for='input_16_75'>Family Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_16_75' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the Family Name field, enter your emergency contact's family name. You must complete this field to complete the application. If you have no emergency contact, enter UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_76\" ><label class='gfield_label gform-field-label' for='input_16_76'>First (Given) Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_16_76' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the First (Given) Name field, enter the emergency contact's first name. You must complete this field to complete the application. If you have no emergency contact (or your contact has only one name), enter UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_84\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_84\" ><label class='gfield_label gform-field-label' for='input_16_84'>E-mail Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_84' id='input_16_84' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><div class='mm_tooltip_text' style='display:none'><p>Enter your emergency contact's email address. Email address is required to complete the application. You may also enter UNKNOWN.<\/p><\/div><\/div><div id=\"field_16_131\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_131\" ><label class='gfield_label gform-field-label' for='input_16_131'>Country Telephone Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_131' id='input_16_131' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choose Country Code' >Choose Country Code<\/option><option value='AF' >AFGHANISTAN (AFG) (+93)<\/option><option value='AX' >ALAND ISLANDS (ALA) (+358)<\/option><option value='AL' >ALBANIA (ALB) (+355)<\/option><option value='DZ' >ALGERIA (DZA) (+213)<\/option><option value='AS' >AMERICAN SAMOA (ASM) (+1)<\/option><option value='AD' >ANDORRA (AND) (+376)<\/option><option value='AO' >ANGOLA (AGO) (+244)<\/option><option value='AI' >ANGUILLA (AIA) (+1)<\/option><option value='AQ' >ANTARCTICA (ATA) (+672)<\/option><option value='AG' >ANTIGUA AND BARBUDA (ATG) (+1)<\/option><option value='AR' >ARGENTINA (ARG) (+54)<\/option><option value='AM' >ARMENIA (ARM) (+374)<\/option><option value='AW' >ARUBA (ABW) (+297)<\/option><option value='AU' >AUSTRALIA (AUS) (+61)<\/option><option value='AT' >AUSTRIA (AUT) (+43)<\/option><option value='AZ' >AZERBAIJAN (AZE) (+994)<\/option><option value='BS' >BAHAMAS (BHS) (+1)<\/option><option value='BH' >BAHRAIN (BHR) (+973)<\/option><option value='BD' >BANGLADESH (BGD) (+880)<\/option><option value='BB' >BARBADOS (BRB) (+1)<\/option><option value='BY' >BELARUS (BLR) (+375)<\/option><option value='BE' >BELGIUM (BEL) (+32)<\/option><option value='BZ' >BELIZE (BLZ) (+501)<\/option><option value='BJ' >BENIN (BEN) (+229)<\/option><option value='BM' >BERMUDA (BMU) (+1)<\/option><option value='BT' >BHUTAN (BTN) (+975)<\/option><option value='BO' >BOLIVIA (BOL) (+591)<\/option><option value='BQ' >BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)<\/option><option value='BA' >BOSNIA AND HERZEGOVINA (BIH) (+387)<\/option><option value='BW' >BOTSWANA (BWA) (+267)<\/option><option value='BV' >BOUVET ISLAND (BVT) (+55)<\/option><option value='BR' >BRAZIL (BRA) (+55)<\/option><option value='IO' >BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)<\/option><option value='BN' >BRUNEI (BRN) (+673)<\/option><option value='BG' >BULGARIA (BGR) (+359)<\/option><option value='BF' >BURKINA FASO (BFA) (+226)<\/option><option value='BU' >BURMA (BUR) (+95)<\/option><option value='BI' >BURUNDI (BDI) (+257)<\/option><option value='KH' >CAMBODIA (KHM) (+855)<\/option><option value='CM' >CAMEROON (CMR) (+237)<\/option><option value='CA' >CANADA (CAN) (+1)<\/option><option value='CT' >CANTON AND ENDERBURY ISLANDS (CTE) (+686)<\/option><option value='CV' >CAPE VERDE (CPV) (+238)<\/option><option value='KY' >CAYMAN ISLANDS (CYM) (+1)<\/option><option value='CF' >CENTRAL AFRICAN REPUBLIC (CAF) (+236)<\/option><option value='TD' >CHAD (TCD) (+235)<\/option><option value='CL' >CHILE (CHL) (+56)<\/option><option value='CN' >CHINA (CHN) (+86)<\/option><option value='CX' >CHRISTMAS ISLAND (CXR) (+61)<\/option><option value='CC' >COCOS (KEELING) ISLANDS (CCK) (+61)<\/option><option value='CO' >COLOMBIA (COL) (+57)<\/option><option value='KM' >COMOROS (COM) (+269)<\/option><option value='CD' >CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)<\/option><option value='CG' >CONGO, REPUBLIC OF (COG) (+242)<\/option><option value='CK' >COOK ISLANDS (COK) (+682)<\/option><option value='CR' >COSTA RICA (CRI) (+506)<\/option><option value='CI' >COTE D&#039;IVOIRE (CIV) (+225)<\/option><option value='HR' >CROATIA (HRV) (+385)<\/option><option value='CU' >CUBA (CUB) (+53)<\/option><option value='CW' >CURACAO (CUW) (+599)<\/option><option value='CY' >CYPRUS (CYP) (+357)<\/option><option value='CZ' >CZECH REPUBLIC (CZE) (+420)<\/option><option value='YD' >DEMOCRATIC YEMEN (YMD) (+967)<\/option><option value='DK' >DENMARK (DNK) (+45)<\/option><option value='DJ' >DJIBOUTI (DJI) (+253)<\/option><option value='DM' >DOMINICA (DMA) (+1)<\/option><option value='DO' >DOMINICAN REPUBLIC (DOM) (+1)<\/option><option value='TP' >EAST TIMOR (TMP) (+670)<\/option><option value='EC' >ECUADOR (ECU) (+593)<\/option><option value='EG' >EGYPT (EGY) (+20)<\/option><option value='SV' >EL SALVADOR (SLV) (+503)<\/option><option value='GQ' >EQUATORIAL GUINEA (GNQ) (+240)<\/option><option value='ER' >ERITREA (ERI) (+291)<\/option><option value='EE' >ESTONIA (EST) (+372)<\/option><option value='ET' >ETHIOPIA (ETH) (+251)<\/option><option value='FK' >FALKLAND ISLANDS (FLK) (+500)<\/option><option value='FO' >FAROE ISLANDS (FRO) (+298)<\/option><option value='FJ' >FIJI (FJI) (+679)<\/option><option value='FI' >FINLAND (FIN) (+358)<\/option><option value='FR' >FRANCE (FRA) (+33)<\/option><option value='FX' >FRANCE METROPOLITAN (FXX) (+33)<\/option><option value='GF' >FRENCH GUIANA (GUF) (+594)<\/option><option value='PF' >FRENCH POLYNESIA (PYF) (+689)<\/option><option value='TF' >FRENCH SOUTHERN TERRITORIES (ATF) (+262)<\/option><option value='GA' >GABON (GAB) (+241)<\/option><option value='GM' >GAMBIA (GMB) (+220)<\/option><option value='GE' >GEORGIA (GEO) (+995)<\/option><option value='DE' >GERMANY (DEU) (+49)<\/option><option value='GH' >GHANA (GHA) (+233)<\/option><option value='GI' >GIBRALTAR (GIB) (+350)<\/option><option value='GR' >GREECE (GRC) (+30)<\/option><option value='GL' >GREENLAND (GRL) (+299)<\/option><option value='GD' >GRENADA (GRD) (+1)<\/option><option value='GP' >GUADELOUPE (GLP) (+590)<\/option><option value='GU' >GUAM (GUM) (+1)<\/option><option value='GT' >GUATEMALA (GTM) (+502)<\/option><option value='GG' >GUERNSEY (GGY) (+44)<\/option><option value='GN' >GUINEA (GIN) (+224)<\/option><option value='GW' >GUINEA-BISSAU (GNB) (+245)<\/option><option value='GY' >GUYANA (GUY) (+592)<\/option><option value='HT' >HAITI (HTI) (+509)<\/option><option value='HM' >HEARD AND MC DONALD ISLANDS (HMD) (+0)<\/option><option value='HN' >HONDURAS (HND) (+504)<\/option><option value='HK' >HONG KONG (HKG) (+852)<\/option><option value='HU' >HUNGARY (HUN) (+36)<\/option><option value='IS' >ICELAND (ISL) (+354)<\/option><option value='IN' >INDIA (IND) (+91)<\/option><option value='ID' >INDONESIA (IDN) (+62)<\/option><option value='IR' >IRAN (IRN) (+98)<\/option><option value='IQ' >IRAQ (IRQ) (+964)<\/option><option value='IE' >IRELAND (IRL) (+353)<\/option><option value='IM' >ISLE OF MAN (IMN) (+44)<\/option><option value='IL' >ISRAEL (ISR) (+972)<\/option><option value='IT' >ITALY (ITA) (+39)<\/option><option value='JM' >JAMAICA (JAM) (+1)<\/option><option value='JP' >JAPAN (JPN) (+81)<\/option><option value='JE' >JERSEY (JEY) (+44)<\/option><option value='JT' >JOHNSTON ISLAND (JTN) (+1)<\/option><option value='JO' >JORDAN (JOR) (+962)<\/option><option value='KZ' >KAZAKHSTAN (KAZ) (+7)<\/option><option value='KE' >KENYA (KEN) (+254)<\/option><option value='KI' >KIRIBATI (KIR) (+686)<\/option><option value='KV' >KOSOVO (KVV) (+383)<\/option><option value='KW' >KUWAIT (KWT) (+965)<\/option><option value='KG' >KYRGYZSTAN (KGZ) (+996)<\/option><option value='LA' >LAOS (LAO) (+856)<\/option><option value='LV' >LATVIA (LVA) (+371)<\/option><option value='LB' >LEBANON (LBN) (+961)<\/option><option value='LS' >LESOTHO (LSO) (+266)<\/option><option value='LR' >LIBERIA (LBR) (+231)<\/option><option value='LY' >LIBYA (LBY) (+218)<\/option><option value='LI' >LIECHTENSTEIN (LIE) (+423)<\/option><option value='LT' >LITHUANIA (LTU) (+370)<\/option><option value='LU' >LUXEMBOURG (LUX) (+352)<\/option><option value='MO' >MACAU (MAC) (+853)<\/option><option value='MK' >MACEDONIA (MKD) (+389)<\/option><option value='MG' >MADAGASCAR (MDG) (+261)<\/option><option value='MW' >MALAWI (MWI) (+265)<\/option><option value='MY' >MALAYSIA (MYS) (+60)<\/option><option value='MV' >MALDIVES (MDV) (+960)<\/option><option value='ML' >MALI (MLI) (+223)<\/option><option value='MT' >MALTA (MLT) (+356)<\/option><option value='MH' >MARSHALL ISLANDS (MHL) (+692)<\/option><option value='MQ' >MARTINIQUE (MTQ) (+596)<\/option><option value='MR' >MAURITANIA (MRT) (+222)<\/option><option value='MU' >MAURITIUS (MUS) (+230)<\/option><option value='YT' >MAYOTTE (MYT) (+262)<\/option><option value='MX' >MEXICO (MEX) (+52)<\/option><option value='FM' >MICRONESIA - FEDERATED STATES OF (FSM) (+691)<\/option><option value='MI' >MIDWAY ISLANDS (MID) (+1)<\/option><option value='MD' >MOLDOVA (MDA) (+373)<\/option><option value='MC' >MONACO (MCO) (+377)<\/option><option value='MN' >MONGOLIA (MNG) (+976)<\/option><option value='ME' >MONTENEGRO (MNE) (+382)<\/option><option value='MS' >MONTSERRAT (MSR) (+1)<\/option><option value='MA' >MOROCCO (MAR) (+212)<\/option><option value='MZ' >MOZAMBIQUE (MOZ) (+258)<\/option><option value='MM' >MYANMAR (MMR) (+95)<\/option><option value='NA' >NAMIBIA (NAM) (+264)<\/option><option value='NR' >NAURU (NRU) (+674)<\/option><option value='NP' >NEPAL (NPL) (+977)<\/option><option value='NL' >NETHERLANDS (NLD) (+31)<\/option><option value='AN' >NETHERLANDS ANTILLES (ANT) (+599)<\/option><option value='NC' >NEW CALEDONIA (NCL) (+687)<\/option><option value='NZ' >NEW ZEALAND (NZL) (+64)<\/option><option value='NI' >NICARAGUA (NIC) (+505)<\/option><option value='NE' >NIGER (NER) (+227)<\/option><option value='NG' >NIGERIA (NGA) (+234)<\/option><option value='NU' >NIUE (NIU) (+683)<\/option><option value='NF' >NORFOLK ISLAND (NFK) (+672)<\/option><option value='KP' >NORTH KOREA (PRK) (+850)<\/option><option value='MP' >NORTHERN MARIANA ISLANDS (MNP) (+1)<\/option><option value='NO' >NORWAY (NOR) (+47)<\/option><option value='OM' >OMAN (OMN) (+968)<\/option><option value='PK' >PAKISTAN (PAK) (+92)<\/option><option value='PW' >PALAU (PLW) (+680)<\/option><option value='PS' >PALESTINIAN TERRITORIES (PSE) (+970)<\/option><option value='PA' >PANAMA (PAN) (+507)<\/option><option value='PG' >PAPUA NEW GUINEA (PNG) (+675)<\/option><option value='PY' >PARAGUAY (PRY) (+595)<\/option><option value='PE' >PERU (PER) (+51)<\/option><option value='PH' >PHILIPPINES (PHL) (+63)<\/option><option value='PN' >PITCAIRN ISLANDS (PCN) (+64)<\/option><option value='PL' >POLAND (POL) (+48)<\/option><option value='PT' >PORTUGAL (PRT) (+351)<\/option><option value='PR' >PUERTO RICO (PRI) (+1)<\/option><option value='QA' >QATAR (QAT) (+974)<\/option><option value='RE' >REUNION (REU) (+262)<\/option><option value='RO' >ROMANIA (ROM) (+40)<\/option><option value='RU' >RUSSIA (RUS) (+7)<\/option><option value='RW' >RWANDA (RWA) (+250)<\/option><option value='BL' >SAINT BARTHELEMY (BLM) (+590)<\/option><option value='KN' >SAINT KITTS AND NEVIS (KNA) (+1)<\/option><option value='LC' >SAINT LUCIA (LCA) (+1)<\/option><option value='MF' >SAINT MARTIN (FRENCH PART) (MAF) (+590)<\/option><option value='VC' >SAINT VINCENT AND THE GRENADINES (VCT) (+1)<\/option><option value='WS' >SAMOA (WSM) (+685)<\/option><option value='SM' >SAN MARINO (SMR) (+378)<\/option><option value='ST' >SAO TOME AND PRINCIPE (STP) (+239)<\/option><option value='SA' >SAUDI ARABIA (SAU) (+966)<\/option><option value='SN' >SENEGAL (SEN) (+221)<\/option><option value='RS' >SERBIA (SRB) (+381)<\/option><option value='CS' >SERBIA AND MONTENEGRO (SCG) (+381)<\/option><option value='SC' >SEYCHELLES (SYC) (+248)<\/option><option value='SL' >SIERRA LEONE (SLE) (+232)<\/option><option value='SG' >SINGAPORE (SGP) (+65)<\/option><option value='SX' >SINT MAARTEN (DUTCH PART) (SXM) (+1)<\/option><option value='SK' >SLOVAKIA (SVK) (+421)<\/option><option value='SI' >SLOVENIA (SVN) (+386)<\/option><option value='SB' >SOLOMON ISLANDS (SLB) (+677)<\/option><option value='SO' >SOMALIA (SOM) (+252)<\/option><option value='ZA' >SOUTH AFRICA (ZAF) (+27)<\/option><option value='GS' >SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)<\/option><option value='KR' >SOUTH KOREA (KOR) (+82)<\/option><option value='SS' >SOUTH SUDAN (SSD) (+211)<\/option><option value='ES' >SPAIN (ESP) (+34)<\/option><option value='LK' >SRI LANKA (LKA) (+94)<\/option><option value='SH' >ST. HELENA (SHN) (+290)<\/option><option value='PM' >ST. PIERRE AND MIQUELON (SPM) (+508)<\/option><option value='SD' >SUDAN (SDN) (+249)<\/option><option value='SR' >SURINAME (SUR) (+597)<\/option><option value='SJ' >SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)<\/option><option value='SZ' >SWAZILAND (SWZ) (+268)<\/option><option value='SE' >SWEDEN (SWE) (+46)<\/option><option value='CH' >SWITZERLAND (CHE) (+41)<\/option><option value='SY' >SYRIA (SYR) (+963)<\/option><option value='TW' >TAIWAN (TWN) (+886)<\/option><option value='TJ' >TAJIKISTAN (TJK) (+992)<\/option><option value='TZ' >TANZANIA (TZA) (+255)<\/option><option value='TH' >THAILAND (THA) (+66)<\/option><option value='TL' >TIMOR-LESTE (TLS) (+670)<\/option><option value='TG' >TOGO (TGO) (+228)<\/option><option value='TK' >TOKELAU (TKL) (+690)<\/option><option value='TO' >TONGA (TON) (+676)<\/option><option value='TT' >TRINIDAD AND TOBAGO (TTO) (+1)<\/option><option value='TN' >TUNISIA (TUN) (+216)<\/option><option value='TR' >TURKEY (TUR) (+90)<\/option><option value='TM' >TURKMENISTAN (TKM) (+993)<\/option><option value='TC' >TURKS AND CAICOS ISLANDS (TCA) (+1)<\/option><option value='TV' >TUVALU (TUV) (+688)<\/option><option value='UG' >UGANDA (UGA) (+256)<\/option><option value='UA' >UKRAINE (UKR) (+380)<\/option><option value='AE' >UNITED ARAB EMIRATES (ARE) (+971)<\/option><option value='GB' >UNITED KINGDOM (GBR) (+44)<\/option><option value='US' >UNITED STATES (USA) (+1)<\/option><option value='UM' >UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)<\/option><option value='UY' >URUGUAY (URY) (+598)<\/option><option value='UZ' >UZBEKISTAN (UZB) (+998)<\/option><option value='VU' >VANUATU (VUT) (+678)<\/option><option value='VA' >VATICAN CITY STATE (HOLY SEE) (VAT) (+379)<\/option><option value='VE' >VENEZUELA (VEN) (+58)<\/option><option value='VN' >VIETNAM (VNM) (+84)<\/option><option value='VG' >VIRGIN ISLANDS (BRITISH) (VGB) (+1)<\/option><option value='VI' >VIRGIN ISLANDS (U.S.) (VIR) (+1)<\/option><option value='WK' >WAKE ISLAND (WAK) (+808)<\/option><option value='WF' >WALLIS AND FUTUNA ISLANDS (WLF) (+681)<\/option><option value='EH' >WESTERN SAHARA (ESH) (+212)<\/option><option value='YE' >YEMEN (YEM) (+967)<\/option><option value='ZR' >ZAIRE (ZAR) (+243)<\/option><option value='ZM' >ZAMBIA (ZMB) (+260)<\/option><option value='ZW' >ZIMBABWE (ZWE) (+263)<\/option><\/select><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Country Code field, enter the country code of your emergency contact's telephone number. The country code is required to complete the application. If you do not have an emergency contact telephone country code you may enter zeros. In the Phone field, enter your emergency contact's telephone number. The telephone number is required to complete the application. If you do not have an emergency contact telephone number you may enter zeros.<\/p><\/div><\/div><div id=\"field_16_78\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_78\" ><label class='gfield_label gform-field-label' for='input_16_78'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_16_78' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='mm_tooltip_text' style='display:none'><p>In the Country Code field, enter the country code of your emergency contact's telephone number. The country code is required to complete the application. If you do not have an emergency contact telephone country code you may enter zeros. In the Phone field, enter your emergency contact's telephone number. The telephone number is required to complete the application. If you do not have an emergency contact telephone number you may enter zeros.<\/p><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_16_139' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this)' value='Previous'  \/> <input type='button' id='gform_next_button_16_139' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this)' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_16_3' class='gform_page' data-js='page-field-id-139' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_16_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_16_137\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_137\" ><h3>ELEGEBILITY QUESTIONS<\/h3>\n<div class=\"gfield_description\" id=\"guidance_on_eligibility_questions\">\n    Need additional guidance on eligibility questions?<br><b style=\"color: #C41E3A;\">Required fields are indicated by a red asterisk*.<\/b><\/div>\n\n<\/div><fieldset id=\"field_16_85\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_85\" ><legend class='gfield_label gform-field-label' >Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_16_85'>- Cholera<br>\n- Diphtheria<br>\n- Tuberculosis, infectious<br>\n- Plague<br>\n- Smallpox<br>\n- Yellow Fever<br>\n- Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo<br>\n- Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.<br><\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_85'>\n\t\t\t<div class='gchoice gchoice_16_85_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='Yes'  id='choice_16_85_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_85_0' id='label_16_85_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_85_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='No' checked='checked' id='choice_16_85_1' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_16_85\"   \/>\n\t\t\t\t\t<label for='choice_16_85_1' id='label_16_85_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_86\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_86\" ><legend class='gfield_label gform-field-label' >Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_86'>\n\t\t\t<div class='gchoice gchoice_16_86_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='Yes'  id='choice_16_86_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_86_0' id='label_16_86_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_86_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='No' checked='checked' id='choice_16_86_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_86_1' id='label_16_86_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_87\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_87\" ><legend class='gfield_label gform-field-label' >Have you ever violated any law related to possessing, using, or distributing illegal drugs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_87'>\n\t\t\t<div class='gchoice gchoice_16_87_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='Yes'  id='choice_16_87_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_87_0' id='label_16_87_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_87_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='No' checked='checked' id='choice_16_87_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_87_1' id='label_16_87_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_88\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_88\" ><legend class='gfield_label gform-field-label' >Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_88'>\n\t\t\t<div class='gchoice gchoice_16_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='Yes'  id='choice_16_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_88_0' id='label_16_88_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='No' checked='checked' id='choice_16_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_88_1' id='label_16_88_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_89\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_89\" ><legend class='gfield_label gform-field-label' >Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_89'>\n\t\t\t<div class='gchoice gchoice_16_89_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Yes'  id='choice_16_89_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_89_0' id='label_16_89_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_89_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='No' checked='checked' id='choice_16_89_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_89_1' id='label_16_89_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_90\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_90\" ><legend class='gfield_label gform-field-label' >Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_90'>\n\t\t\t<div class='gchoice gchoice_16_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Yes'  id='choice_16_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_90_0' id='label_16_90_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='No' checked='checked' id='choice_16_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_90_1' id='label_16_90_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_91\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_91\" ><legend class='gfield_label gform-field-label' >Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_91'>\n\t\t\t<div class='gchoice gchoice_16_91_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Yes'  id='choice_16_91_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_91_0' id='label_16_91_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_91_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='No' checked='checked' id='choice_16_91_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_91_1' id='label_16_91_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_92\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_92\" ><legend class='gfield_label gform-field-label' >Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_92'>\n\t\t\t<div class='gchoice gchoice_16_92_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_92' type='radio' value='Yes'  id='choice_16_92_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_92_0' id='label_16_92_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_92_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_92' type='radio' value='No' checked='checked' id='choice_16_92_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_92_1' id='label_16_92_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_93\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio borde-abajo gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_93\" ><legend class='gfield_label gform-field-label' >Have you traveled to, or been present in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_16_93'>\n\t\t\t<div class='gchoice gchoice_16_93_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Yes'  id='choice_16_93_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_93_0' id='label_16_93_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_93_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='No' checked='checked' id='choice_16_93_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_93_1' id='label_16_93_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_16_117\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_117\" ><label class='gfield_label gform-field-label' for='input_16_117'>Pa\u00eds<\/label><div class='ginput_container ginput_container_select'><select name='input_117' id='input_16_117' class='small gfield_select'     aria-invalid=\"false\" ><option value='' >Elige pa\u00eds<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Iraq' >Iraq<\/option><option value='Siria' >Siria<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><\/select><\/div><\/div><div id=\"field_16_118\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_118\" ><label class='gfield_label gform-field-label' for='input_16_118'>Desde (elige el mes)<\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_16_118' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' >Elige mes<\/option><option value='Enero' >Enero<\/option><option value='Febrero' >Febrero<\/option><option value='Marzo' >Marzo<\/option><option value='Abril' >Abril<\/option><option value='Mayo' >Mayo<\/option><option value='Junio' >Junio<\/option><option value='Julio' >Julio<\/option><option value='Agosto' >Agosto<\/option><option value='Septiembre' >Septiembre<\/option><option value='Octubre' >Octubre<\/option><option value='Noviembre' >Noviembre<\/option><option value='Diciembre' >Diciembre<\/option><\/select><\/div><\/div><div id=\"field_16_119\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_119\" ><label class='gfield_label gform-field-label' for='input_16_119'>Desde (elige el a\u00f1o)<\/label><div class='ginput_container ginput_container_select'><select name='input_119' id='input_16_119' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' >Elige a\u00f1o<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><\/select><\/div><\/div><div id=\"field_16_120\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_120\" ><label class='gfield_label gform-field-label' for='input_16_120'>Hasta (elige el mes)<\/label><div class='ginput_container ginput_container_select'><select name='input_120' id='input_16_120' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' >Elige mes<\/option><option value='Enero' >Enero<\/option><option value='Febrero' >Febrero<\/option><option value='Marzo' >Marzo<\/option><option value='Abril' >Abril<\/option><option value='Mayo' >Mayo<\/option><option value='Junio' >Junio<\/option><option value='Julio' >Julio<\/option><option value='Agosto' >Agosto<\/option><option value='Septiembre' >Septiembre<\/option><option value='Octubre' >Octubre<\/option><option value='Noviembre' >Noviembre<\/option><option value='Diciembre' >Diciembre<\/option><\/select><\/div><\/div><div id=\"field_16_121\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_121\" ><label class='gfield_label gform-field-label' for='input_16_121'>Hasta (elige el a\u00f1o)<\/label><div class='ginput_container ginput_container_select'><select name='input_121' id='input_16_121' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' >Elige a\u00f1o<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><\/select><\/div><\/div><div id=\"field_16_122\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_122\" ><label class='gfield_label gform-field-label' for='input_16_122'>Motivo principal<\/label><div class='ginput_container ginput_container_select'><select name='input_122' id='input_16_122' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' >Elige motivo<\/option><option value='Viajar como turista (vacaciones)' >Viajar como turista (vacaciones)<\/option><option value='Para viaje personal o visita familiar (incluye emergencias)' >Para viaje personal o visita familiar (incluye emergencias)<\/option><option value='Por prop\u00f3sitos comerciales\/empresariales' >Por prop\u00f3sitos comerciales\/empresariales<\/option><option value='Para realiza tareas especiales como empleado a tiempo completo del gobierno de un pa\u00eds del Visa Waiver Program' >Para realiza tareas especiales como empleado a tiempo completo del gobierno de un pa\u00eds del Visa Waiver Program<\/option><option value='Para prestar servicio militar en las fuerzas armadas de un pa\u00eds del Visa Waiver Program' >Para prestar servicio militar en las fuerzas armadas de un pa\u00eds del Visa Waiver Program<\/option><option value='Para realizar trabajos como periodista' >Para realizar trabajos como periodista<\/option><option value='Para realizar trabajos humanitarios en nombre de una organizaci\u00f3n internacional o una organizaci\u00f3n (multilateral o intergubernamental) regional' >Para realizar trabajos humanitarios en nombre de una organizaci\u00f3n internacional o una organizaci\u00f3n (multilateral o intergubernamental) regional<\/option><option value='Para realizar tareas oficiales en nombre de un gobierno subnacional o cuerpo de un pa\u00eds de la VWP' >Para realizar tareas oficiales en nombre de un gobierno subnacional o cuerpo de un pa\u00eds de la VWP<\/option><option value='Para asistir a una instituci\u00f3n acad\u00e9mica' >Para asistir a una instituci\u00f3n acad\u00e9mica<\/option><option value='Para participar en un intercambio profesional o conferencia' >Para participar en un intercambio profesional o conferencia<\/option><option value='Para participar en un programa de intercambio cultural' >Para participar en un programa de intercambio cultural<\/option><option value='Otro' >Otro<\/option><\/select><\/div><\/div><div id=\"field_16_123\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_123\" ><label class='gfield_label gform-field-label' for='input_16_123'>Escribe el motivo del viaje<\/label><div class='ginput_container ginput_container_text'><input name='input_123' id='input_16_123' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_16_140' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this)' value='Previous'  \/> <input type='button' id='gform_next_button_16_140' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this)' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_16_4' class='gform_page' data-js='page-field-id-140' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_16_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_16_95\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_95\" ><h3>CERTIFICATION<\/h3>\n<p>I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.<\/p>\n\n<p>I have read and understand that by this declaration, for the duration of my travel authorisation obtained through ESTA, I waive all rights to review or appeal any determination regarding my admissibility made by a U.S. Customs and Border Protection officer. I also waive the right to contest, except under a claim for asylum, any removal action arising from my application for admission under the Visa Waiver Program.<\/p>\n\n<p>In addition to the aforementioned waiver of rights, as a condition of each admission to the United States under the Visa Waiver Program, I agree that the submission of biometric identifiers (including fingerprints and photographs) during processing upon arrival in the United States will reaffirm my waiver of any right to review or appeal the determination made by a U.S. Customs and Border Protection officer regarding my admissibility. I also waive the right to contest, except under a claim for asylum, any removal action arising from my application for admission under the Visa Waiver Program.<\/p><\/div><fieldset id=\"field_16_96\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_96\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Acceptance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_16_96'><div class='gchoice gchoice_16_96_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.1' type='checkbox'  value='I accept the certification and the &lt;a target=&#039;_blank&#039; href=&#039;https:\/\/www.usa-esta-visa.com\/en\/terms-and-conditions\/&#039;&gt;Terms and Conditions&lt;\/a&gt; of the website.'  id='choice_16_96_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_16_96_1' id='label_16_96_1' class='gform-field-label gform-field-label--type-inline'>I accept the certification and the <a target='_blank' href='https:\/\/www.usa-esta-visa.com\/en\/terms-and-conditions\/'>Terms and Conditions<\/a> of the website.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_16_97\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_97\" ><h3>REVIEW<\/h3>\n<p>Please <strong>carefully review all the information<\/strong> entered in this form before submitting it. You can go back and check the information entered by clicking the <strong>Previous<\/strong> button.<\/p>\n<\/div><div id=\"field_16_98\" class=\"gfield gfield--type-html gfield--input-type-html titulo-seccion-formulario gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_98\" ><h3>PAYMENT<\/h3>\nThe service fee includes payment of the official U.S. government fees, correction of errors in the submitted form to avoid rejections, full tracking of the process until the visa is approved, and delivery of an approved visa copy in PDF format. All these benefits are designed to provide you with a worry-free ESTA visa application experience and improve your chances of success.<br>\n<p>The processing fee for the <strong>ESTA\/WAIVER VISA service is $98 USD<\/strong>.<\/p><\/div><div id=\"field_16_104\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_16_104 gfield_product_16_104 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_104\" ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_16_104_1'>ESTA Visa Processing<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_104.1' value='ESTA Visa Processing' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_16_104' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_16_104' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_104.2' id='ginput_base_price_16_104' class='gform_hidden' value='$98.00' aria-label='ESTA Visa Processing Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_104.3' value='1' class='ginput_quantity_16_104 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_16_132\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_16_132\" ><div class=\"gfield_description\" id=\"guidance_on_eligibility_questions\">\n    Make your payment by card in a <strong>secure banking environment<\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_16' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this)' value='Previous'  \/> <input type='submit' id='gform_submit_button_16' class='gform_button button' onclick='gform.submission.handleButtonClick(this)' value='Send and Pay'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_16' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_16' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='16' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_16' value='WyJ7XCIxMDQuMVwiOlwiNTk0ZjAxZWI2YzNmMjdkNjM1YzZiOWQ0ZTY0MjIwZjlcIixcIjEwNC4yXCI6XCI2YTYwMGVlY2IyNjJmMDM5Y2EzMjM0MmE1NDY5NWRmNlwifSIsIjZlYmE1ZjVhZjFjMjRlYjI4YTJmOWUwZjY4NzQxMGE0Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_16' id='gform_target_page_number_16' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_16' id='gform_source_page_number_16' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_16' value='' \/><\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 16, 'https:\/\/www.usa-esta-visa.com\/en\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_16').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_16');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_16').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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