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Application |
| Full Name |
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Birth Date |
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Day |
Month |
Year |
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Birth Place |
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Country Claimed |
Indicate the country you are claiming in order to participate in the
Lottery. Normally, this is the country in which you were born. If your birth
country is not eligible for participation in the Green Card Lottery, indicate
the eligible country in which your spouse or either parent was born. |
|
Explanation of Country Claimed |
If you are claiming a country that is not the country in which you were born,
please explain why. |
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Sex
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Contact Information |
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Mailing Address |
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Telephone |
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| Fax |
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Email 1 |
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Email 2 |
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Work Experience :
Your experience must have occurred in the past 10 years
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Education |
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Indicate your highest level of
education : |
Marital status and Number
of children
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Are you married? |
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Number of children |
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Optional Information |
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Would you like to receive email updates from us? |
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| How did your hear about or find us? |
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